Where is the South African prevention of fetal alcohol spectrum disorder programme? A call to action
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i10.3278Keywords:
Foetal Alcohol Spectrum Disorder, prenatal alcohol exposure, Choline, PolicyAbstract
Fetal alcohol spectrum disorder (FASD) prevalence is high in South Africa, and is a significant public health concern. The long-term
consequences of FASD are devastating to the individual, their family and society. Costs associated with managing these patients and the consequences of their disorder are significant. National ownership and multisectorial involvement are required to design and implement a successful FASD prevention programme.
References
1. Lange S, Probst C, Gmel G, et al. Global prevalence of fetal alcohol spectrum disorder among children
and youth: A systematic review and meta-analysis. JAMA Pediatr 2017;171(10):948-956. https://doi.
org/10.1001/jamapediatrics.2017.1919
2. Louw JG, Broodryk M, White L, et al. A multi‐year, multi‐site study of the prevalence of fetal alcohol
syndrome in South Africa. Alcohol Clin Experiment Res 2024;48(5):867-879. https://doi.org/10.1111/
acer.15306
3. Adebiyi BO, Mukumbang FC, Beytell AM. A guideline for the prevention and management of fetal
alcohol spectrum disorder in South Africa. BMC Health Serv Res 2019;19(809):1-3. https://doi.
org/10.1186/s12913-019-4677-x
4. Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol
syndrome and fetal alcohol effects. J Dev Behavioral Pediatr 2004;25(4):228-238. https://doi.
org/10.1097/00004703-200408000-00002
5. Thanh NX, Jonsson E, Moffatt J, Dennett L. Fetal alcohol spectrum disorder – poverty trap. J Popul
Ther Clin Pharmacol 2013;20(1):e63-e66. https://jptcp.com/index.php/jptcp/article/view/400
(accessed 14 October 2025).
6. Lubbe M, van Walbeek C, Vellios N. The prevalence of fetal alcohol syndrome and its impact on a
child’s classroom performance: A case study of a rural South African school. Int J Environ Res Pub
Health 2017;14(8):896. https://doi.org/10.3390/ijerph14080896
7. Broodryk M, Louw JG, Acker D, Viljoen DL, Olivier L. Life outcomes in adults living with FASD
in a rural South African community: A follow-up study. Afr J Disability 2024;13(0):7. https://doi.
org/10.4102/ajod.v13i0.1386
8. Greenmyer JR, Klug MG, Kambeitz C, Popova S, Burd L. A multicountry updated assessment of the
economic impact of fetal alcohol spectrum disorder: Costs for children and adults. J Addiction Med
2018;12(6):466-473. https://doi.org/10.1097/ADM.0000000000000438
9. Credé S, Sinanovic E, Adnams C, London L. The utilisation of healthcare services by children with fetal
alcohol syndrome in the Western Cape, South Africa. Drug Alcohol Dependence 2011;115(3):175-182.
https://doi.org/10.1016/j.drugalcdep.2010.10.019
10. Centers for Disease Control and Prevention. Alcohol use in pregnancy. Atlanta: CDC, 2021. https://
www.cdc.gov/alcohol-pregnancy/about/index.html (accessed 7 January 2025).
11. May PA, Hasken JM, de Vries MM, et al. Maternal and paternal risk factors for fetal alcohol spectrum
disorders: Alcohol and other drug use as proximal influences. Alcohol Clin Experiment Res
2023;47(11):2090-2109. https://doi.org/10.1111/acer.15193
12. National Department of Health, Statistics South Africa, South African Medical Research Council, ICF.
South Africa Demographic and Health Survey 2016. Pretoria: NDoH, Stats SA, SAMRC, ICF, 2019.
https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf (accessed 7 January 2025).
13. Astley SJ, Bailey D, Talbot C, Clarren K. FAS primary prevention through FAS diagnosis: II. A
comprehensive profile of 80 birth mothers of children with FAS. Alcohol Alcoholism 2000;35(5):505-
519. https://doi.org/10.1093/alcalc/35.5.509
14. Tough S, Tofflemire K, Clarke M, Newburn-Cook C. Do women change their drinking behaviors while
trying to conceive? An opportunity for preconception counseling. Clin Med Res 2006;4(2):97-105.
https://doi.org/10.3121/cmr.4.2.97
15. Shreffler KM, Roland A, Joachims CN, Croff JM. The role of pregnancy intentions in US women’s
contraceptive and alcohol use behaviors. SAGE Open Nurs 2024;10:23779608241301858. https://doi.
org/10.1177/23779608241301858
16. Maier SE, West JR. Drinking patterns and alcohol-related birth defects. Alcohol Res Health
2001;25(3):168. https://pmc.ncbi.nlm.nih.gov/articles/PMC6707176/pdf/arcr-25-3-168 (accessed
7 January 2025).
17. Makua M, Massyn N. Antenatal 1st visit coverage. District Health Barometer 2019/20. Durban:
Health Systems Trust, 2020. https://www.hst.org.za/publications/District%20Health%20Barometers/
DHB%202019-20%20Complete%20Book.pdf (accessed 7 January 2025).
