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Re: Alcohol intake and pregnancy in Spain: A silent crisis

We would like to comment on aspects related to Elliott et al's report (1). Fetal Alcohol Syndrome (FAS) constitutes just the tip of the iceberg in the effects observable due to alcohol intake during pregnancy. The few abilities to detect and quantify alcohol intake, the culture of drinking in Mediterranean regions, and the low perception of risk in society makes it so that children are not diagnosed with FAS. However, many end up having FAS disorders or traits that are difficultly labelled or never diagnosed. We would like to share data from the first 220 of the 1000 mother-child pairs we hope to recruit for a follow-up study initiated in 2007 in our hospital (2). Preliminary data based on an in-person questionnaire conducted by a trained nurse after the child's birth and during the mother's hospital stay, shows that during the 1st trimester 52% of pregnant women drank up to 8 grams (g) of alcohol per day, 10% drank 8-20 g/day, and 5% drank more than 20 g/day. Though 82% of women were looking for their pregnancies, we did not observe differences in alcohol intake in the women who were looking to become pregnant. It seems that pregnant women only changed their intake once they found out they were pregnant. Intake of alcohol diminishes with the course of the pregnancy. By the 3rd trimester, 76% of women affirm that they did not ingest any alcohol. In recent meconium samples analyzed for fatty acid ethyl esters (FAEE) in Spain, 45% contained a total of seven FAEE equal to or above 2 nmol/g meconium, the internationally accepted cut-off to differentiate heavy maternal alcohol consumption during pregnancy from occasional use or no use (3). The high prevalence of drinking in pregnant women in our area and the low risk perception are related to the daily intake of one glass of alcohol (8g ethanol) with lunch and/or another with dinner. It is urgent to increase risk perception in the Spanish population in general, but especially among health professionals involved with pregnancies and infant health. Political, public health, and educational actions are necessary. Increasing the education and training of health professionals involved in pregnancies and infant health is necessary not only to better diagnose among the FAS spectrum of disorders and traits, but also to teach clinical abilities to detect and quantify the correct exposure to the alcohol, to treat the addiction, and to actively collaborate with educational campaigns and prevention programs during well child-visits and healthy pregnancy programs. We would like to thank Dr. Luz Claudio and the Mount Sinai International Exchange Program for their support in our investigations related to preventing alcohol intake during pregnancy.

1. Elliott EJ, Payne JM, Morris A, Haan E, Bower CA. Fetal alcohol syndrome: a prospective national surveillance study. Arch Dis Child 2007 Aug 17. [Epub ahead of print]

2. Ortega Garcia JA, Pastor Torres E, Martinez Lorente I, et al. Malama project in the Region of Murcia (Spain): environment and breastfeeding. An Pediatr (Barc) 2008;68:447-453.