It’s an uncomfortable truth, but we are rapidly coming to the conclusion that no level of alcohol can be deemed entirely safe, despite the UK government’s advice of 14 or fewer units per week.

This is of even greater importance during pregnancy, and also the period of trying for a baby. Since 2016, the Chief Medical Officer for England and Wales has recommended ‘no alcohol to be consumed in pregnancy and when planning a pregnancy’.

Yet despite this, Foetal Alcohol Spectrum Disorder (FASD) remains the commonest, yet most preventable, non-genetic developmental disorder.

The important word is preventable. Estimates of the disorder’s prevalence range from one per cent to 17 per cent. The true figure may be around three per cent, or more than 20,000 births a year in the UK.

Despite this, FASD doesn’t receive the media attention afforded to many other neurodevelopmental disorders, with a poor understanding among the public and professionals. A recent survey indicated many paediatricians were not confident to make a diagnosis. Resources are limited, with few specialist clinics.

Though textbooks talk about the classic facial features of Foetal Alcohol Syndrome (FAS), the most severe end of the spectrum of FASD, these only affect 10 per cent of babies. The facial features develop between 6-9 weeks, so alcohol exposure during this time is more likely to affect facial characteristics.

Abnormalities include small narrow eyes, a smooth philtrum (the ridge between the nose and upper lip), a thin upper lip, microcephaly (small head) and reduced stature. With age, some of these may appear less obvious.

Yet the effects of alcohol on the unborn child can last a lifetime. FASD is associated with poorer achievement at all levels, difficulties with social interaction, increased risk of severe mental illness, and greater likelihood of criminal behaviour. Alcohol is more harmful than any other recreational drug, and is sometimes used with recreational drugs in pregnancy, magnifying the problem. Seventy percent of children with FASD are in the care system at some point during their childhood.

When a mother drinks, alcohol passes through the placenta and into the baby’s circulation. Because the unborn child’s liver has not developed, it builds up in their system affecting the brain, spinal cord and all other organs. The blood alcohol level of the foetus will be exactly that of the mother. This exposure affects all organs, resulting an array of physical and mental health complications. Current advice is that even children up to the age of 18 ideally shouldn’t consume alcohol as their brains are still growing. The period in the womb represents the most rapid phase of blossoming, from a fused sperm and egg to a living being, so exposure here has the greatest potential for significant harm.

Although first identified in the 1970s, polls indicated that even in the 1990s three quarters of women drank in pregnancy, with a third admitting to binge drinking. Thankfully, due to greater public awareness of the safety of alcohol and especially in pregnancy, today this number is much lower.

A diagnosis of FASD is reached by ruling out other neurodevelopmental disorders, and will be made by paediatricians with special interest in the condition. As for any medical complexity, this may require several assessments, as well as blood tests and scans.

Despite all of the above, the diagnosis isn’t a death sentence, and is the first step to getting help from multiple services, so that a child can receive the appropriate resources to allow them to achieve as independent a life as possible. FASD is a spectrum, hence while some may be severely affected, others may be much less so and have very happy and fulfilling lives.

The issue of consuming alcohol in breast feeding is contentious. Although it is true that one unit of alcohol will be metabolised after two hours and hence not enter breast milk, more than one drink may build up in your system and it can be difficult to judge. Alcohol also has the potential to interrupt your milk supply.

If you have been drinking and then discover you are pregnant, this does not necessarily mean your child will be affected by FASD.Perhaps the ideal is for would be mothers and their partner (if applicable) to abstain from alcohol while attempting conception and for the entire pregnancy.

If you are struggling with your alcohol consumption, please seek help.

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