Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan

The consequences of prenatal alcohol exposure were first described more than 40 years ago.

The term “fetal alcohol syndrome” (FAS) was first used to describe the cluster of birth defects due to prenatal alcohol exposure (including growth restriction, craniofacial abnormalities and intellectual disabilities) with lifetime consequences.The term “fetal alcohol spectrum disorder” (FASD) has since been adopted to describe a broader spectrum of presentations and disabilities resulting from alcohol exposure in utero. The prevalence has been estimated at 1 in 100 people, which translates to more than 330 000 affected individuals in Canada.The development of clinical capacity for FASD diagnosis remains difficult,because the diagnosis requires a medical evaluation and neurodevelopmental assessment conducted by a multidisciplinary team.

In 2005, an international, collaborative, evidence-based guideline for diagnoses related to prenatal alcohol exposure was published.Since then, the field has evolved, and additional evidence, expertise and experience have emerged to suggest that a revision was required to improve both diagnoses and outcomes. The literature has also shown that impairments in behaviour and function associated with FASD have been detected from exposure to binge drinking, even infrequently or early in pregnancy, which underscores the importance of pre-pregnancy counselling. Specific research involving infants, young children and adults with FASD, as well as further insight into the neurodevelopmental dysfunction and nomenclature, prompted the update and revision process. A literature review and broad consultation process was undertaken to revise the 2005 guideline for diagnosing FASD.

 Author interview (CMAJ) https://soundcloud.com/cmajpodcasts/141593-guide