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FASD is a prevalent lifelong neurodevelopmental disorder. It is heterogenous and GPs will see a variety of presentations in all age groups each year in their practice.
The GP and other practitioners in the GP surgery are in vital positions to give pre-conceptual advice around the reasons for alcohol abstinence in pregnancy in order to prevent babies being born with permanent brain damage.
GPs who can recognise possible cases of FASD are a vital first step on the life-changing path to diagnosis and appropriate support. 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 associated issues.
1. Inform women of childbearing age about the risks of alcohol in pregnancy.
2. Give pregnant women take-home printed information about the risks of alcohol in pregnancy.
3. Refer people presenting with physical, behavioural or developmental difficulties and possible prenatal alcohol exposure for FASD assessment.
4. Adult patients with FASD may experience continual issues with social relationships, mental health, employment, housing instability or substance misuse and may need referral for extra support and benefits.
5. Use FASD strategies when seeing or supporting a patient has FASD or suspected FASD.
6. Encourage local health boards and commissioners to ramp up FASD services. Ideas based on UK best practice are available in The Time is Now report.
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The September 2021 DHSC FASD Needs Assessment for England is a must-read for healthcare practitioners. It identifies the seriousness of FASD in England and it lists priority areas for improving care for those with FASD. It highlights:
All GPs and other healthcare professionals will find it useful to familiarise themselves with the coming NICE Quality Standard on FASD (2021), which is based on Scottish SIGN 156 (see below). 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.
The current draft identifies areas for improving quality of care regarding FASD and encourages training for GPs, community paediatric services, child development centres and CAMHS. The current draft includes:
Scottish SIGN 156 (2019), “Children and Young People Exposed Prenatally to Alcohol” sets the diagnostic criteria for FASD. It has been accepted by NICE so it also is now the guidance for England.
Confirming prenatal alcohol exposure
Confirmation of prenatal alcohol exposure requires documentation that the biological mother consumed alcohol during the index pregnancy based on:
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.
New diagnostic terms
There is no ‘mild’ FASD
According to SIGN 156, “A diagnosis of FASD is only made when there is evidence of pervasive brain dysfunction, which is defined by severe impairment in three or more of the following neurodevelopmental domains”:
“Severe impairment is defined as a global score or a major subdomain score on a standardized neurodevelopmental measure that is 2 or more standard deviations (SD) below the mean with appropriate allowance for test error.”
PHE’s Maternity High Impact Area report, “Reducing the incidence of harms caused by alcohol in pregnancy” (2020) states:
“Drinking any alcohol can cause difficulties in pregnancy and can result in Foetal Alcohol Spectrum Disorder (FASD), causing lifelong disabilities for children. There is no safe time or safe amount of alcohol to drink during pregnancy.”
It lays out areas for improved commissioning of services.
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The National FASD 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:
Identifies areas for improving quality of care
Newly released in September 2021 – a must read!
Children and young people exposed prenatally to alcohol (this has been accepted by NICE so also applies to England
Based on roundtables with more than 60 leading practitioners, policy makers, experts and people with lived experiences, this document highlights best practices from across the UK and provides practical tips
Pamphlet explaining the new diagnostic process