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GPs and Healthcare Professionals

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GP surgeries are on the frontline of FASD prevention, diagnosis and support

FASD is a lifelong condition and GPs will see a variety of presentations in all age groups each year in their practice.

The GP and others in the GP surgery are in a vital position to give pre-conceptual advice around the reasons for alcohol abstinence in pregnancy in order to prevent babies being born with permanent brain damage.

For cases of suspected FASD GPs providing the correct referrals can make the world of difference to the outcomes for an individual and their families and could reduce the likelihood of secondary difficulties.

Key points

  • FASD is considered the most prevalent PAE ‘one of the commonest preventable causes of impairment’ (SIGN 156). A UK prevalence screening study estimated that more than 6% could have conditions caused by pre-natal alcohol exposure (McQuire et al., 2018).
  • Assessment should be undertaken regarding the pre- and during pregnancy alcohol consumption of all women presenting as pregnant.
  • Advice should be given to all women presenting as wanting to conceive or as pregnant regarding no safe level of alcohol use in pregnancy.
  • Where there has been any level of alcohol use in pregnancy, it should be noted and an early referral made to a midwife.
  • FASD is a spectrum disorder and whilst all will have the neurobehavioural difficulties, less than 10% will have the dysmorphic facial features.
  • FASD diagnosis will require referrals for further investigation.

Change is coming!

All GPs and other healthcare professionals should familiarise themselves with the coming NICE Quality Standard on FASD (January 2021). All CCGs and NHS Trusts have to ‘have regard’ for NICE Quality Standards and show how they are improving the quality of services. This change will often start with the initial contact in GP surgeries.

Referrals are

Was it an alcohol-exposed pregnancy?

These are the types of proof that can be provided re an alcohol-exposed pregnancy. Sometimes a review of the maternal records with a fresh set of eyes by the professionals can yield the proof needed. This is from Scottish SIGN guidelines that have been accepted by NICE as the basis for the upcoming NICE Quality Standard on FASD:


Confirmation of PAE requires documentation that the biological mother consumed alcohol during the index pregnancy based on:

  • reliable clinical observation
  • self report or reports by a reliable source
  • medical records documenting positive blood alcohol concentrations, or
  • alcohol treatment or other social, legal or medical problems related to drinking during the pregnancy.

 

NOTE: a diagnosis of FASD is possible without confirmation of alcohol-exposed pregnancy in the <10% of instances when three sentinel facial features are present.

GPs need more training

The NOFAS-UK GP Survey was conducted by OnePoll between August 22nd and September 1st, 2017.  It polled 150 GPs that work in England.  Principal outcomes were as follows:

  • Only 31% has in-depth education regarding FASD
  • 41% have not received clear guidance regarding a pathway for diagnosis and support of FASD
  • Only 23% strongly agreed that they feel confident that all those with FASD are being diagnosed properly
  • Participants were recruited online and were paid.

Further reading

Resources

Scottish SIGN 156 Guidance

Children and young people exposed prenatally to alcohol

View

Recognising FASD

Pamphlet explaining the new diagnostic process

PDF

FASD in Focus – Assessments

PDF

BMA Report on Alcohol in Pregnancy

(2016)

View
Formal diagnosis at the earliest possible stage is paramount as it permits the implementation of early intervention and treatment programmes.”
BMA (2016)
Early diagnosis and intervention from birth and in the first years of life can make significant differences to the developmental progress of the affected child, and better understanding of the condition can help parents and professionals cope more appropriately with the child’s difficulties.”
SIGN (2019), quoting Paley et al.
Receiving an accurate and early diagnosis allows parents and carers to best accommodate the child’s environment to meet their needs and allows access to early interventions that may help to prevent secondary disabilities.”
SIGN (2019)

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