title: Under-reporting of foetal alcohol spectrum disorders: an analysis of hospital episode statistics.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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), no such increases were seen in the numbers of FASD-related conditions (all p < 0.05). 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Henry Cotton Campus (third floor), 15-21 Webster Street, Liverpool L3 2ET, UK. m.j.morleo@ljmu.ac.uk
authors.forename: Michela
authors.initials: M
authors.lastname: Morleo
authors.forename: Kerry
authors.initials: K
authors.lastname: Woolfall
authors.forename: Dan
authors.initials: D
authors.lastname: Dedman
authors.forename: Raja
authors.initials: R
authors.lastname: Mukherjee
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.forename: Penny A
authors.initials: PA
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D009017:Morbidity / Q000639:trends; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012306:Risk; D055815:Young Adult