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Lack of evidence is not the same as evidence of absence of risk and, in this case, no evidence of harm does not mean evidence of no harm; subsequently, no amount of alcohol during pregnancy can be considered safe based on research evidence. Newborns exposed to maternal alcohol during pregnancy can develop a spectrum of characteristic facial features, impaired neurodevelopment, cognitive and behavioural disabilities, and fetal growth restriction known as fetal alcohol spectrum disorder (FASD), with the most severe form, including specific morphological facial abnormalities, defined as fetal alcohol syndrome (FAS).1–6 However, most patients with FASD exhibit only a subset of the characteristics of FAS, such as cognitive and behavioural deficits, and, possibly, facial abnormalities.4 FASD and FAS represent the most recurrent and easily preventable cause of acquired development disabilities in newborns.2 ,6 It is a serious problem for the individual and for society; it entails not only human suffering but also loss of productivity, and a high burden of medical and social costs.5 ,6
There are several unsolved questions related to prenatal alcohol exposure and adverse neurodevelopmental outcomes. The true rate of prenatal alcohol consumption in different countries using reliable tools of estimation is unknown. It is recognised that FASD is entirely preventable through alcohol abstinence, but worldwide 30% (60% in certain countries) of pregnant women consume alcohol during pregnancy.7 ,8 In Canada, prevalence rates of FAS and FASD have been reported to be 1–3 and 9 per 1000 live births, respectively, higher than the FAS prevalence of 0.5–2.0 per 1000 live infants in the USA.9 ,10 Currently, in Europe, there are no systematic data on FAS and FASD prevalence rates, nor on prenatal exposure to ethanol, and only one retrospective study in Italy showed a prevalence of FAS …
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Commissioned; externally peer reviewed.
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