MHM Magazine

Issue 5 | 2025 | MENTAL HEALTH MATTERS | 27 MHM Foetal Alcohol Spectrum Disorders (FASD) represent one of the most preventable yet deeply under-recognised causes of neurodevelopmental disability globally. Defined as a range of lifelong physical, behavioural, and cognitive impairments caused by prenatal alcohol exposure, FASD is a public health crisis that demands urgent attention, particularly in South Africa, where prevalence rates are among the highest in the world. Understanding FASD and Its Causes Foetal Alcohol Spectrum Disorder is the collective term now used to describe the spectrum of conditions resulting from alcohol exposure during pregnancy. While the term Foetal Alcohol Syndrome (FAS) was once used to describe children with the most visible signs of alcohol- related damage, it’s now understood to be one condition within a broader continuum that includes partial foetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD). Importantly, FASD can occur even when mothers are not heavy or regular drinkers. There is no safe amount of alcohol during pregnancy. Even small quantities can cause irreversible harm to the developing foetus, particularly during the first trimester when vital organs are forming. The brain, however, remains vulnerable throughout pregnancy, meaning that alcohol exposure at any stage can result in lifelong cognitive, physical and behavioural impairments. In South Africa, the challenge is compounded by the reality that approximately 78 percent of pregnancies are unplanned. As a result, many women consume alcohol before realising they’re pregnant, inadvertently exposing their developing babies to harm during the most critical stages of foetal development. Diagnosis and Early Detection Diagnosing FASD remains a complex and challenging process. There are no prenatal tests that can identify the condition before birth, and even after delivery, physical signs are often absent. Contrary to popular belief, the vast majority, approximately 80 percent of individuals with FASD, don’t display the distinctive facial features historically associated with the syndrome. The primary damage lies within the brain, which can’t be observed through outward appearance alone. Accurate diagnosis requires a multidisciplinary approach involving medical specialists, psychologists, and trained diagnostic teams. This process includes comprehensive neurodevelopmental assessments and detailed maternal interviews to rule out other potential causes of developmental delay such as birth complications, infections, or exposure to medications. While initial concerns may arise in infancy, formal diagnosis is most reliable between the ages of three and ten, when behavioural and cognitive difficulties become more evident. Recognising the Signs: Cognitive and Behavioural Impact The symptoms of FASD are predominantly cognitive and behavioural rather than physical. Affected children may struggle with learning, memory, attention, and problem-solving. Abstract reasoning, such as understanding mathematical concepts or cause-and-effect relationships, is often particularly impaired. These challenges can manifest By Dr Leana Olivier CEO of the Foundation for Alcohol Related Research (FARR) and Chairperson of the Africa Foetal Alcohol Spectrum Disorders Alliance Lo@farrsa.org.za UNDERSTANDING FOETAL ALCOHOL SPECTRUM DISORDERS: THE EPIDEMIC IN SOUTH AFRICA MHM | 2025 | Volume 12 | Issue 5 | Understanding Foetal Alcohol Spectrum Disorders: The Epidemic in South Africa MHM