Day 42 of 99 Days to FASDay: Int’l Prevalence of FASD

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Keeping with our International theme from yesterday, today’s infographic reports on world-wide prevalence of Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorder (FASD). The information comes from the report titled:

Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis.

by Svetlana Popova, Shannon Lange, Charlotte Probst, Gerrit Gmel, Jürgen Rehm 

This report was published in January 2017 by The Lancet Global Health. Copyright © The Author(s). Published by Elsevier Ltd. You can download the full report by clicking the link above. It is an Open Access article under the CC BY-NC-ND license.

According to the authors:

We aimed to estimate the prevalence of alcohol use during pregnancy and of FAS among the general population, by country, WHO region (ie, African region [AFR], Eastern Mediterranean region [EMR], European region [EUR], region of the Americas [AMR], South-East Asia region [SEAR], and Western Pacific region [WPR]), and globally.

In line with the International Charter on Prevention of FASD, the current study provides the best understanding of the scope of the problem at this time and is intended to both inform and draw the attention of health-care practitioners, public health authorities, policy makers, and government officials.

Although there are currently no confirmed statistics on the number of people in Canada with FASD, the population of Canada in 2017 is 36,634,185.

Rates are estimated anywhere between 1 – 5%:

  • 1% = 366,341 people with FASD.
  • 3% = 1,099,025 people with FASD.
  • 5% = 1,831,709 people with FASD.

Therefore, in Canada, there are between 366,341 – 1,831,709 people with FASD. It is also important to note that the prevalence of FASD is currently unknown. The most commonly cited rough estimate of the prevalence of FASD is 9 per 1,000 (Roberts & Nanson, 2000).

The Canada FASD Research Network (CanFASD) uses a 4% prevalence.

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2018 Update:

A report released by the Centre for Addiction and Mental Health earlier this year revealed a prevalence rate of up to 3%.

The results were based on a survey of 2,555 seven – to nine-year-olds in the Greater Toronto Area, one of the largest sample sizes used in a Canadian study and according to the team’s lead researcher, Dr. Svetlana Popova, the first survey reflective of Canada’s diverse population.

We are more confident now, she says, that FASD can happen to anyone, regardless of race, ethnicity, socioeconomic status.

Previous Canadian studies on FASD have focused on narrow groups such as kids in care. They have also relied on medical records to estimate the prevalence of the disorder.

But as Popova explains, many children with FASD are misdiagnosed or not diagnosed at all. So her team — which included leading geneticists, psychologists and pediatricians — independently assessed each student.

The above information is from an article on the Toronto CAS website, however unable to leave link for reference as it is no longer valid.

Dr. Popova explained during media interviews after the release of the report that even 3% was low because reporting of drinking by participants was likely downplayed and less than half responded to requests for participation.

For more information on this Study, and links to news articles, check out: What a week for FASD in Ontario  (last part of page).

According to a 2016 Health Review on FASD by the International Alliance for Responsible Drinking:  Information on the prevalence of FASD, both globally and in individual countries, is scarce, and where it exists, is highly varied and of questionable reliability.

While it has been suggested that, globally, 5% of all pregnancies may result in children with FASD, individual studies cover few countries, where they often focus on small populations. 

The IARD Review reported the following statistics for FASD prevalence:

  • Australia: 0.26 per 1,000 live births
  • Canada: 9 per 1,000 live births
  • Norway: 0.3 per 1,000 births
  • Israel: 150 per 1,000 among pre-adoption and foster children
  • Italy: 36 per 1,000 school children
  • New Zealand: 0.11 per 1,000 births
  • South Africa: 113.22 per 1,000 births
  • United States: 16.5 per 1,000 school children

2019 Update:

From an article by Egon Jonsson, PhD, published in 2019 in the Canadian Journal of Psychiatry

In Canada, like in many other jurisdictions, the prevalence of FASD at the population level is not known. Most older studies of prevalence focused on FAS in certain geographical areas and in specific population groups, such as those in foster care, in correctional systems, in schools, and among indigenous peoples.

The challenge of establishing a true frequency of FASD is more complicated than for most other conditions.:

  • Early diagnosis is usually not possible before school age.
  • Resources for and training in diagnosing FASD are limited, and
  • It may become difficult, or sometimes impossible, to follow up with mothers to get confirmation of alcohol use during pregnancy.
  • Above all, FASD does not have an ICD code for administrative and billing purposes and therefore does not show up in administrative databases or in other statistics.

A study from the province of Alberta in 2015 found that the prevalence rate of FASD might be in between 1.42% and 4.38%, if FASD cases, possibly misclassified into a diagnosis that mimics FASD, such as attention-deficit hyperactivity disorder, learning disability, oppositional defiant disorder, mental retardation, nervous system defects, and so forth, are included.

A study from a representative state in a Midwestern US community published in 2014 showed a prevalence rate of FASD among first-grader school children of 2.4% to 4.8% (midpoint 3.6%), and another prevalence study from four communities in the US (Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern) published in 2018 showed an FASD prevalence rate also among first graders ranging from 1.1% to 5%.

Even higher prevalence rates, approximately 2% to 6%, have been reported in studies from the Lazio Region, including Rome in Italy.

Several studies from provinces in South Africa reported that 6% to 8% of school children are affected by the most severe forms of FASD, namely, FAS and partial FAS.

Meanwhile, in November 2018, new research was published in Preventive Medicine that revealed up to 17 per cent of children in the United Kingdom could have symptoms consistent with fetal alcohol spectrum disorder (FASD).

Researchers from the University of Bristol and Cardiff University worked with clinicians to assess a wide range of information on mothers’ drinking in pregnancy and studied the development of 13,495 children from Bristol’s Children of the 90s study.

They applied a screening tool and found that up to 79 per cent of children in the sample were exposed to alcohol in pregnancy and that to up to 17 per cent screened positive for symptoms of FASD.

A positive FASD screen was defined as problems with at least three different areas of learning or behaviour, with or without physical anomalies (growth deficiency and distinctive facial features, which include a smooth philtrum, thin upper lip and small eye openings).

Our results showed that a significant number of children screened positive for features consistent with FASD. The results are based on a screening tool, which is not the same as a formal diagnosis. Nevertheless, the high rates of prenatal alcohol use and FASD-relevant symptoms that we found in our study suggest that FASD is likely to be a significant public health concern in the UK.

To find out more about this study visit: University of Bristol

If you know of a new prevalence study or report, please leave a comment below so we can update this post with the most up to date information.

Tomorrow we look at cost of FASD.

3 thoughts on “Day 42 of 99 Days to FASDay: Int’l Prevalence of FASD

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