Cultural & other aspects of fetal alcohol spectrum disorder prevention & identification in Lithuania
Theme: Perinatal mental health
Fetal alcohol syndrome is the topic that is much discussed in many countries, and in Lithuania, as well. The incorrect prejudices that “some alcohol is even useful for a pregnant woman” has done a lot of harm for the health of the newborns resulting in fetal alcohol syndrome. Eglė Žilinskienė has been interested in the topic since her studies in university and has done some research under the guidance of prof. Aurelijus Veryga (Lithuanian University of Health sciences). Below you will find some information about their research and conclusions.
(Foreword by Ramunė Mazaliauskienė)
For many years Lithuania was one of the top alcohol consuming countries according to World Health Organization report. In the year 2007 per capita consumption of pure alcohol in Lithuania was 14.3 litres. Unfortunately, women of age 25-34 had the highest levels of problematic alcohol consumption. Meanwhile the Department of Statistics states that most prevalent mother’s age during first delivery was 28 years. Correlation between alcohol consumption during pregnancy and Fetal alcohol spectrum disorder (FASD) has been scientifically proven 40 years ago. Infant morbidity rate of fetal alcohol syndrome (FAS, heaviest form of FASD) worldwide varies from 0.1:1000 to 1:1000 newborns. This diversity of statistical data suggests both cultural differences of alcohol consumption and diagnostic challenges of the syndrome.
Nonetheless, identification of this condition and its treatment remains a challenge to Lithuanian health care system. One of possible reasons why women consume alcohol during pregnancy could be doctor’s obsolete traditions to recommend alcohol for pregnant women as a remedy.
During our investigation we aimed to investigate family doctors‘ and obstetricians-gynaecologists’ behaviour in relation to recommendations of alcohol use during pregnancy and to compare epidemiological data of FAS (FASD) in Lithuania and other countries. A pilot questionnaire was given to 74 general practitioners and obstetricians-gynaecologists to evaluate attitudes towards alcohol use of pregnant women and to 27 neonatologists to assess frequency of newborns with typical FAS symptoms (not necessarily diagnosing Q86.0) in their clinical practice. Official statistical data was taken from open-source European hospital morbidity database of World Health Organization and Department of Statistics to the Government of the Republic of Lithuania.
During our investigation we received the following results: 12% of surveyed physicians do recommend alcoholic beverages as a remedial mean for their pregnant patients. 43% of participants claimed that their pregnant patients use alcohol following recommendations of another doctor.
On the other hand, majority of neonatologists (83%) state that they have diagnosed FAS (Q86.0) during their practice. In the Hospital of Lithuanian University of Health Sciences every neonatologist encounters averagely 6.61±6.65 newborns with typical FAS symptoms (not necessarily diagnosing Q86.0). Reported frequency varies from 0 to 25 cases per year in the same hospital department among neonatologists. During the period of 2007-2011 in Lithuania 10 cases of FAS were officially diagnosed. Consequently, infant morbidity rate of FAS in Lithuania during this period was 0.045:1000 newborns.
So, during our investigation we made the following conclusions:
Despite strong scientific recommendations to abstain from alcohol during pregnancy, some physicians do recommend it as a remedy for pregnant patients.
In the Hospital of Lithuanian University of Health Sciences every neonatologist encounters approximately 6 FAS cases per year.
During the period of 2007-2011 10 cases of FAS were officially diagnosed in Lithuania, while in only one Lithuanian hospital neonatologists treat more than 100 newborns with typical FAS symptoms per year.
Much higher FAS morbidity rate worldwide suggests that the syndrome is underdiagnosed in Lithuania and needs more attention from health care system. □