Fetal Alcohol Syndrome: Prevalence High in Child Care Systems

Larry Hand

September 09, 2013

The pooled prevalence of fetal alcohol spectrum disorders (FASD) among children and adolescents living in various child care systems is approximately 17 to 19 times higher than that in the general population in North America, according to a meta-analysis published online September 9 in Pediatrics.

The researchers emphasize that this high prevalence of screening for FASD in child care settings, such as foster care and orphanages, is necessary to obtain an early diagnosis and implement interventions.

Shannon Lange, MPH, from the Social and Epidemiological Research Department, Centre for Addiction and Mental Health, and the Dalla Lana School of Public Health, Toronto, Ontario, Canada, and colleagues conducted a systematic literature review and meta-analysis of studies that reported the prevalence of fetal alcohol syndrome (FAS) and FASD in child care systems in 8 countries. Of 551 total studies reviewed, the authors included 33 in the final analysis.

The researchers calculated a pooled prevalence of FAS to be 6.0% (95% confidence interval [CI], 3.8% - 8.5%) and a pooled prevalence of FASD to be 16.9% (95% CI, 10.9% - 23.8%). Overall age range was 0 to 20 years in the 27 studies that reported age. In 23 studies that reported sex, 31% to 67% of the participants were male.

The studies were from 6 major settings: boarding schools, child welfare agencies, foster care, homes for children with mental deficiencies, orphanages, and mixed care. Although in boarding schools children remain under parental custody when not in school, children in the other settings are not in parental custody possibly because of parental abuse, neglect, or abandonment.

The researchers characterize the children as "a unique population with disproportionately increased rates of developmental disabilities, congenital malformations, and mental health diagnoses." Risk for FAS is likely to be elevated in this population, they write, and FASD is an umbrella term for a range of problems caused by prenatal exposure to alcohol.

Russia and Sweden had the highest prevalence of FAS (42.7% - 68.0%) in orphanages for children with special needs. The highest reported prevalences for FASD were 39.7% for Russian orphanages and 52.1% for adoptees from Eastern Europe in Sweden.

The lowest FAS prevalence was 0.53% for children in the US child welfare system. However, 2 studies reported a 0% prevalence for orphanages and foster care in Eastern Europe and among adoptees from China. The lowest FASD prevalence (4%) was found among foster and preadoption children in Israel and adoptees from Eastern Europe in the United States. Limitations of the study include possible data irregularities among some studies and the lack of generalizability to a general population. The authors also note that FASD is not widely recognized by clinicians and is likely to be underdiagnosed.

"Efforts need to be made to increase the capacity of primary care pediatricians and physicians all over the world with regard to FASD recognition and diagnosis," the researchers write. "This will not only raise awareness of FASD in general but will also raise awareness of the severe consequences of prenatal alcohol exposure and, it is hoped, prevent subsequent alcohol-exposed pregnancies."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 9, 2013.

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