Protecting the unborn baby from alcohol

European Parliament, 17 September 2013

Dr Lars MøllerProgramme Manager

World Health OrganizationRegional Office for Europe

Published in June 2013

Recorded alcohol consumption in the EU including Norway and Switzerland, 1990 – 2010 (in litres pure alcohol per capita 15+).

Regional categorization

Central-Western and Western Country Group

Central-Eastern and Eastern Country Group

Nordic Countries Southern Europe

Country differences in recorded alcohol consumption (15+)

1970

1976

1982

1988

1994

2000

2006

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

ItalyGermanySpainUKPolandCzech Republic

Changes in alcohol policy areas over the five years 2006 - 2011 (N=30)

Number of countries carrying out national awareness-raising activities during 2009-2011 (N=30)

Illegal alcohol

Indigenous people

Social harm

Alcohol at work

Alcohol and pregnancy

Alcohol and health

Youth

Drink–driving

0 5 10 15 20 25 30

Number of countries

Lifetime abstainers in the EU, candidate countries, Norway and Switzerland, females

Denmark

FranceCzech Repu...AustriaHungarySwedenIcelandEstoniaLatviaLuxem

bourgLithuaniaRom

aniaSwitzerlandG

reeceSpainM

ontenegroPortugalTurkey

0102030405060708090

100

%

Alcohol abstention rates in the world among women (WHO, 2011)

• Lifetime abstention rate among women in the world - 55.0%

• Lifetime abstention rates among women in WHO regions:– African Region - 65.2%– Eastern Mediterranean Region - 93.4% – European Region (53 Member States) - 24.6%– Region of the Americas - 27.4% – South-East Asia Region - 92.8%– Western Pacific region -44.5% 

Prevalence of heavy episodic drinking among past-year female drinkers (WHO, 2011)

Maternal Alcohol Use during Pregnancy by CountryThe ranges are inclusive of any amount of alcohol consumed and at any point during pregnancy

72

57

16

55

20

1 511

5158

61

25

1

37

69

48

61

78

92 90

68

78

89

18

42 44

85 87

60

30 32

81

67

912 11

2114

2827

1418 20

54535645

18

01020

3040

5060

708090

100

Australia

BelgiumBra

zil

Canada

Chile

Croatia

Czech

Repub

lic

Denmark

Finland

France

German

y

Ghana

Italy

Irelan

dIsr

ael

Japa

n

Mexico

Netherlan

ds

New Zealand

Norway

Portugal

Russia

South Africa

Spain

Sweden

Taiwan

Uganda

United K

ingdom

United S

tates

Uruguay

The upper estimate ≥85%: Denmark (92%); Finland (90%); Ireland (89%); SA (87%); Russia (85%)The lower estimate: <5% Israel (1.1%); Taiwan and the US (1.4%); Japan (4.6%)

Prevalence of FASD

• Data available in only 21 countries, often outdated and methodologically unreliable

• Prevalence estimates:– USA1: FAS: 2-7 per 1000

FASD: estimated 2-5% in young school children

– Italy2: FAS: 3.4 - 7.4 per 1000 primary school children FASD: 35 per 1000 primary school children

– France3,4: FAS: 1.3 – 4.8 per 1000 birthsFASD: 5.6 per 1000 births

– Norway5: FAS: 1.2 per 1000 FASD: 1.5 per 1000

1 May et al., 2009; 2 May et al., 2006; 3 Sampson et al., 1997; 4 De Chazeron et al., 2008; 5 Elgen et al., 2007

Annual and lifetime cost per individual associated with FASD in Canadian studies (CND; Adjusted for inflation January 2009)

Reference Year of study

Prevalence Age Annual cost(95% CI)

Annual cost per individual(95% CI)

Stade et al 2006

2003 3 1-21 $386.6M $16,105 ($14,582-$17,627)

Stade et al 2009

2007 3 0-53 $5.5B ($4.2B-$6.6B)

$22,260 ($20,409-$24,728)

Than & Jonsson 2009 (based on Stade et al 2006)

Various years,Alberta

3-9 incidence

0-72 $148.4M- $428.4

$1.23M (lifetime cost per individual)

Results from the USA studiesAnnual Cost associated with FAS in the USA studies (USD; Adjusted for inflation Jan 2009)

Global Strategy and European action plan to Reduce the Harmful Use of Alcohol: Health Services’ Response…

• (b) supporting initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings; such initiatives should include early identification and management of harmful drinking among pregnant women and women of child-bearing age;

• (c) improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome…; …

WHO Guidelines on Identification and Management of Substance Use and SUD in Pregnancy• Covering use of alcohol and major classes of illicit

drugs in pregnancy• Development in parallel to WHO guidelines on

identification and management of tobacco use in pregnancy

• In collaboration with UNODC and other partners• First meeting of the Guidelines Development Group

took place 28 February – 1 March 2013 in Washington D.C.

• Publication planned for 2014.

More rigorous epidemiological prevalence studies are needed

• The first step in understanding the severity and

impact of FASD is to determine how many people have this condition.

• Policies and programs can be planned to benefit those living with FASD and to prevent more children from being born with this condition.

WHO Research Project on Child Development with a Focus on FASD: project milestones

• WHO meeting "Alcohol, Health and Development:agenda for international research". Stockholm, Sweden, 24-25 September 2009

• Planning meeting for international research project on Fetal Alcohol Spectrum Disorder (FASD). Rolduc, Kerkrade, The Netherlands, 2-3 November 2010

• Study protocol elaboration and securing initial funding (NIAAA): 2011-2012

• Training on FASD identification and prevalence research for researchers from Central and Eastern Europe. Minsk, Belarus, 12-15 October 2011

• WHO Research Ethics Review Committee approval of the study protocol: December 2012

WHO Global study on FASD: Objectives

• Generate new knowledge on prevalence of FASD among children of 7-9 years old and prevalence of prenatal risk factor exposure (focus on alcohol)– First wave of data collection in Canada, Namibia, Poland,

Ukraine, Republic of Belarus, Republic of Moldova and 1-2 other countries in Africa (to be determined in October 2013)

• Raise awareness of FASD and strengthen capacity for prevention and identification of FASD and promote treatment and support of affected individuals and families

• Support international collaboration, networking and partnerships for advancing FASD-related research globally.

Thank you!Contact details:LMO@euro.who.int

Website: http://www.euro.who.int/alcohol

European information system on alcohol and health:http://who.int/gho/eisah