Intended for healthcare professionals

Rapid response to:


Low level alcohol consumption and the fetus

BMJ 2005; 330 doi: (Published 17 February 2005) Cite this as: BMJ 2005;330:375

Rapid Response:

Substance abuse in pregnancy: a neglected disease of international importance

Dear Editors - In the light of some preliminary data analysis for our
Gabonese parasitological study cohorts, we would like to follow up on your
February editorial stressing the risks of maternal alcohol consumption
during pregnancy[1]. About one third of women interviewed at delivery in
our semi-urban study area in Gabon reported alcohol consumption during

In a rapid response to your editorial, Rajan already has mentioned an
“increasing alcohol consumption among women in
developing countries”. The importance of this problem is further supported
by our findings, which are all the more alarming as not only African
origin has been described as a strong risk factor for the development of
fetal alcohol syndrome (FAS)[2], but it furthermore has been speculated
that malnutrition, which is highly prevalent in developing countries,
might increase the susceptibility to teratogenic effects of prenatal
alcohol exposure[3]. However, a literature search resulted in worryingly
few relevant publications on the epidemiology of FAS/fetal alcohol
spectrum disorder and alcohol abuse in pregnant women in Africa. Even in
our studies, drinking behaviour was not further differentiated and alcohol
-related dysmorphologies were not specifically recorded, as data on this
subject was collected only incidentally as basic sociodemographic
information but not as a specific outcome variable. In addition to the
scarcity of publications on this topic in the African context, almost all
investigations available referred to South African populations. Clearly,
patterns of substance abuse may differ significantly between different
African populations, and while, e.g., the overall prevalence of alcohol
consumption during pregnancy in a South African cohort has been reported
to be comparable to our numbers, combined use of alcohol and tobacco was
quite common in that study[4], whereas it was almost negligible in ours.
Altogether, even the most basic data describing the epidemiology of FAS
and alcohol consumption in pregnant women, associated behavioural patterns
and other risk factors, are lacking for most parts of Africa, hampering
any attempts to tackle these problems effectively.

Ironically, your editorial appeared on the very same pages as the one
titled “Neglected Diseases”[5]. In our humble opinion, it becomes evident
from the above remarks, that alcohol consumption and other substance abuse
during pregnancy is exactly one of these. The attention of the scientific
community and international health authorities must be drawn to this
neglected public health problem, which endangers not only the unborn,
weakest individuals, but also especially the already deprived, yet growing
populations in the developing world.

Lutz Ph. Breitling, physician,

Institute for Tropical Medicine,
Department of Parasitology,
University of Tübingen, Germany

Ayola A. Adegnika, PhD student

Medical Research Unit,
Albert Schweitzer Hospital,
Lambaréné, Gabon

Reference List

1. Mukherjee RAS, Hollins S, Abou-Saleh MT, Turk J. Low level alcohol
consumption and the fetus. BMJ 2005;330:375-6.

2. Sokol RJ, Ager J, Martier S, Debanne S, Ernhart C, Kuzma J et al.
Significant determinants of susceptibility to alcohol teratogenicity. Ann
NY Acad Sci 1986;477:87-102.

3. Riley EP, Guerri C, Calhoun F, Charness ME, Foroud TM, Li TK et
al. Prenatal alcohol exposure: advancing knowledge through international
collaborations. Alcohol Clin Exp Res 2003;27:118-35.

4. May PA, Gossage JP, Brooke LE, Snell CL, Marais AS, Hendricks LS
et al. Maternal Risk Factors for Fetal Alcohol Syndrome in the Western
Cape Province of South Africa: A Population-Based Study. Am J Public
Health 2005; DOI 10.2105/AJPH.2003.037093.

5. Rawlins MD. Neglected diseases. BMJ 2005;330:376-7.

Competing interests:
None declared

Competing interests: No competing interests

15 June 2005
Lutz Ph. Breitling
Ayola A. Adegnika
Institute for Tropical Medicine, University of Tübingen, 72070 Tübingen, Germany