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A Bio-Social and Ethical Framework for Understanding Fetal Alcohol Spectrum Disorders

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Abstract

The diagnosis of Fetal Alcohol Spectrum Disorders (FASDs) is embedded in a matrix of biological, social and ethical processes, making it an important topic for crossdisciplinary social and ethical research. This article reviews different branches of research relevant to understanding how FASD is identified and defined and outlines a framework for future social and ethical research in this area. We outline the character of scientific research into FASD, epidemiological discrepancies between reported patterns of maternal alcohol consumption during pregnancy and the incidence of FASD, and the social and ethical considerations that may impact on who is, and is not, diagnosed. We highlight what further research investigating FASD diagnostic processes, as well as the multi-generational impacts of FASD, is needed. Important research priorities are to: 1) enumerate the variety of stakeholders involved in seeking FASD diagnoses; 2) understand the experiences and perspectives of mothers from different backgrounds who have consumed alcohol during pregnancy and their affected children; and 3) collect health histories of maternal alcohol consumption in families to determine the effect of FASD at sub-cultural and cultural levels.

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References

  1. Haycock, Philip. 2009. Fetal alcohol spectrum disorders: the epigenetic perspective. Biology of Reproduction 81: 607–617.

    Article  Google Scholar 

  2. Gray, Ron, Raja Mukherjee, and Michael Rutter. 2009. Alcohol consumption during pregnancy and its effects on neurodevelopment: what is known and what remains uncertain. Addiction 104: 1270–1273.

    Article  Google Scholar 

  3. Golden, Janet. 2005. Message in a bottle: the making of fetal alcohol syndrome. Cambridge: Harvard University Press.

    Google Scholar 

  4. Majewski, Frank. 2011. Clinical symptoms in patients with fetal alcohol syndrome. In Alcohol, pregnancy and the developing child, ed. Hans-Ludwig Spohr and Hans-Christoph Steinhausen, 15–39. Cambridge: Cambridge University Press.

    Google Scholar 

  5. Jones, Kenneth, David Smith, Christy Ulleland, and Anne Streissguth. 1973. Pattern of malformation in offspring of chronic alcoholic mothers. The Lancet 30: 1267–1271.

    Article  Google Scholar 

  6. Spadoni, Andrea, Christie McGee, Susanna Fryer, and Edward Riley. 2007. Neuroimaging and fetal alcohol spectrum disorders. Neuroscience and Biobehavioural Reviews 31: 239–245.

    Article  Google Scholar 

  7. Mattson, Sarah, and Edward Riley. 1998. A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research 22: 279–294.

    Article  Google Scholar 

  8. Lewis, Sarah, Luisa Zuccolo, George Davey Smith, John Macleod, Santiago Rodriguez, Elizabeth Draper, Margaret Barrow, Rosa Alati, Kapil Sayal, Susan Ring, Jean Golding, and Ron Gray. 2012. Fetal alcohol exposure and IQ at age 8: evidence from a population-based birth-cohort study. PLoS ONE 7: e49407.

    Article  Google Scholar 

  9. Coles, Claire, and Li Zhihao. 2011. Functional neuroimaging in the examination of effects of prenatal alcohol exposure. Neuropsychological Review 21: 119–132.

    Google Scholar 

  10. Watkins, Rochelle, Elizabeth Elliott, Amanda Wilkins, Raewyn Mutch, James Fitzpatrick, Janet Payne, Colleen O’Leary, Heather Jones, Jane Latimer, Lorian Hayes, Jane Halliday, Heather D’Antoine, Sue Miers, Elizabeth Russell, Lucinda Burns, Anne McKenzie, Elizabeth Peadon, Maureen Carter, and Carol Bower. 2013. Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatrics 13: 156.

    Article  Google Scholar 

  11. Spohr, Hans-Ludwig, and Hans-Christoph Steinhausen (eds.). 1996. Alcohol, pregnancy and the developing child. Cambridge: Cambridge University Press.

    Google Scholar 

  12. Jutel, Annemarie. 2009. Sociology of diagnosis: a preliminary review. Sociology of Health Illness 31: 278–299.

    Article  Google Scholar 

  13. Jutel, Annemarie. 2011. Putting a name to it: diagnosis in contemporary society. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  14. Jutel, Annemarie, and Sarah Nettleton. 2011. Towards a sociology of diagnosis: reflections and opportunities. Social Science and Medicine 73: 793–800.

