Fetal Alcohol Spectrum Disorder in Australia: From Fiction to Fact and to the Future

In 2004, when we asked FAS in Australia: Fact or Fiction? we lacked sufficient data on fetal alcohol syndrome (FAS) to answer that question. Despite coming relatively late to the issue in Australia, research has shifted FAS from the realm of fiction to fact in two decades. We now have good Australian data on patterns of prenatal alcohol exposure (PAE) and women’s and health professionals’ knowledge, attitudes, and practice regarding alcohol use in pregnancy and fetal alcohol spectrum disorder (FASD). Indigenous-led research provides population-based data on FASD prevalence in high-risk remote communities and its impacts at home and school; and prevalence data are available for FASD in a juvenile detention center. Data linkage studies estimate the frequency of PAE effects in infancy and in the long-term, while pregnancy cohorts allow exploration of biological markers, including epigenetics and three-dimensional (3D) facial imaging, to inform pathological understanding, screening, and early diagnosis of FASD. Importantly, using a model that could be adopted elsewhere, we have taken a systematic approach to FASD, established collaborative national research and clinical networks, consulted with caregivers, engaged and supported health professionals, and worked closely with governments and non-government organizations, advocates, politicians, and policymakers to ensure that research is translated into clinical and public health practice and policy. Challenges remain but we look to a future that includes early diagnosis, effective treatment, and prevention of FASD, underpinned by a sound, current, and contextual evidence base.