Page 14 - Zero for nine: Reducing alcohol use during pregnancy via health counselling and Internet-based computer-tailored feedback

Chapter 1
(Chudley, et al., 2005). Common effects are poor social functioning, hyperactivity, mental retardation, learning disabilities, poor memory and autistic behaviour (Niccols, 2007).
When a child has been prenatally exposed to alcohol and has all three characteristics (i.e. smaller than average, facial abnormalities and neurological damage), it may be diagnosed with the chronic condition of Foetal Alcohol Syndrome (FAS; Bertrand, et al., 2004). If a child does not have all the features of FAS, there may be other diagnoses, such as Alcohol Related Neurodevelopmental Disorder (ARND; Bertrand, et al., 2004). The term Foetal Alcohol Spectrum Disorder (FASD) covers the whole area of defects caused by prenatal alcohol exposure (Streissguth & O’Malley, 2000).
It is unclear how many people in the Netherlands suffer from an FASD, due to a lack of valid epidemiological studies. One study has investigated the prevalence of FASD by asking all Dutch paediatricians to report their experiences with FASD. This study, conducted in 2007 and 2008, revealed a total of 39 cases of FASD (van Wieringen, et al., 2009). The authors subsequently estimated that the prevalence of FASD in the Netherlands might be approximately 1 in every 10,000 births. However, self-report by paediatricians may be responsible for a large underestimation of actual cases, as not all children with an FASD may visit a paediatrician and not all paediatricians may be adequate in diagnosing FASD. A more accurate method is population-based, active case ascertainment in which FASD cases are sought through structured outreach in a defined population. In Europe, only four studies have been carried out using this method, involving two Italian studies (May, et al., 2006; May, et al., 2011) and two Croatian studies (Petkovic & Barisic, 2010, 2013). In these studies, schoolchildren were screened for FAS and FASD. Depending on the criteria that were established, the Italian studies showed prevalence rates of FAS varying between 3.7 and 12.0 per 1,000 children and of FASD varying between 20.3 and 63.0 per 1,000 children; the Croatian studies showed FAS prevalence rates between 6.4 and 16.9 per 1,000 children and FASD prevalence rates varying between 34.0 and 66.7 per 1,000 children. Although the Dutch drinking pattern may differ from the
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