How common are fetal alcohol spectrum disorders?

May, P. , A.  et al. | Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities | JAMA| 2018| 319| Vol. 5| DOI: 10.1001/jama. 2017.21896

Researchers from University Of California,  Sand Diego School of Medicine looked at 4 regions in the US between 2010 and 2016, examined the incidence of fetal alcohol spectrum disorders (FASD); found that a significant number had fetal alcohol spectrum disorders.  The findings of this study, may represent more accurate prevelance rates of  FASD  than previous studies indicate.



Importance  Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples.

Objective  To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States.

Design, Setting, and Participants  Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled.

Exposures  Alcohol consumption during pregnancy.

Main Outcomes and Measures  Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation.

Results  A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children.

Conclusions and Relevance  Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach.

The full article is available for Rotherham NHS staff from the hospital library or can be requested here



Humanising birth: Does the language used matter?

A new post on the the BMJ blog outlines how those providing maternity care need to consider their language carefully. This requires thoughtful use of language, reflection on their practice as caregivers, alongside listening and communicating to women appropriately  and respectfully to guide them through the complexities of maternity care.

The authors highlight how the latest version of the NICE Intrapartum Care Guideline emphasises the importance of good intrapartum communication.  During a three month period, they  analysed the language used in maternity settings using a multidisciplinary, collaborative Facebook group to identify how language could improve the experiences of women, babies and families.



Within a week 121 comments were received offering further input regarding commonly used phrases and expressions used in maternity care, which should be challenged.
From these comments, six key categories were identified that required change:

  • paternalistic or patronising language
  • language which objectifies women
  • anxiety-provoking language
  • dictatorial language
  • discouraging language
  • exclusive or codified language.

Examples of poor language are shown alongside suggested alternatives, on the BMJ blog.

The researchers emphasise that good communication during the birthing process is critical to good maternity care; but achieving a shift in deeply ingrained language, and the thinking it reflects, is difficult.
They also recognise that  there is a fine line between changing terminology to use  language which is more respectful, and less intimidating for the mother, and substituting vague language which hinders the original message.

These newspaper articles may also be of interest:

Extra funding for pregnant and new mothers’ mental health announced

NHS England has announced extra funding will be made available to improve the mental health of at least 3,000 pregnant women and those who have recently given birth.
 A total of £23 million is available during wave 2 of the  Perinatal Mental Health community services development fund.

The funding is part of a major programme of improvement and investment supporting the ambition in the Mental Health Five Year Forward View that, by 2020/21, there will be increased access to specialist perinatal mental health support , enabling  an additional 30,000 women to receive evidence-based treatment, closer to home, when they need it.

From 2019/20  funding for specialist perinatal mental health community services will be allocated through clinical commissioning group baseline (CCG) budgets.

 This funding will see 30,000 additional women getting specialist mental health care, in person and through online consultations including over Skype, during the early stages of motherhood, by 2021.

Further information can be found on the NHS England website 

Maternity services survey 2017

Maternity services survey 2017 |  The Care Quality Commission


This survey looked at the experiences of women receiving maternity services. The results show that overall women are reporting a more positive experience of maternity care and treatment. The publication highlights improvements in areas such as choice of where to give birth, quality of information and access to help and support after giving birth, when compared to the results from previous years’ surveys.

Compared with the last survey in 2015 a greater proportion of women said that they:

  • were offered the choice of giving birth in a midwife-led unit or birth centre
  • saw the same midwife at every antenatal appointment
  • were ‘always’ treated with dignity and respect during labour and birth
  • were never left alone during the birth of their baby at a time when it worried them
  • could ‘always’ get help from a member of staff within a reasonable time while in hospital after the birth

For more information, please see the statistical release, which provides the results for all questions: Maternity services survey 2017: Statistical release

Child and maternal health statistics

Updated statistics to support improvements in decision making when planning services for pregnant women, children, young people and families | Public Health England

Contents include:

  1. Overview of child health and child health profiles
  2. Pregnancy and birth statistics
  3. Breastfeeding statistics
  4. Early years statistics
  5. School-age children statistics
  6. Young people statistics
  7. Health visitor service delivery metrics
  8. Child development outcomes at 2 to 2 and a half years metrics

Full detail at Public Health England


Child development outcomes at 2 to 2 and a half years metrics: 2017 to 2018

The latest statistics for child development outcomes have been published by Public Health England  (PHE) which collects data submitted by local authorities.


The data is collected from the health visitor reviews completed at 2 to 2 and a half years using the Ages and Stages Questionnaire 3 (ASQ-3).

The metrics presented are ‘the percentage of children who were at or above the expected level’ in these areas of development:

  • communication skills
  • gross motor skills
  • fine motor skills
  • problem solving skills
  • personal-social skills
  • all five areas of development

The  data table and statistical commentary  are available

Guidance on using these statistics and other resources can also be found here


Implementing Better Births: Continuity of Carer

This guidance sets out how local maternity systems can improve their services so that women experience continuity in the clinicians providing their maternity care | NHS England

Continuity of care and relationship between care giver and receiver has been proven to lead to better outcomes and safety for the woman and baby, as well as offering a more positive and personal experience. It was also the single biggest request of women using maternity  services heard during the 2016 National Maternity Review report, ‘Better Births’.

This guidance outlines four main principles that will need to underpin the provision of continuity of carer models across the country:

1. Provide for consistency of the midwife and/or obstetrician who cares for a woman throughout the antenatal, intrapartum and postnatal periods.

2. Include a named midwife who takes on responsibility for co-ordinating a woman’s care throughout the antenatal, intrapartum and postnatal periods.

3. Enable the woman to develop an ongoing relationship of trust with her midwife

4. Where possible be implemented in both the hospital and community settings.

Full document: Implementing Better Births: Continuity of Carer

better birth
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