Fetal alcohol-spectrum disorders: identifying at-risk mothers

International Journal of Women’s Health Dovepress open access to scientific and medical research Review International Journal of Women's Health downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Open Access Full Text Article Fetal alcohol-spectrum disorders: identifying at-risk mothers This article was published in the following Dove Press journal: International Journal of Women’s Health 21 July 2016 Number of times this article has been viewed Annika C Montag Department of Pediatrics, Division of Dysmorphology and Teratology, University of California San Diego, San Diego, CA, USA Introduction Correspondence: Annika C Montag Department of Pediatrics, Division of Dysmorphology and Teratology, University of California San Diego, 9500 Gilman Drive – MC 0828, La Jolla, San Diego, CA 92093, USA Tel +1 619 890 0285 Fax +1 858 246 1793 Email Fetal alcohol-spectrum disorders (FASDs) are a collection of diverse disorders all caused by prenatal alcohol exposure (PAE). FASD is the leading known cause of developmental disabilities, and represents a serious international public health problem. Over the past four decades, research has established specific patterns of physical effects and an array of neurobehavioral harms resulting from PAE.1–5 As our ability to diagnose FASD improves, and more active case-ascertainment research studies are performed, more realistic prevalence estimates from more populations are becoming available. While there are no reliable global estimates of FASD prevalence, studies from the US, European and Scandinavian countries, Australia, and South Africa have estimated that as many as 5% of the general population may be affected.6–11 Higher FASD-prevalence rates may occur among specific subgroups, eg, people who are in foster care, adopted, or incarcerated.12–14 Estimates vary, due to cultural differences in patterns of alcohol consumption and contraceptive use, as well as methods of FASD ascertainment and differential occurrence of modifying factors.7 Despite increasing awareness of FASD, PAE remains a problem. Recently published data from the 2011–2013 National Survey of Family Growth estimated that 7.3% of 311 submit your manuscript | www.dovepress.com International Journal of Women’s Health 2016:8 311–323 Dovepress © 2016 Montag. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IJWH.S85403 Powered by TCPDF (www.tcpdf.org) Abstract: Fetal alcohol-spectrum disorders (FASDs) are a collection of physical and neuro behavioral disabilities caused by prenatal exposure to alcohol. To prevent or mitigate the costly effects of FASD, we must identify mothers at risk for having a child with FASD, so that we may reach them with interventions. Identifying mothers at risk is beneficial at all time points, whether prior to pregnancy, during pregnancy, or following the birth of the child. In this review, three approaches to identifying mothers at risk are explored: using characteristics of the mother and her pregnancy, using laboratory biomarkers, and using self-report assessment of alcohol-consumption risk. At present, all approaches have serious limitations. Research is needed to improve the sensitivity and specificity of biomarkers and screening instruments, and to link them to outcomes as opposed to exposure. Universal self-report screening of all women of childbearing potential should ideally be incorporated into routine obstetric and gynecologic care, followed by brief interventions, including education and personalized feedback for all who consume alcohol, and referral to treatment as indicated. Effective biomarkers or combinations of biomarkers may be used during pregnancy and at birth to determine maternal and fetal alcohol exposure. The combination of self-report and biomarker screening may help identify a greater proportion of women at risk for having a child with FASD, allowing them to access information and treatment, and empowering them to make decisions that benefit their children. Keywords: fetal alcohol-spectrum disorder (FASD), alcohol, pregnancy, screening, biomarkers, SBIRT Dovepress International Journal of Women's Health downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Montag women of childbearing age in the US (3.3 million women) were at risk of an alcohol-exposed pregnancy.15 Women were considered “at risk” if they were non-pregnant and nonsterile, consumed alcohol, and had sex with a nonsterile male. Similar or higher risk estimates have been reported elsewhere.16–21 The national 10-year objectives designed to improve the health of Americans – Healthy People 2020 – emphasized the importance of FASD prevention with three separate goals: “Increase abstinence from alcohol among pregnant women” (maternal, infant, and child health [MICH]-11.1); “Increase the proportion of women delivering a live birth who did not drink alcohol prior to pregnancy” (MICH-16.4); and “Reduce the occurrence of fetal alcohol syndrome” (MICH-25).22 Are risk factors for alcohol-exposed pregnancy identical to risk factors for giving birth to a child with FASD? Clearly, they are not. For example, in the National Survey of Family Growth study, older age and having completed fewer years of education were not associated with greater risk of PAE, whereas in most studies they are risk factors for having a child with FASD. Part of the answer as to why risk factors for alcohol-exposed pregnancy and giving birth to a child with FASD are different lies with modifiers of risk that are unevenly distributed among population groups. Another part of the answer lies in our ability to detect alcohol effects. Finally, not all women who are at risk of having an alcoholexposed pregnancy will give birth. Investigations into identification of women at risk of giving birth to a child affected by FASD are complicated by challenges in diagnosing FASD. There are many reasons that children are not diagnosed with FASD or misdiagnosed.23–27 The cardinal facial dysmorphologies of fetal alcohol syndrome, the most complete manifestation under the umbrella diagnosis of FASD, are typically seen in a small subset of affected persons, leaving the majority of those affected without the more visible physical features.7 The timing, pattern, and magnitude of exposure contribute to differing outcomes. The wide (...truncated)