Fetal alcohol spectrum disorders: preventing collateral damage from COVID-19.

During the COVID-19 pandemic, slowing the spread of the disease and caring for people whose survival and health are jeopardised have rightly been prioritised. Now, attention is increasingly being focused on the unwelcome consequences of COVID-19 for individuals, families, communities, and society. These consequences form a long and daunting—but incomplete—list. To date, a potential source of collateral damage by COVID-19 has remained oddly invisible.

In The Lancet Public Health, the Editorial in the June, 2020, issue discussed harmful use of alcohol, but the heightened risk and predictable harm of fetal alcohol spectrum disorders (FASD) have not been addressed. This silence mirrors that of professionals and the inaction of governments, even in countries notable for high levels of both alcohol consumption and unintended pregnancies.

An unhealthy relationship with alcohol carries heavy personal, economic, health, and societal costs, which were explored in the Editorial. But, discussion of FASD was absent. A spike in fetal alcohol harm could be a potential negative outcome of the COVID-19 lockdown because of alcohol consumption combined with being home-bound, feelings of extraordinary stress or fear, and restricted access to contraception.

Alcohol exposure in utero is the leading cause of neurodevelopmental damage, learning disabilities, and behavioural problems, but is also the most underacknowledged and misdiagnosed neurodevelopmental condition. FASD cannot be cured, reversed, or outgrown, and can have devasting secondary effects, ranging from school problems and substance abuse to mental health issues and ill-fated criminal justice encounters.

Public health messages have too often focused almost exclusively on the alcohol side of the problem, while ignoring unintended pregnancies. Providing contraceptives more widely during lockdown could be useful to tackle FASD.

Although we might soon enter a post-COVID era, new cases of FASD will persist for decades and permanently compromise the lives and life chances of those affected. FASD is both predictable and largely preventable but has been consistently ignored. This omission is a missed public health opportunity during the first wave of COVID-19. Will FASD remain a blind spot during any subsequent wave(s)?