18. National Department of Health, South Africa. Circular: Pregnancy screening circular 01 of 2020.
Pretoria: NDoH, 2020. https://knowledgehub.health.gov.za/system/files/elibdownloads/2023-04/Pre
gnancy%2520Screening%2520circular%252001%2520of%25202020.pdf (accessed 20 January 2025).
19. Rossouw L, Burger RP, Burger R. An incentive-based and community health worker package
intervention to improve early utilisation of antenatal care: Evidence from a pilot randomised controlled
trial. Matern Child Health J 2019;23(5):633-640. https://doi.org/10.1007/s10995-018-2677-9
20. Venter F, Majam M, Jankelowitz L, et al. South African HIV self-testing policy and guidance
considerations. South Afr J HIV Med 2017;18(1):775. https://doi.org/10.4102/sajhivmed.v18i1.775
21. World Health Organization. Implementation of self-care interventions for health and well-being.
Geneva: WHO, 2021. https://www.who.int/publications/i/item/9789240094888 (accessed 25 January
2025).
22. Department of Public Service and Administration, South Africa. Policy on quality in health care for
South Africa. Pretoria: DPSA, 2000. https://www.gov.za/sites/default/files/gcis_document/201409/
qhc-policy.pdf (accessed 25 January 2025).
23. Smith JG, Ross C, Manenzhe T, et al. Fetal alcohol syndrome knowledge and risk behaviors among
university students and community residents in Limpopo, South Africa. S Afr J Psychol 2023;53(1):5-
17. https://doi.org/10.1177/00812463221089539
24. Tsang TW, Elliott EJ. Predictors of alcohol use during pregnancy in Australian women. Drug Alcohol
Rev 2022;41(1):171-181. https://doi.org/10.1111/dar.13330
25. Ishitsuka K, Hanazawa K, Aoyama C, Nishimura S, Yokoyama Y. Determinants of alcohol consumption
in women before and after awareness of conception. Matern Child Health J 2020;24(2):165-176.
https://doi.org/10.1007/s10995-019-02840-2
26. Popova S, Dozet D, Shield KD, Rehm J. Profile of mothers of children with fetal alcohol spectrum
disorder: A population-based study in Canada. Int J Environ Res Public Health 2020;17(21):7986.
https://doi.org/10.3390/ijerph17217986
27. Hen-Herbst L, Zeilig T, Weingarten-Baror C, Sznitman SR. Pregnant women’s alcohol consumption
and knowledge about its risks: An Israeli survey. Drug Alcohol Depend 2021;228:109023. https://doi.
org/10.1016/j.drugalcdep.2021.109023
28. McDonald BW, Watson PE. Maternal alcohol intakes before and during pregnancy: Impact on the
mother and infant outcome to 18 months. Nordic Stud Alcohol Drugs 2020;37(2):153-171. https://doi.
org/10.1177/1455072520905404
29. Rotheram-Borus MJ, Tomlinson M, le Roux IM, Stein JA. Philani Plus (+): A Mentor Mother
community health worker home visiting programme to improve maternal and infants’ outcomes. Prev
Sci 2011;12(4):372-388. https://doi.org/10.1007/s11121-011-0238-1
30. Williams AD, Nkombo Y, Nkodia G, Leonardson G, Burd L. Prenatal alcohol exposure in the Republic
of the Congo: Prevalence and screening strategies. Birth Defects Res 2013;97(7):489-496. https://doi.
org/10.1002/bdra.23127
31. Namagembe I, Jackson LW, Zullo MD, et al. Consumption of alcoholic beverages among pregnant
urban Ugandan women. Matern Child Health J 2010;14(4):492-500. https://doi.org/10.1007/s10995-
009-0500-3
32. May PA, Hasken JM, de Vries MM, et al. Maternal risk factors for fetal alcohol spectrum disorders:
Distal variables. Alcohol Clin Experimental Res 2024;48(2):319-344. https://doi.org10.1111/acer.15246
33. Driscoll DL, Barnes VR, Johnston JM, Windsor R, Ray R. A formative evaluation of two FASD prevention
communication strategies. Alcohol Alcoholism 2018;53(4):461-469. https://doi.org/10.1093/alcalc/
agx122
34. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy
experience. Geneva: WHO, 2016. https://www.who.int/publications/i/item/9789241549912 (accessed
25 January 2025).
35. National Department of Health, South Africa. National integrated maternity and perinatal care guidelines.
Pretoria: NDoH, 2024. https://knowledgehub.health.gov.za/system/files/elibdownloads/2024-10/
Integrated%20Maternal%20and%20Perinatal%20Care%20Guideline_23_10_2024_0.pdf (accessed 25
January 2025).
