Screening

Ideally, all pregnant women should be questioned at their first antenatal visit about their alcohol consumption, including the amount and frequency of intake and the pattern of intake in the 3 months before and during the pregnancy, including prior to pregnancy awareness.[8][29][61][62]​ Screening helps clinicians identify women (and their unborn children) who are at risk and to assess their risk level. It also allows assessment for referral for appropriate treatment if necessary.

Screening of the asymptomatic child is impractical at a population level but targeted screening of high risk groups may be used to identify children with FASD with confirmed antenatal alcohol exposure. Early diagnosis of FASD is associated with a decreased risk of developing secondary disabilities in adolescence and adulthood, including disrupted education, drug and alcohol problems, mental health disorders, problems with the law or incarceration, and high rates of unemployment.[40]

Screening tests for alcohol use in pregnancy

All pregnant women should be asked about their alcohol intake.[29][63][64] The frequency and amount of a woman’s alcohol intake should be asked and recorded routinely, ideally using a validated, standardised tool.[65] Many screening tools are available (including TWEAK, T-ACE, and AUDIT), which take the form of a short questionnaire. However, most have been developed for identification of hazardous rather than low-level drinking.[8] The Canadian Association of Paediatric Health Centres with funding from the Public Health Agency of Canada has recently published a tool to enable health professionals to screen for alcohol use in pregnancy. To increase the likelihood that the tool would change practice at the primary health care level, the guide includes information on a valuable, 3-stage knowledge translation plan.[64]

Biomarker screening

Fatty acid ethyl esters (FAEE) can be detected in maternal hair or meconium.[66][67] Maternal hair analysis is an emerging screening tool that detects alcohol use in the 6 months before collection.[67] Meconium analysis for FAEE (>2 nmol/g) detects heavy fetal alcohol exposure. The meconium must be collected within 72 hours of birth. This test does not capture first-trimester alcohol consumption.[66]

Antenatal ultrasonography

Antenatal ultrasonography can be used in pregnant women with heavy alcohol intake to assess fetal growth parameters and to look for congenital anomalies.

Facial photography

Digital facial photography, used in conjunction with facial diagnostic software, has been used for screening children in foster care who are referred for detailed assessment at an FASD diagnostic clinic if they have facial features suggestive of fetal alcohol syndrome (FAS).[48] Stereo image matching has also been used for analysis of 3-dimensional (3-D) images to assist in screening for FAS.[53] In the future 3-D imaging may be increasingly valuable for screening and diagnosis.[49]

Fetal alcohol syndrome screen checklist

A checklist has been used to screen children in preschool for FASD. The checklist has 32 items, including facial features, musculoskeletal anomalies, and development. The sensitivity was 100%, specificity 94%, and positive predictive value 92%.[68]

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