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. 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), 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. 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, 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”. 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,
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Competing interests: No competing interests