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US prevalence of fetal alcohol syndrome remains unclear
Assessing the true burden of fetal alcohol syndrome has been difficult, according to the CDC, which recently conducted surveillance among children in Arizona, Colorado and New York.
“There is a wide variation in reported prevalence [of fetal alcohol syndrome] depending on the study population and surveillance method,” study researcher Deborah J. Fox, MPH, of the New York State Department of Health, and colleagues wrote. “Generally, records-based birth prevalence studies report estimates of 0.2 to 1.5 per 1,000 live births, whereas studies that use in-person, expert assessment of school-aged children in a community report estimates of 6 to 9 per 1,000 population.”
To identify children, aged 7 to 9 years, with fetal alcohol syndrome living in Arizona, Colorado and New York in 2010, researchers utilized passive reporting and actively reviewed records from genetic and developmental clinics, hospital discharge files, Medicaid claims, HMO records and the juvenile justice system.
The overall prevalence of fetal alcohol syndrome among the study population was 0.3 per 1,000 children (95% CI, 0.3-0.4). The prevalence was 0.3 per 1,000 children in Arizona and Colorado, and was elevated to 0.8 per 1,000 children in New York.
American Indian/Alaska Native children had the highest prevalence of fetal alcohol syndrome at 2 per 1,000 children (95% CI, 1.4-2.8). By comparison, Hispanic children had the lowest rates, 0.2 per 1,000 children (95% CI, 0.1-0.2). Age and sex did not affect prevalence, the authors wrote.
These findings are significantly lower vs. those obtained from studies using in-person, expert assessment, according to the researchers. These discrepancies may owe to physicians’ inaccurate recognition of physical and behavioral characteristics of fetal alcohol syndrome, insufficient documentation of these characteristics in medical records and not considering prenatal alcohol exposure when diagnosing behavioral and learning problems, the investigators wrote.
In response, the CDC funded six Fetal Alcohol Spectrum Disorders Practice and Implementation Centers in 2014.
“Recognition of children with [fetal alcohol syndrome] is critically important to ensure their access to appropriate services and interventions. However, identifying affected children through population-based surveillance continues to be a challenge,” Fox and colleagues wrote. “Prevalence estimates from the Fetal Alcohol Syndrome Surveillance Network II demonstrate that fetal alcohol syndrome is still underrecognized.”
Disclosure: The researchers report no relevant financial disclosures.
