The international charter on prevention of fetal alcohol spectrum disorder.

The fi rst international conference on prevention of fetal alcohol spectrum disorders was held in Edmonton, AB, Canada, on Sept 23–25, 2013. The conference resulted in the production, endorsement, and adoption of the following international charter on the prevention of fetal alcohol spectrum disorder by more than 700 people from 35 countries worldwide, including senior government offi cials, scholars and policymakers, clinicians and other front-line service providers, parents, families, and indigenous people. It is presented to all concerned in the international community as a call for urgent action to prevent fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder is a serious health and social problem, as well as an educational and legal issue, which aff ects individuals, families, and societies worldwide. The disorder is caused by alcohol use during pregnancy—no known amount of alcohol is safe for a growing embryo and fetus, which can develop extensive brain damage and physical abnormalities from exposure to alcohol. Although early intervention and supportive care can improve outcomes for individuals with fetal alcohol spectrum disorder, the associated cognitive, behavioural, and physical impairments can have devastating implications for the individual, family, and other caregivers. Fetal alcohol spectrum disorder is a lifelong disorder. The cause and consequences of fetal alcohol spectrum disorder have been known for 40 years, yet the disorder continues to affl ict millions of people worldwide—about one in every 100 livebirths. In countries where drinking among women of childbearing age is common, the prevalence of fetal alcohol spectrum disorder can be substantially higher. This disorder is of overwhelming concern in some populations. Fetal alcohol spectrum disorder is preventable. However, one major obstacle to prevention is lack of awareness of the disorder’s existence and of risks associated with women drinking alcohol during pregnancy. Opinionbased advice and confl icting messages from diff erent studies about presumed safe amounts of maternal alcohol consumption cause confusion and contribute to a failure to perceive the risk of fetal alcohol spectrum disorder. Findings from basic research have shown clearly that even low to moderate consumption of alcohol can cross the placenta and interfere with the normal development of the embryo and fetus. Heavy or frequent alcohol use increases the risk of giving birth to a baby with fetal alcohol spectrum disorder. People with fetal alcohol spectrum disorder have additional challenges as a result of their disorder, such as breakdown in family relations, disruption of schooling, unemployment, homelessness, and alcohol and drug misuse. Adolescents and adults with fetal alcohol spectrum disorder are also at high risk of encounters with the criminal justice system, either as off enders or victims. Many individuals go to jail and become repeat off enders and are often victimised themselves. The fi nancial burden of fetal alcohol spectrum disorder on families, communities, and governments is substantial. To address their complex needs, individuals with fetal alcohol spectrum disorder often require additional support in health, social, educational, legal, and correctional services. The associated fi nancial costs are unsustainable for many countries. The cost of people ignoring the problem and not taking action for prevention is going to further increase the strain on scarce societal resources. Although maternal alcohol consumption during pregnancy is the direct cause of fetal alcohol spectrum disorder, many underlying causes exist for drinking during pregnancy. Reasons include women having little information about the risks of drinking while pregnant, drinking before pregnancy is recognised, dependence on alcohol, untreated mental health disorders, and social pressures to drink. The complex biological and social determinants of health, including genetics, poverty, malnutrition, and poor social support networks and personal autonomy, also aff ect drinking behaviour and the severity of its results to the fetus. The risk of alcohol-exposed pregnancy increases with adverse life events, gender-based violence, trauma, stress, and social isolation. Whatever the reasons for women drinking during pregnancy, eff ective prevention strategies need to be identifi ed and addressed within the social, economic, and cultural context of every community. Lancet Glob Health 2014