What About Fetal Alcohol Exposure?

Abstract

Back to table of contents Previous article Next article Letters to the EditorFull AccessWhat About Fetal Alcohol Exposure?Carl C. Bell, M.D., Radhika Chimata, M.A., M.D.Carl C. BellSearch for more papers by this author, M.D., Radhika ChimataSearch for more papers by this author, M.A., M.D.Published Online:1 Oct 2017https://doi.org/10.1176/appi.ajp.2017.17040376AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: When we saw the title of the Review and Overview article by O’Donnell and Meaney (1), “Fetal Origins of Mental Health: The Developmental Origins of Health and Disease Hypothesis,” published in the April 2017 issue of the Journal, we were overjoyed because we thought this was indication that our field was finally getting a leg up on prevention. Although the thesis of the review was directionally correct (i.e., the quality of fetal growth and development predicting the risk for a range of noncommunicable, chronic illnesses), the review missed one of the most obvious causes of these problems: fetal alcohol exposure. We appreciated the discussion that fetal growth predicts risk for later psychopathology, such as attention deficit hyperactivity disorder (ADHD), but missing was one of the most common causes of low birth weight and prematurity: fetal alcohol exposure.Fetal alcohol exposure is one of the leading causes of intellectual disability and is associated with impairment in executive functioning, learning, memory, mood or behavioral regulation, attention, and impulse control. DSM-5 lists the prevalence of the proposed diagnosis of neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) as between 2% and 5% in the United States. The problem has been found at even higher rates in other countries. For example, May et al. (2) found rates of ND-PAE of 18.2%−25.9% in four rural communities in South Africa, and Fitzpatrick et al. (3) found rates of 12% in a rural Australian community. More disturbingly, we have found rates of 39% in a family medicine center on Chicago’s South Side (4), and this research revealed that patients—whose mental health problems had fetal origins—were misdiagnosed as having bipolar disorder, depression, schizophrenia, and ADHD.To the authors’ credit, they did briefly mention that children born small were likely to be born to mothers with high-risk lifestyles that include increased alcohol consumption. However, our study revealed that the vast majority of mothers who were caring for adult children with ND-PAE engaged only in social drinking before they realized they were pregnant (4). We hope this letter to the editor will place more emphasis on more common problems in life, such as ND-PAE.From the Department of Psychiatry, University of Illinois at Chicago; and the Department of Psychiatry, Rush University Medical Center, Chicago.Address correspondence to Dr. Bell ([email protected]).The authors report no financial relationships with commercial interests.References1 O’Donnell KJ, Meaney MJ: Fetal origins of mental health: the developmental origins of health and disease hypothesis. Am J Psychiatry 2017; 174:319–328Link, Google Scholar2 May PA, de Vries MM, Marais AS, et al.: The continuum of fetal alcohol spectrum disorders in four rural communities in South Africa: prevalence and characteristics. Drug Alcohol Depend 2016; 159:207–218Crossref, Medline, Google Scholar3 Fitzpatrick JP, Latimer J, Carter M, et al.: Prevalence of fetal alcohol syndrome in a population-based sample of children living in remote Australia: the Lililwan Project. J Paediatr Child Health 2015; 51:450–457Medline, Google Scholar4 Bell CC, Chimata R: Prevalence of neurodevelopmental disorders among low-income African Americans at a clinic on Chicago’s south side. Psychiatr Serv 2015; 66:539–542Link, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 174Issue 10 October 01, 2017Pages 999-999 Metrics KeywordsFetal Alcohol ExposureNeurodevelopmental Disorders of ChildhoodPDF download History Accepted 1 July 2017 Published online 1 October 2017 Published in print 1 October 2017