    Article  Google Scholar 

  15. Choudhury, Suparna, Saskia Nagel, and Jan Slaby. 2009. Critical neuroscience: linking neuroscience and society through critical practice. BioSocieties 4: 61–77.

    Article  Google Scholar 

  16. Choudhury, Suparna, and Jan Slaby (eds.). 2012. Critical neuroscience: a handbook of the social and cultural contexts of neuroscience. Chichester: Wiley-Blackwell.

    Google Scholar 

  17. Pickersgill, Martyn. 2013. From ‘implications’ to ‘dimensions’: science, medicine and ethics in society. Health Care Analysis 21: 31–42.

    Article  Google Scholar 

  18. Lemoine, Paul, H. Harousseau, J. Borteyru, and J. Menuet. 1968. Les enfants de parents alcooliques: anomalies observees a propos de 127 cas. Ouest Medical 25: 476–482.

    Google Scholar 

  19. Coles, Claire. 1994. Critical periods for prenatal alcohol exposure: evidence from animal and human studies. Alcohol Health and Research World 18: 22–29.

    Google Scholar 

  20. Henderson, Jane, Ron Gray, and Peter Brocklehurst. 2007. Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome. BJOG: An International Journal of Obstetrics and Gynaecology 114: 243–252.

    Article  Google Scholar 

  21. Jacobson, Joseph, and Sandra Jacobson. 1994. Prenatal alcohol exposure and neurobehavioural development: where is the threshold? Alcohol Health and Research World 18: 30–36.

    Google Scholar 

  22. Davey Smith, George, and Ebrahim Shah. 2003. ‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease? International Journal of Epidemiology 32: 1–22.

    Article  Google Scholar 

  23. Abel, Ernest. 1995. An update on incidence of FAS: FAS is not an equal opportunity birth defect. Neurotoxicology and Teratology 17: 437–443.

    Article  Google Scholar 

  24. Bolumar, Francisco, Marisa Rebagliato, Ildefensio Hernandez-Aguado, and C. Florey. 1994. Smoking and drinking habits before and during pregnancy in Spanish women. Journal of Epidemiology and Community Health 48: 36–40.

    Article  Google Scholar 

  25. Chang, Grace, E. Tay McNamara, John Orav, and Louise Wilkins-Haug. 2006. Alcohol use by pregnant women: partners, knowledge and other predictors. Journal of Studies on Alcohol 67: 245–251.

    Google Scholar 

  26. Comasco, Erika, Gunilla Hallberg, Anders Helander, Lars Oreland, and Viveka Sundelin-Wahlsten. 2012. Alcohol consumption among pregnant women in a Swedish sample and its effects on the newborn outcomes. Alcoholism: Clinical & Experimental Research 36: 1779–1786.

    Article  Google Scholar 

  27. Harrison, Patricia, and Abbey Sidebottom. 2009. Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Maternal and Child Health Journal 13: 386–394.

    Article  Google Scholar 

  28. Ockene, Judith, Ma Yunsheng, Jane Zapka, Lori Pbert, Karin Goins, and Anne Stoddard. 2002. Spontaneous cessation of smoking and alcohol use among low-income pregnant women. American Journal of Preventative Medicine 23: 150–159.

    Google Scholar 

  29. Palma, Silvia, Rosa Pardo-Crespo, Marcial Mariscal, Rocio Perez-Iglesias, Javier Llorca, and Miguel Delgado-Rodriguez. 2007. Weekday but not weekend alcohol consumption before pregnancy influences alcohol cessation during pregnancy. The European Journal of Public Health 17: 394–399.

    Article  Google Scholar 

  30. Pirie, Phyllis, Harry Lando, Susan Curry, Colleen McBride, and Louis Grothaus. 2000. Tobacco, alcohol, and caffeine use and cessation in early pregnancy. American Journal of Preventive Medicine 18: 54–61.

    Article  Google Scholar 

  31. Powers, Jennifer, Deborah Loxton, Lucy Burns, Anthony Shakeshaft, Elizabeth Elliott, and Adrian Dunlop. 2010. Assessing pregnant women’s compliance with different alcohol guidelines: an 11-year prospective study. Medical Journal of Australia 192: 690–693.

    Google Scholar 

  32. Skagerstrom, Joanna, Grace Chang, and Per Nilsen. 2011. Predictors of drinking during pregnancy: a systematic review. Journal of Women's Health 20: 901–913.

