Foetal Alcohol Spectrum Disorder: A preventable lifelong disability

As South Africa marks International Foetal Alcohol Spectrum Disorder (FASD) Awareness Day on 9 September, healthcare professionals are renewing calls for greater public awareness of one of the country's most significant, yet entirely preventable, child health challenges.

Foetal Alcohol Spectrum Disorder (FASD) is a lifelong neurodevelopmental disability caused exclusively by alcohol exposure before birth. It affects brain development and can result in lasting difficulties with learning, memory, attention, behaviour, emotional regulation and everyday functioning.

Although FASD occurs worldwide, South Africa continues to report some of the highest documented prevalence rates internationally. Globally, an estimated 10% of women consume alcohol during pregnancy, and approximately one in 67 gives birth to a child with Foetal Alcohol Syndrome (FAS), the most recognisable and severe form of FASD.

"FASD remains one of the leading preventable causes of lifelong neurodevelopmental disability," says Dr Graham Jones, Specialist Paediatrician at Mediclinic Sandton. "Because its only known cause is alcohol exposure during pregnancy, every alcohol-free pregnancy is an opportunity to prevent permanent harm."

No safe amount has been established

Despite decades of research, misconceptions about alcohol use during pregnancy persist.

"One of the most common myths is that small amounts of alcohol are safe," says Dr Jones. "While heavy and binge drinking carry the greatest risk, no study has established a level of alcohol consumption that is proven to be safe for every pregnancy."

He explains that every pregnancy is biologically different, making it impossible to predict which developing baby may be affected.

"The medical message is therefore simple: there is no known safe amount of alcohol, no known safe type of alcoholic beverage, and no known safe time during pregnancy to consume alcohol. The safest recommendation is to avoid alcohol throughout pregnancy and, ideally, while planning a pregnancy."

A hidden disability

FASD is often described as a hidden disability because most affected children do not have the characteristic facial features associated with Foetal Alcohol Syndrome.

"The greatest injury is usually within the developing brain, not the face," explains Dr Jones. "Many children look completely healthy but experience lifelong difficulties with thinking, learning, planning, attention, emotional regulation and adaptive functioning."

Because these challenges are largely invisible, children are often misunderstood as lazy, poorly behaved or unmotivated when they are living with an underlying neurodevelopmental disability.

There is no single blood test, brain scan or genetic test that confirms FASD. Diagnosis depends on recognising a pattern of developmental, learning, behavioural and adaptive difficulties together with a history of confirmed or suspected prenatal alcohol exposure.

"Early diagnosis is important because it opens the door to speech and occupational therapy, educational support, behavioural interventions and family guidance," says Dr Jones. "Although the underlying brain injury cannot be reversed, early intervention can significantly improve long-term outcomes and reduce secondary problems such as school failure, mental health difficulties and social vulnerability."

Prevention through support, not blame

While FASD is entirely preventable, Dr Jones emphasises that prevention should be grounded in compassion rather than judgement.

"Women who consume alcohol during pregnancy are often facing complex challenges, including poverty, trauma, mental health conditions, intimate partner violence or alcohol dependence. Blame and stigma make prevention more difficult. Compassionate, evidence-based healthcare is far more likely to help women access the support they need."

He adds that prevention should include accurate public education, routine screening for alcohol use, early antenatal care, access to mental health and addiction services, and stronger developmental support for children at risk.

For women who consumed alcohol before realising they were pregnant, Dr Jones offers reassurance.

"This is a common situation, and the first message is: don't panic. Stop drinking alcohol as soon as pregnancy is recognised, begin or continue antenatal care without delay, and discuss the exposure honestly with your healthcare provider. Stopping alcohol at any stage of pregnancy remains beneficial."

A shared responsibility

International FASD Awareness Day is observed annually on 9 September at 09:09, symbolising the nine months of pregnancy and the importance of alcohol-free pregnancies.

Dr Jones believes South Africa is well placed to lead through research, prevention and public awareness.

"South African researchers have made important contributions to our understanding of FASD, but reducing its burden requires more than scientific knowledge. It requires healthcare professionals, educators, policymakers, communities and families to work together to support healthy pregnancies and recognise affected children early."

His closing message is clear: "Every child deserves the healthiest possible start in life. Preventing prenatal alcohol exposure is one of the few opportunities in medicine to prevent a lifelong neurodevelopmental disability before it occurs. At the same time, children living with FASD deserve early diagnosis, appropriate support and the opportunity to reach their full potential."