36. Chang G. Alcohol-screening instruments for pregnant women. Alcohol Res Health 2001;25(3):204-
209. https://pmc.ncbi.nlm.nih.gov/articles/PMC6707175/
37. Jolma M, Koivu-Jolma M, Niemelä O, Autti-Rämö I, Kahila H. Rapid urine screening for ethyl
glucuronide from pregnant women as a tool for detecting prenatal alcohol exposure. BMC Pregnancy
Childbirth 2023;23(1):464. https://doi.org/10.1186/s12884-023-05789-x
38. Washio Y, Erasmus-Claassen LA, Taylor SN, et al. An incentive-based text-messaging intervention to
reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings
from a single-arm pilot study. Alcohol Clinical Experimental Res 2024;48(8):1600-1609. https://doi.
org/10.1111/acer.15392
39. Nkabane-Nkholongo E, Mpata Mokgatle M, Bickmore T, et al. Change in sexual and reproductive
health knowledge among young women using the conversational agent ‘Nthabi’ in Lesotho: A clinical
trial. BMC Glob Public Health 2024;2(1):60. https://doi.org/10.1186/s44263-024-00091-0
40. Silva KD, Sampaio AA, Miguel AD. Contingency management applied to alcohol use disorder: Systematic
review. Psicologia Teoria Pesquisa 2022;38:e38215. https://doi.org/10.1590/0102.3772e38215.en
41. Robb L, Joubert G, Jordaan EM, Ngounda J, Walsh CM. Choline intake and associations with egg and
dairy consumption among pregnant women attending a high-risk antenatal clinic in South Africa:
The NuEMI study. BMC Pregnancy Childbirth 2021;21(1):1‑9. https://doi.org/10.1186/s12884-021-
04314-2
42. Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves
child sustained attention: A 7-year follow-up of a randomised controlled feeding trial. FASEB J
2022;36(1):e22054. https://doi.org/10.1096/fj.202101217R
43. Jacobson SW, Carter RC, Molteno CD, et al. Efficacy of maternal choline supplementation during
pregnancy in mitigating adverse effects of prenatal alcohol exposure on growth and cognitive function:
A randomised, double-blind, placebo-controlled clinical trial. Alcoholism Clin Experimental Res
2018;42(7):1327-1341. https://doi.org/10.1111/acer.13769
44. Warton FL, Molteno CD, Warton CM, et al. Maternal choline supplementation mitigates alcohol
exposure effects on neonatal brain volumes. Alcoholism Clin Experimental Res 2021;45(9):1762-1774.
https://doi.org/10.1111/acer.14672
45. Jaiswal A, Dewani D, Reddy LS, Patel A. Choline supplementation in pregnancy: Current evidence and
implications. Cureus 2023;15(11):e48538 . https://doi.org/10.7759/cureus.48538
46. Canadian Agency for Drugs and Technologies in Health. Choline supplementation for infants,
children, and pregnant people: Rapid review. Ottawa: Canadian Agency for Drugs and Technologies in
Health, 2024. https://www.ncbi.nlm.nih.gov/books/NBK605544/ (accessed 7 January 2025).
47. South Africa. Foodstuffs, Cosmetics and Disinfectants Act No. 54 of 1972. Regulations: Health messages
on container labels of alcoholic beverages. https://www.gov.za/documents/notices/foodstuffs-cosmeticsand-
disinfectants-act-regulations-health-messages-container (accessed 5 November 2024).
48. Cil G. Effects of posted point-of-sale warnings on alcohol consumption during pregnancy and on birth
outcomes. J Health Econo 2017;5:131-155. https://doi.org/10.1016/j.jhealeco.2017.03.004
49. Adebiyi BO, Mukumbang FC. Alcohol ban during the COVID-19 pandemic lockdown: Lessons for
preventing fetal alcohol spectrum disorder in South Africa. Afr J Primary Health Care Fam Med
2022;14(1):1-4. https://doi.org/10.4102/phcfm.v14i1.3686
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