    Article  Google Scholar 

  33. Zuccolo, Luisa, Sarah Lewis, George Davey Smith, Kapil Sayal, Elizabeth Draper, Robert Fraser, Margaret Barrow, Rosa Alati, Sue King, John Macleod, Jean Golding, Jon Heron, and Ron Gray. 2013. Prenatal alcohol exposure and offspring cognition and school performance. A ‘mendelian randomization’ natural experiment. International Journal of Epidemiology 42: 1358–1370.

    Article  Google Scholar 

  34. Jones, Sandra, and Joanne Telenta. 2012. What influences Australian women to not drink alcohol during pregnancy? Australian Journal of Primary Health 18: 68–73.

    Article  Google Scholar 

  35. Salmon, Amy. 2011. Aboriginal mothering, FASD prevention and the contestations of neoliberal citizenship. Critical Public Health 21: 165–178.

    Google Scholar 

  36. May, Philip, Lesley Brooke, Phillip Gossage, Julie Croxford, Colleen Adnams, Kenneth Jones, Luther Robinson, and Denis Viljoen. 2000. Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape province. American Journal of Public Health 90: 1906–1912.

    Google Scholar 

  37. Oldani, Michael. 2009. Uncanny scripts: understanding pharmaceutical emplotment in the aboriginal context. Transcultural Psychiatry 46: 131–156.

    Article  Google Scholar 

  38. Burns, Lucy, Courtney Breen, Carol Bower, Colleen O’Leary, and Elizabeth Elliott. 2013. Counting fetal alcohol spectrum disorder in Australia: the evidence and the challenges. Drug Alcohol Review 32: 461–467.

    Google Scholar 

  39. Deborah, Lupton. 2012. ‘Precious cargo’: foetal subjects, risk and reproductive citizenship. Critical Public Health 22: 329–340.

    Article  Google Scholar 

  40. Leppo, Anna. 2012. The emergence of the foetus: discourses on foetal alcohol syndrome prevention and compulsory treatment in Finland. Critical Public Health 22: 179–191.

    Article  Google Scholar 

  41. Potter, Deborah. 2012. Drawing the line at drinking for two: governmentality, biopolitics, and risk in state legislation on Fetal Alcohol Spectrum Disorders. In Critical perspectives on addiction, ed. Julie Netherland, 129–153. Advances in Medical Sociology 14. UK: Emerald Group Publishing Limited.

  42. Foucault, Michel. 1978. The history of sexuality. New York: Pantheon Books.

    Google Scholar 

  43. Israelsson, Magnus, and Arne Gerdner. 2012. Compulsory commitment to care of substance misusers: International trends during 25 Years. European Addiction Research 18: 302–321.

    Article  Google Scholar 

  44. Armstrong, Elizabeth. 2003. Conceiving risk, bearing responsibility. Fetal alcohol syndrome and the diagnosis of a moral disorder. Baltimore: The John Hopkins University Press.

    Google Scholar 

  45. Lowe, Pam, Ellie Lee, and Liz Yardley. 2010. Under the influence? the construction of foetal alcohol syndrome in UK newspapers. Sociological Research Online 15: 2.

    Article  Google Scholar 

  46. Charles, Sonya. 2011. Obstetricians and violence against women. American Journal of Bioethics 11: 51–56.

    Article  Google Scholar 

  47. Partridge, Brad, Jayne Lucke, and Wayne Hall. 2011. In the face of uncertainty about the risks of low-level drinking, abstinence is prudent, not misogynistic, advice. The American Journal of Bioethics 11: 66–67.

    Article  Google Scholar 

  48. Bell, Kirsten, Darlene McNaughton, and Amy Salmon. 2009. Medicine, morality and mothering: public health discourses on foetal alcohol exposure, smoking around children and childhood overnutrition. Critical Public Health 19: 155–170.

    Article  Google Scholar 

  49. Armstrong, Elizabeth, and Ernest Abel. 2000. Fetal alcohol syndrome: the origins of a moral panic. Alcohol and Alcoholism 35: 276–282.

    Article  Google Scholar 

  50. Payne, Janet, Kathryn France, Nadine Henley, Heather D’Antoine, Anne Bartu, Colleen O’Leary, Elizabeth Elliott, and Carol Bower. 2011. Changes in health professionals’ knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder. Paediatrics and Perinatal Epidemiology 25: 316–327.

    Article  Google Scholar 

  51. Todorow, Michelle, Karela Paris, and Ellen Fantus. 2012. Ethical considerations when communicating a diagnosis of a fetal alcohol spectrum disorder to a child. Journal of Population Therapeutics and Clinical Pharmacology 19: e361–e368.

