Open Access Open Badges Research article

Under-reporting of foetal alcohol spectrum disorders: an analysis of hospital episode statistics

Michela Morleo1*, Kerry Woolfall2, Dan Dedman3, Raja Mukherjee4, Mark A Bellis1 and Penny A Cook1

Author Affiliations

1 Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus (third floor), 15-21 Webster Street, Liverpool L3 2ET, UK

2 MRC North West Hub for Trials Methodology Research, Department of Mental Health and Well-being, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK

3 School of Public Health and Clinical Sciences, University of Central Lancashire, Preston PR1 2HE, UK

4 FASD Specialist Behavioural Clinic, Surrey and Border Partnership NHS Foundation Trust, 116-118 Station Road East, Oxted, Surrey, RH8 0QA UK

For all author emails, please log on.

BMC Pediatrics 2011, 11:14  doi:10.1186/1471-2431-11-14

Published: 8 February 2011



Internationally, 0.97 per 1,000 live births are affected by foetal alcohol syndrome (FAS). However, prevalence intelligence has been limited in the UK, hindering the development of appropriate services. This analysis compares hospital admissions over time, between regions and with alcohol-related admissions for adult females to assess whether established patterns (such as the North experiencing elevated harms) can be identified.


A retrospective analysis of hospital admissions data (April 2002 to March 2008) for foetal alcohol spectrum disorder (FASD)-related conditions: foetal alcohol syndrome (dysmorphic) (n = 457); foetus and newborn affected by maternal use of alcohol (n = 157); maternal care for (suspected) damage to foetus from alcohol (n = 285); and 322,161 women admitted due to alcohol-related conditions.


Whilst the rate of admission for alcohol-related conditions in women aged 15-44 years increased significantly by 41% between 2002/03 and 2007/08 (p < 0.0001), significant increases were only seen in the numbers of FAS. Established regional rates of admission for alcohol-related conditions in women aged 15-44 years old were not associated with admission for FASD-related conditions.


It would be expected that the North West and North East regions, known to have higher levels of alcohol harm would have higher levels of FASD-related conditions. However, this was not reflected in the incidence of such conditions, suggesting under-reporting. With incomplete datasets, intelligence systems are severely limited, hampering efforts to develop targeted interventions. Improvements to intelligence systems, practitioner awareness and screening are essential in tackling this.