Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth: A Systematic Review and Meta-analysis

Fetal alcohol spectrum disorder (FASD) is an umbrella term for the wide range of adverse effects to the developing fetus when exposed to alcohol during pregnancy, some of which are lifelong. The severity and type of defects induced by FASD are affected by the age of embryo at exposure, pattern of exposure, and dose; however, other factors including genetic background, maternal age, and environmental influences also appear to impact susceptibility. Prevalence estimates play a key role in planning and allocating effective healthcare initiatives to high-needs populations such as children and youth afflicted with FASD. In much of the world, a lack of data has prevented the development of these epidemiologic reports; however, recent publications and improved data sets now allow for estimates of FASD globally. This comprehensive systematic review and meta-analysis aimed to estimate the prevalence of FASD among children and youth globally, by theWorld Health Organization (WHO) region, and by country. The authors then compared prevalence rates of FASD among the general population to the prevalence in special populations including aboriginal, low socioeconomic status, correctional, those undergoing psychiatric care, and children in care such as orphanages. Data were drawn from original quantitative studies published between November 1, 1973, and June 30, 2015, that reported the prevalence of FASD among children and youth, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used. Additional criteria were used for critical appraisal of study data inclusion. A random-effects model for meta-analyses was performed to determine the pooled prevalence of FASD in countries with 2 or more selected studies. For countries with 1 or no study meeting inclusion criteria, prevalence estimates were calculated using data on the proportion of women using alcohol during pregnancy per 1 case of FASD. Data were extracted from 24 studies including 1416 children and youth (aged 0-16.4 years) diagnosed with FASD. The global prevalence of FASD was found to be 7.7 of 1000 births (95% confidence interval [CI], 4.9-11.7 per 1000), and 76 countries (of 187 for which observed or predicted estimates were available) had an FASD prevalence greater than 1%. The European Region had the highest overall prevalence (19.8 of 1000 births [95% CI, 14.1-28.0 per 1000]), whereas the Eastern Mediterranean Region had the lowest overall prevalence (0.1 per 1000 births [95% CI, 0.1-0.5 per 1000]). The prevalence of FASD among special populationswas higher than among the general population, specifically 15.6 to 24.6 times higher among aboriginal populations, 5.2 to 67.7 times higher among children in care, 30.3 times higher in a correctional population, 23.7 times higher in a low socioeconomic status population, and 18.5 times higher among a population in psychiatric care. This study finds that FASD is a moderately prevalent condition on a global spectrum. Further research on the efficacy of specific educational interventions and screening methods is needed in order to increase prevention of this debilitating disorder.