New tools needed to diagnose and treat fetal alcohol spectrum disorders

Mar 2, 2022

Fetal alcohol spectrum disorder (FASD) is a group of conditions affecting the brain and body after an individual becomes prenatally exposed to alcohol. Currently, the prevalence of FASD among Canadian children and youth is 1 per 1000 (0.1%), though the prevalence is significantly higher among those who identified as Indigenous and lived off reserve (1.2%).

Some of the main symptoms of FASD include facial abnormalities, developmental delays, and intellectual disabilities. Furthermore, psychological symptoms of FASD include poor judgement and impulsivity, as well as other ADHD-like symptoms.

However, standard ADHD treatments are often ineffective in children exposed to alcohol in-utero. According to a recent article published in Smithsonian Magazine, there are several significant obstacles to children receiving an accurate diagnosis for FASD, including lack of awareness, a shortage of specialists, and social stigma, resulting in its under-diagnosis in Canada.

In recent years, scientific researchers have focused on searching on identifying biomarkers in efforts to improve FASD diagnosis, as well as identifying effective treatments and interventions. In a recent study conducted at the University of California, Los Angeles published by Dr. Mary O’Connor and her team determined that using brain scans measuring the diffusion of water through white matter in the brain could accurately distinguish ADHD with and without prenatal alcohol exposure. Although further research is needed to determine whether these scans can work in a clinical setting, researchers continue searching for biomarkers that could ultimately lead to more accurate diagnoses.

Other studies currently focus on examining patients’ epigenetic profiles, targeting molecular markers that are linked to changes in gene expression to improve the accuracy of diagnosis, as well as to explain why children exposed to similar levels of alcohol in-utero can develop different symptoms.

The goal of this research is to develop protocols so that a technician can use brain scans and behavioural testing to diagnose patients at mental health clinics.

Due to increases in alcohol consumption in the U.S. and Canada during the ongoing COVID-19 pandemic, some health experts have suggested that this could increase the prevalence of FASD.

According to Jonathan Sher, a public health advocate who leads the Healthier Pregnancies, Better Lives program at the Queen’s Nursing Institute Scotland, the pandemic has created an environment in which “the risk of more FASD is actually pretty obvious and pretty heightened.”

In 2020, Dr. Sher published a letter published by the medical journal Lancet, warned of the possibility of FASD as preventable “collateral damage” of the pandemic.

Although many women know that alcohol can be damaging to the fetus during pregnancy, health experts also suggest that some women may consume alcohol during the first trimester before they know they’re pregnant, increasing the risk of FASD.

“It’s just very painful to see this happening and the lack of hope that the parents had,” said Dr. O’Connor after seeing an inpatient last year who was taking heavy doses of medication to treat FASD. “The question is, could he have been diagnosed earlier and could he have been managed better by people who understood this diagnosis better?”