Fetal alcohol syndrome and COVID lockdowns

[bob sterman]

So BBC is running a story saying...

More Covid 'lockdown babies' damaged by alcohol

https://www.bbc.co.uk/news/articles/cjw7g1zjwpeo

Small problem with this bold headline claim - it is not based on any published research. Instead...

Women drinking more alcohol than usual during Covid pandemic lockdowns has led to more children starting school this September with a disease caused by mothers drinking in pregnancy, a paediatric consultant fears

And...

Founder of the FASD Network in Stockton, Maria Catterick, also believes there is a link between increased alcohol consumption during lockdowns and a rise in the number of children with the condition.

It's entirely plausible. And with news stories like this - it will no doubt pass into collective knowledge as an adverse outcome of "lockdowns". But how about some actual data?

The article has an estimate of the incidence in the North-East. But no estimate of any changes in incidence.

[IvanV]

Fetal alcohol spectrum disorder (FASD) is a rather complicated thing (wiki) to diagnose. And in consequence both considerably underdiagnosed and misdiagnosed. So, like that other infamous spectrum thing, any careful attempt to measure changes in incidence during specific periods is likely to get horribly mixed up with diagnosis issues. But maybe some specific symptoms - that might be more routinely diagnosed - might appear to have increased during specific periods that can be associated with pregnancies during lockdown.

But there is a logical/statistical argument that if alcohol consumption markedly increased during a period, then some increase in FASD is inevitable. Not necessarily in the same proportion, but some increase seems very likely. In modern times, very many of the pregnant carefully avoid alcohol. So it might seem possible that all of the increase in consumption was in the non-pregnant. But we know that some proportion, probably a small proportion, of the pregnant are not so careful, for all sorts of reasons. Some because they are unaware they are pregnant; some because they can't or don't control themselves; some because they just don't care that much; some because they don't want to reveal they are pregnant; etc. And there is that unfortunate social pressure that just a little bit won't matter, we're celebrating, it's just this once, it's real champagne, do have a teensy-weensy top-up, that can't hurt.

So whilst it seems likely that the increase in alcohol consumption in the pregnant will be rather less than the average increase in alcohol consumption during that period, it seems statistically very likely that there must be some increase in alcohol consumption by the pregnant. Which will fairly inevitably lead to some increase in FASD.

But having made this observation, one goes, well what do we want to do with this information? It's what it is. Certain outcome conditions might have somewhat elevated incidence during a particular period. Most or all of these conditions can't be cured, only ameliorated. It probably doesn't matter very much to know that they might have been the result of FASD.

[Gfamily]

Purely anecdote, but in the school where MrsG is a governor, this year's reception class (children that would have been conceived during lockdown) has a lot of children with behavioural problems, far more than they normally expect.

IvanV notes that pregnant women generally follow the advice to avoid alcohol, but with the recognised increase in consumption during lockdown, it is possible that women had been drinking significant amounts before realising they were pregnant - it may be relevant that the UK had a ~2% increase in the birth rate in 2021 relative to the year before, the first annual increase in almost a decade.
ETA
It would be an interesting question to ask the other schools in their academy chain if they have noted something similar in their reception classes.

[bob sterman]

Overall alcohol consumption in England actually fell during the pandemic - not by much (total volume down 1.2%) - but it did fall.

Yes - there were increases in off-sales for consumption at home - but these were slightly outweighed by the huge decreases in sales through pubs/restaurants.

https://www.gov.uk/government/publicati ... ic-summary

Now it could be that pregnant women were a group that showed increased consumption when the overall trend was for a decrease. But note that PHE found it was the heaviest buying quintile of drinkers who accounted for a big chunk of the increase in off-sales.

[El Pollo Diablo]

I was chatting about this yesterday with our social worker, FASD is as Ivan said extremely difficult to know or diagnose, and may be causing plenty of behavioural issues in children already. So the current prevalence isn't known, and developmentally, the time when alcohol has the biggest impact is at the embryonic stage, when many pregnant women won't know they are pregnant.

For those going through the adoption process, it's near enough impossible to know whether FASD is playing a role in cases where information is scant on pregnancy and the child isn't showing obvious signs. That's to the extent where it's probably best to assume that it is there.

It is plausible that there may be a change, but behavioural issues will also be caused by lots of other pandemic related factors too - FASD is a spectrum disorder so the relativity of those things is incredibly complex.

[purplehaze]

Maternity units in hospitals do give warnings to councils if there's a spike in FASD, which will impact SEND needs in education. I agree with Ivan, overwhelmingly pregnant women do avoid alcohol and other drinks; for me it was tea and coffee, plus alcohol because of morning sickness - which went on for weeks and lasted through the day! Basically, the call is for women giving birth who are drunk and alcohol dependent, usually young and in a precarious lifestyle anyway.