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Vulnerable subpopulations have higher prevalence of fetal alcohol spectrum disorder

Compared with the general population, global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations had significantly higher prevalence of fetal alcohol spectrum disorder, according to study findings published in Addiction.

No previous study has encompassed all available data on the prevalence of fetal alcohol spectrum disorder (FASD) among all special subpopulations, Svetlana Popova, MD, PhD, MPH, from the Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, and colleagues wrote.

“Consolidating all existing evidence on the prevalence of FASD among special subpopulations will aid in the identification of knowledge gaps and areas of study for which evidence is limited or absent, with the intention of ultimately improving prevalence estimates,” they wrote. “Improving estimates of FASD within special subpopulations and service-defined populations would provide improved data to plan services and budgets to serve people affected by prenatal alcohol exposure.”

Researchers conducted a systematic literature review and meta-analysis to determine the global prevalence estimates of FASD among general vs. special subpopulations (as defined by service use). The studies included five sub-populations: children in care, people in correctional services, Aboriginal populations, people in special education services and people using specialized clinical services, like psychiatric care.

Popova and colleagues performed country-, disorder- (fetal alcohol syndrome [FAS] and FASD, inclusive of FAS) and population-specific meta-analyses for countries with two or more studies that used active case ascertainment and/or clinic-based and specified the diagnostic criteria used to obtain cases of FAS/FASD in each population.

Overall, 69 studies, comprising 6,177 individuals diagnosed with FASD from 17 countries, were included in the analysis. The countries with studies were Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), Russia (n = 9), U.S. (n =25), and one each in Eastern Europe (Moldova, Romania and Ukraine), Germany, Israel, Lithuania, the Netherlands, Poland, South Korea, Spain and Sweden.

Analysis indicated that the prevalence of FASD in the five special subpopulations was 10 to 40 times higher than the global FASD prevalence in the general population (7.7 per 1,000 people; 95% CI, 4.9-11.7). Compared with the estimated global prevalence of FASD in the general population, the prevalence among children in care was 32 times higher in the U.S. (251.5 per 1,000; 95% CI, 220-281.7) and 40 times higher in Chile (312.4 per 1,000; 95% CI, 283.6-339.1).

In individual studies, the prevalence of FASD among children in care with mental deficits was 620 per 1,000 in Chile. Also, the prevalence of FASD among children in correctional services was estimated at more than 140 per 1,000 among psychiatric care populations in the U.S., according to the data.

"Public policy and clinical care for people with FASD needs to recognize the severity of the problem globally. Routine screening protocols should be established to identify people with FASD in child welfare, special education, justice system and other settings to provide appropriate support and early interventions,” Popova said in a press release. “Service staff should be trained in FASD awareness, identification, and interventions to provide better care. Women should completely abstain from any type of alcohol during their entire pregnancy and while trying to get pregnant." – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.