How Prevalent is Fetal Alcohol Spectrum Disorder in the US?

BACKGROUND AND PURPOSE:

  • Fetal alcohol spectrum disorders include
    • Fetal alcohol syndrome (FAS)
    • Partial fetal alcohol syndrome
    • Alcohol-related neurodevelopmental disorder
  • Leading cause of developmental disabilities worldwide
    • Accepted US estimate: 10/1000 children affected
  • However, likely that prevalence underestimated due to ‘not diagnosed’ or ‘misdiagnosis’
  • Other countries use ‘active case ascertainment’ where “surveillance personnel are hired and trained to abstract data from all data sources. Abstractors regularly visit or have electronic access to participating institutions, such as hospitals and clinics” (CDC)
  • Philip et al. (JAMA, 2018) used active case ascertainment to estimate the overall prevalence of fetal alcohol spectrum disorder in the United States

METHODS:

  • Active case ascertainment methods using a cross-sectional design
  • Two research teams, both funded by the National Institute on Alcohol Abuse and Alcoholism
  • Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum:
    • Dysmorphic features
    • Physical growth
    • Neurobehavioral development
    • Prenatal alcohol exposure
  • The settings were 4 communities in the US
    • The Rocky Mountains
    • Midwestern US
    • Southeastern US
    • Pacific Southwestern US
  • First-grade children and their parents or guardians were enrolled
  • The primary outcome was Prevalence of fetal alcohol spectrum disorder in the 4 communities

RESULTS:

  • 6,639 children were included in the study population
    • Boys, 51.9% | Mean age, 6.7 years [SD, 0.41] | White maternal race, 79.3%
  • A total of 222 cases of fetal alcohol spectrum disorders were identified
  • The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children
    • Calculated as total number of children with alcohol spectrum disorder divided by number of children participating in first grade or selected randomly
  • The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children
    • Denominator restricted to children with sufficient information to be properly classified with the condition

CONCLUSION:

  • Using a conservative estimate, fetal alcohol spectrum disorder has a prevalence between 1.1% to 5.0% of the population with much higher prevalence using weighted approach
  • Supporting evidence “that harmful fetal alcohol exposure is common in the United States today”
  • For perspective, CDC autism spectrum disorder estimates are 14.6/1000 children (approximately 1/2 the lowest conservative estimate for fetal alcohol spectrum disorders)

Learn More – Primary Sources:

Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities