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Guidance on fetal alcohol syndrome aims to improve diagnosis and treatment in Scotland

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l396 (Published 24 January 2019) Cite this as: BMJ 2019;364:l396

Re: Guidance on fetal alcohol syndrome aims to improve diagnosis and treatment in Scotland

The new fetal alcohol spectrum disorder (FASD) guidelines by the Scottish Intercollegiate Guidelines Network highlight the importance of reducing alcohol use during pregnancy (1). FASD, however, remains one part of a larger problem. Parental alcohol misuse (PAM) affects children across the life course, often going unnoticed, impairing parenting and with significant effects on children's health and development (2). In Figure 1 (https://imgur.com/dArHHFC), we demonstrate the rise of parental increased risk drinking following birth (>14 units/112g of ethanol per week) (3), using repeated cross-sectional data from the Millennium Cohort Study (MCS), Avon Longitudinal Study of Parents children (ALSPAC) and the Born in Bradford Cohort study (BiB) (4). We found that approximately 2.2% in the BiB, and 5.6% of mothers in the ALSPAC study meet criteria for increased risk drinking during pregnancy (4). By age 11 and 12 of children, the prevalence of mother's increased risk drinking had risen to 10.9% and 15.2% in the MCS and the ALSPAC study, respectively. By age 14, 18.1% of mothers and 26% of fathers in the MCS were classified as increased risk drinkers.

To reduce the high levels of increased risk drinking, questions about parental alcohol use could be included in early routine child health assessments and when children present with related psychological problems. All services should also consider the effects on the family and routinely ask about parental responsibilities and children at home. At-risk parents can then be referred to early intervention, with support that is sensitive to stigma and the family needs.

Acknowledgements
This letter utilises data from the Millennium Cohort Study which is funded by ESRC grants. The alcohol use and attitudes variables in MCS5 were co-funded by grant AA013606 from the U.S. National Institute on Alcohol Abuse and Alcoholism.

References
1. Wise J. Guidance on fetal alcohol syndrome aims to improve diagnosis and treatment in Scotland. BMJ; 2019.
2. Rossow I, Felix L, Keating P, McCambridge J. Parental drinking and adverse outcomes in children: A scoping review of cohort studies. Drug and alcohol review. 2016;35(4):397-405.
3. Department of Health and Social Care. UK Chief Medical Officers’ Low Risk Drinking Guidelines. Department of Health and Social Care London; 2016.
4. Syed S, Gilbert R, Wolpert M. Parental Alcohol Misuse and the Impact on Children: A Rapid Evidence Review of Service Presentations and Interventions. UCL Great Ormond Street Institute of Child Health, CPRU;2018.

Competing interests: No competing interests

11 February 2019
Shabeer Syed
Researcher in Psychiatric Epidemiology
Ruth Gilbert, Professor of Clinical Epidemiology, NIHR Senior Investigator, Population Policy and Practice Programme, University College London, Great Ormond Street Institute of Child Health
Population Policy and Practice Programme, University College London, Great Ormond Street Institute of Child Health
30 Guilford Street, London, WC1X 1EH