Fetal alcohol spectrum disorder amid COVID-19: Fewer services, potential boost in rates

Fetal alcohol spectrum disorder (FASD) is the leading developmental disability in Canada. Despite its preventable nature, there is concern among FASD researchers about a potential increase in FASD prevalence rates as a result of COVID-19, in addition to the impact the pandemic is having on the community.

FASD is a lifelong disability affecting people who were exposed to alcohol prenatally. In Canada, more people have FASD than autism spectrum disorder, cerebral palsy and Down syndrome combined.

Current rates are conservatively estimated to be approximately four percent in North America. However, FASD is very challenging to diagnose, and many experts believe that its prevalence is actually much higher.

COVID-19 compounds challenges in this community

Anecdotally, we know that individuals with FASD and their families are facing increased challenges as a result of this pandemic. Caregivers are concerned about a lack of supports, disruption in daily routine and mental health challenges.

Canadians with disabilities have drawn attention to their exclusion from COVID-19 messaging, as well to program cancelations and experiences of social isolation.

While these disruptions can have a negative impact on all individuals, they can have greater consequences for individuals with FASD and their families. People with FASD thrive with consistency and routine, but the pandemic has caused massive changes to our daily lives.

There is also concern about the future impact on mental health. While this body of evidence is still unfolding, parents reported changes in their children’s emotional state in a recent preprint manuscript (a preliminary paper that has yet to be formally reviewed), including difficulty concentrating, boredom, irritability, restlessness and nervousness. Experiences of parenting stress are also higher during COVID-19 among families reporting these emotional changes in their children.

These findings are concerning, especially for families of individuals with FASD who report higher levels of parenting stress compared to families of typically developing children and even those of children with other disabilities.

Little research has been conducted to date on the impact of COVID-19 on individuals with disabilities. However, we cannot ignore the complexities of FASD when talking about the impact COVID-19 has had in Canada, especially in terms of feelings of increased social isolation and the reported lack of services and unmet needs facing individuals and families during this time.

Alcohol consumption is on the rise

In addition to the challenges faced by individuals and their families living with FASD, the COVID-19 pandemic has also drawn attention to concerns about FASD prevention.

Recent global data have suggested that online alcohol sales for beer, wine and spirits have risen by a staggering 291 percent during the pandemic, although that figure does not account for any decrease in in-person alcohol sales. The Canadian Center on Substance Use and Addiction revealed that as many as 20 percent of Canadians have increased their alcohol use during COVID-19, and women report drinking, on average, more drinks per day than recommended in Canada’s Low Risk Alcohol Drinking Guidelines.

Common reasons for the increase in alcohol consumption included a lack of a regular schedule, boredom, stress and loneliness.

There is currently no data to quantify if there has been an increase in alcohol use during pregnancy. However, the rise in general alcohol consumption raises concerns about the potential increase in alcohol-exposed pregnancies.

Alcohol can impact fetal development at any stage of pregnancy. There is no known safe amount, safe time or safe type of alcohol, but women often don’t know they’re pregnant until several weeks along and approximately half of all pregnancies are unplanned.

Experts recommend that individuals and couples go alcohol-free if they are pregnant, trying to get pregnant or having unprotected sex, which increases the risk for an unplanned pregnancy. Individuals and couples who wish to continue drinking should use reliable forms of contraception or go alcohol-free until they know they are not pregnant.

Awareness and understanding are key

Reducing the number of alcohol-exposed pregnancies is an important step forward in helping to reduce the prevalence of FASD. However, encouraging individuals and couples to go alcohol-free is only one piece of the broader FASD puzzle. The realities of the pandemic have also highlighted the lack of supports and services available for people with FASD and their families.

Addressing FASD in Canada is complex. Supportive policies, effective support and accessible services are all important pieces in a more comprehensive FASD plan, but they are not enough. In order to effectively address this national issue, we need all Canadians engaged and united with awareness and understanding.

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