Dr. Svetlana Popova: Defining, Understanding, and Preventing Fetal Alcohol Spectrum Disorder

Dr. Svetlana Popova: Defining, Understanding, and Preventing Fetal Alcohol Spectrum Disorder

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Dr. Svetlana Popova
Senior Scientist, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health,
World Health Organization/Pan-American Health Organization Collaborating Centre in Addiction and Mental Health
Associate Professor, Epidemiology Division, Dalla Lana School of Public Health, University of Toronto
Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto
Graduate Faculty Associate Member, Institute of Medical Science, University of Toronto

By: Ana Stosic
Photo courtesy of Dr. Popova

Health myths readily propagate through society: “We only use 10% of our brains, bubble gum remains in your stomach for seven years, eggs are bad for your heart.”

While common, we often pay little attention to these statements if we’re aware of their invalidity. Yet, when faced with indisputable evidence-based medical recommendations: “do not consume alcohol during pregnancy”, we seem to fail.  

In 2017, a study published in The Lancet Global Health estimated that globally, on average, one in 10 women consume alcohol during pregnancy and 20% of these women binge drink, meaning they consume four or more alcoholic drinks on a single occasion.2 These findings are alarming because 50% of the pregnancies in developed countries and over 80% in developing countries are known to be unplanned. That means that many women do not realize they are pregnant during the early stages and continue drinking when pregnant.  

Alcohol is a teratogen and thus, poisonous to the developing fetus throughout all nine months of gestation. When a mother-to-be consumes alcohol, it goes directly to the fetus through her blood stream. These children may be born with Fetal Alcohol Spectrum Disorder (FASD), which is an umbrella term that covers several alcohol-related diagnoses. This includes Fetal Alcohol Syndrome (FAS), which is the most severe and visibly identifiable form of FASD.

Dr. Svetlana Popova is one of the leading scientists at the frontier of advocacy for FASD intervention and prevention.  She is a Senior Scientist in the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health. Amongst her numerous accolades, she holds two faculty appointments at the University of Toronto: Associate Professor at the Dalla Lana School of Public Health, Epidemiology Division, and the Factor Inwentash Faculty of Social work, and a Graduate Faculty Associate Member position with the Institute of Medical Sciences.

Dr. Popova is currently the principal investigator of an international initiative aimed to estimate the global prevalence of FASD, guided by the World Health Organization (WHO) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The ultimate goal of these studies is to prevent future cases and implement adequate policy and program responses for people diagnosed with FASD.  She served previously as the principal investigator of a study supported by the Public Health Agency of Canada aiming to assay the burden and economic cost associated with FASD in Canada.

FASD is a serious, incurable, and disabling condition, which is associated with a wide range of physical and central nervous system disabilities. These can include behavioural and learning problems, growth impairments, facial abnormalities, and developmental delays. In a recent comprehensive literature review and meta-analysis published in The Lancet, Dr. Popova and her team identified more than 400 conditions that co-occur in people with FASD.3 Unfortunately, FASD is highly unreported and unrecognized by health care providers globally. As such, many people suffering from FASD go undiagnosed or misdiagnosed, and experience a barrier to receiving proper health care and other interventions.

Recently, the group led by Dr. Popova completed and published the results of the Canadian Component of the WHO International Study on the Prevalence of FASD. Prior to this study, the prevalence of FASD amongst the general Canadian population was unknown.  Their study design focused on screening children between the ages of seven and nine years from elementary schools in the Greater Toronto Area (GTA). This study was the first of its kind to provide a population-based estimate for the prevalence of FASD among elementary school children, citing a prevalence of 2-3%.1  This estimate suggests that the prevalence of FASD is higher than the prevalence of some more commonly known birth defects in Canada, such as anencephaly, Down syndrome, spina bifida, as well as autism spectrum disorder.

It is important that preventative measures targeting maternal alcohol consumption be taken, as FASD is preventable.  However, it is equally important that individuals with FASD are properly diagnosed, as FASD is a complex and chronic condition, for which lifelong assistance and interventions are required.

Dr. Popova’s work is not limited to epidemiology and economic analyses of maternal alcohol consumption and FASD.  Dr. Popova is responsible for an impressive history of prevention and intervention strategies, as well as education initiatives.  In collaboration with the Pan American Health Organization (PAHO)/WHO and other colleagues, Dr. Popova undertook several workshops on FASD diagnostics for countries in Africa, Latin America, and Eastern and Central Europe. The most recent workshop was conducted in the Dominican Republic in October 2018 in order to “teach their pediatricians, psychologists, psychiatrists, and other health professionals how to diagnose children with FASD” explains Dr. Popova. “During this workshop we diagnosed the first child in the country with FAS! It’s very important because the first child that was diagnosed with FAS in the world was in the United States in 1973.”

With the first diagnosis being a mere 40 years ago, many countries are still unaware of the detrimental consequences of alcohol consumption during pregnancy, including FASD.  However, educational interventions by Dr. Popova and her colleagues have made great strides in bridging this gap. Dr. Popova notes that, “in some countries, like the Dominican Republic, the population was unaware of this problem.  It was eye-opening for them; now, they plan to implement their own research and their own policies, and even include diagnostic of FASD in medical schools’ curricula.”

The utilization of platforms catering to the future of health care is critical.  Dr. Popova’s work targets education, prevention, and intervention, all with a specific aim: “One of my goals is to educate our public about the health risks of prenatal alcohol exposure and the young IMS population is a great resource, as they are the future of healthcare.”

“Ultimately, I want to communicate one crystal-clear message, because messages from the media are quite often mixed and confusing for the public.” She explains. “There is no safe amount, there is no safe type, and there is no safe time to drink alcohol during pregnancy or when planning to become pregnant.  Therefore, women should completely abstain from alcohol during the entire nine months of pregnancy and up to three months when they are trying to get pregnant.”

While health myths propagate through society, Dr. Popova’s research has indisputably shown that alcohol consumption during pregnancy should be recognized globally as a serious public health problem. More effective prevention strategies targeting alcohol use before and during pregnancy are needed worldwide.

References:

  1. Popova, S., Lange, S., Chudley, A.E., Reynolds, J.N., & Rehm, J. in collaboration with May, P.A. and Riley, E.P. (2018). World Health Organization International Study on the Prevalence of Fetal Alcohol Spectrum Disorder (FASD): Canadian Component. Toronto, ON: Centre for Addiction and Mental Health.
  2. Popova, S., Lange, S., Probst, C., Gmel, G., & Rehm, J. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health, 5(3), e290–e299.
  3. Popova, S., Lange, S., Shield, K., Mihic, A., Chudley, A. E., Mukherjee, R. A. S., Bekmuradov, D., & Rehm, J. (2016). Co-morbidity of Fetal Alcohol Spectrum Disorder: A systematic literature review and meta-analysis. The Lancet, 387, 978-8.