    Google Scholar 

  52. Peadon, Elizabeth, and Elizabeth Elliott. 2010. Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical guidelines. Neuropsychiatric Disease and Treatment 6: 509–515.

    Article  Google Scholar 

  53. Aronson, Marita, Bibbi Hagberg, and Christopher Gillberg. 1997. Attention deficits and autistic spectrum problems in children exposed to alcohol during gestation: a follow-up study. Developmental Medicine and Child Neurology 39: 583–587.

    Article  Google Scholar 

  54. Newschaffer, Craig, Lisa Croen, Julie Daniels, Ellen Giarelli, Judith Grether, Susan Levy, David Mandell, Lisa Miller, Jennifer Pinto-Martin, Judy Reaven, Ann Reynolds, Catherine Rice, Diana Schendel, and Gayle Windham. 2007. The epidemiology of autism spectrum disorders. Annual Review of Public Health 28: 235–258.

    Article  Google Scholar 

  55. Zizzo, Natalie, Nina Di Pietro, Courtney Green, James Reynolds, Emily Bell, and Eric Racine. 2013. Comments and reflections on ethics in screening for biomarkers of prenatal alcohol exposure. Alcohol Clinical and Experimental Research 37: 1451–1455.

    Article  Google Scholar 

  56. Joya, Xavier, Bibiana Friguls, Sandra Ortigosa, Ester Papaseit, Susana Martinez, Andrea Manich, Oscar Garcia-Algar, Roberta Pacifici, Oriol Vall, and Simona Pichini. 2012. Determination of maternal-fetal biomarkers of prenatal exposure to ethanol: a review. Journal of Pharmaceutical and Biomedical Analysis 69: 209–222.

    Article  Google Scholar 

  57. Astley, Susan, Julie Stachowiak, Sterling Clarren, and Cherie Clausen. 2002. Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. The Journal of Pediatrics 141: 712–717.

    Article  Google Scholar 

  58. Douglas, Heather, Janet Hammill, Elizabeth Anne Russell, and Wayne Hall. 2012. The importance of foetal alcohol spectrum disorder for criminal law practice: views of Queensland criminal lawyers. Queensland Lawyer 32: 153–164.

    Google Scholar 

  59. Douglas, Heather, Janet Hammill, Elizabeth Anne Russell, and Wayne Hall. 2012. Judicial views of foetal alcohol spectrum disorder in Queensland’s criminal justice system. Journal of Judicial Administration 21: 178–188.

    Google Scholar 

  60. Freckleton, Ian. 2013. Fetal alcohol spectrum disorder and the law in Australia: the need for awareness and concern to translate into urgent action. Journal of Law and Medicine 20: 481–492.

    Google Scholar 

  61. Mela, Mansfield, and Glen Luther. 2013. Fetal alcohol spectrum disorder: can diminished responsibility diminish criminal behaviour. International Journal of Law and Psychiatry 36: 46–54.

    Article  Google Scholar 

  62. Streissguth, Ann, Fred Bookstein, Helen Barr, Paul Sampson, Kieran O’Malley, and Julie Kogan Young. 2004. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics 25: 228–238.

    Article  Google Scholar 

  63. Latour, Bruno. 2004. Why has critique run out of steam? from matters of fact to matters of concern. Critical Inquiry 30: 225–248.

    Article  Google Scholar 

  64. Singh, Ilina. 2008. Beyond polemics: science and ethics of ADHD. Nature Reviews Neuroscience 9: 957–964.

    Article  Google Scholar 

  65. Lende, Daniel, and Greg Downey (eds.). 2012. The encultured brain: an introduction to neuroanthropology. Cambridge: The MIT Press.

    Google Scholar 

  66. Latour, Bruno. 1993. We have never been modern. Cambridge: Harvard University Press.

    Google Scholar 

  67. Latour, Bruno. 2004. The politics of nature. Cambridge: Harvard University Press.

    Google Scholar 

  68. Raine, Adrian. 2013. The anatomy of violence: the biological roots of crime. Toronto: Random House.

    Google Scholar 

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Correspondence to Carla Meurk.

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Meurk, C., Lucke, J. & Hall, W. A Bio-Social and Ethical Framework for Understanding Fetal Alcohol Spectrum Disorders. Neuroethics 7, 337–344 (2014). https://doi.org/10.1007/s12152-014-9207-2

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