Epidemiology
There is geographical variation in rates of fetal alcohol spectrum disorder (FASD) and in the way cases are counted (i.e., population- or clinic-based studies, active or passive surveillance) and reported. Rates are reported as incidence, prevalence, or birth prevalence (i.e., number of children born with a congenital disorder compared per 1000 total live births in a specific time frame).[4][5]
FASD affects all ethnic groups, but rates vary within countries and particular groups are at higher risk. Fetal alcohol syndrome (FAS) rates are more commonly reported than rates for alcohol-related birth defects and alcohol-related neurodevelopmental disorder, which are more difficult to diagnose. Rate trends and variations may reflect health professionals' awareness of the spectrum.
In one 2017 meta-analysis, global prevalence of FASD was estimated at 8 of 1000 in the general population, with the prevalence exceeding 1% in 76 out of 187 countries.[5] The World Health Organisation (WHO) European Region had the highest prevalence (19.8 per 1000 population), and the WHO Eastern Mediterranean Region the lowest (0.1 per 1000 population). Of the 187 countries, South Africa was estimated to have the highest prevalence of FASD (111.1 per 1000 population), followed by Croatia (53.3 per 1000 population) and Ireland (47.5 per 1000 population).The prevalence of FASD in certain high-risk populations was found to be notably higher than in the general population, for example, 15.6 to 24.6 times higher among high risk indigenous populations, and 5.2 to 67.7 times higher among children in care.[5]
Based on data from the 1980s and 1990s, US birth prevalence estimates for FASD collectively were 10 per 1000 births, and for FAS 0.5 to 2 per 1000 births.[6] Using active case ascertainment methods, a cross-sectional study found that among first-graders in 4 US communities between 2010 and 2016 conservative estimates of the prevalence of FASD ranged from 11.3 (95% CI 7.8 to 15.8) to 50.0 (95% CI 39.9 to 61.7) per 1000 children, with FAS accounting for less than 20% of the overall prevalence of FASD (weighted prevalence estimates for FAS ranged from 0 [95% CI 0.00 to 12.7] to 7.8 [95% CI 4.2 to 13.5] per 1000 children).[7] US rates are highest in Southwestern Plains Native Americans (9.8 per 1000 births) and lowest in Asian Americans (0.03 per 1000 births).[6]
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