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

Abstract

Importance: Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD.

Objective: To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally.

Data sources: MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions.

Study selection: Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included.

Data extraction and synthesis: Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated.

Main outcomes and measures: Prevalence of FASD.

Results: A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population).

Conclusions and relevance: Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.

Figure 1.. Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth in the General Population in 2012

Data are expressed as number per 1000 population.

Figure 2.. Comparison of the Prevalence of Fetal Alcohol Spectrum Disorder in Special Populations With the Global Prevalence Among Children and Youth in the General Population

Data in special populations are obtained from select studies. Special populations include adoptees from Eastern Europe in Sweden (521.1 per 1000 population; Landgren et al), foster and adopted youth referred to a US children’s mental health center (285.2 per 1000 population; Chasnoff et al), a correctional population in Canada (233.5 per 1000 population; Fast et al), an aboriginal population in Canada (189.7 per 1000 population; Robinson et al), a rural population with low socioeconomic status (SES) in South Africa (182.4 per 1000 population; de Vries et al), children in an orphanage in Brazil (170.2 per 1000 population; Strömland et al), a US population in psychiatric care (142.4 per 1000 population; Bell and Chimata), an aboriginal population in Australia (120.4 per 1000 population; Fitzpatrick et al), and children before adoption or in foster care in Israel (40.0 per 1000 population; Tenenbaum et al). Prevalence in the general population is described in Table 2. Error bars indicate 95% CI.