Abstract
BackgroundFetal alcohol spectrum disorder (FASD) is one of the most disabling potential outcomes of prenatal alcohol exposure. The population-based prevalence of FASD among the general population of Canada was unknown. The objective of this study was to determine the population-based prevalence of FASD among elementary school students, aged 7 to 9 years, in the Greater Toronto Area (GTA) in Ontario, Canada.MethodsThis screening study used a cross-sectional, observational design utilizing active case ascertainment, along with retrospective collection of prenatal alcohol exposure information. Data collection involved two phases. Phase I consisted of taking growth measurements, a dysmorphology examination, and obtaining a history of behavioral and/or learning problems. Phase II consisted of a neurodevelopmental assessment, maternal interview, and behavioral observations/ratings by parents/guardians. Final diagnostic screening conclusions were made by consensus by a team of experienced multidisciplinary experts during case conferences, using the 2005 Canadian guidelines for FASD diagnosis. The prevalence of FASD was estimated, taking into consideration the selection rate, which was used to account for students who dropped out or were lost to follow-up during each phase. Monte Carlo simulations were employed to derive the confidence interval (CI) for the point estimates.ResultsA total of 2555 students participated. A total of 21 cases of suspected FASD were identified. The prevalence of FASD was estimated to be 18.1 per 1000, or about 1.8%. Using a less conservative approach (sensitivity analysis), the prevalence of FASD was estimated to be 29.3 per 1000, or about 2.9%. Therefore, the population-based prevalence of FASD is likely to range between 2 and 3% among elementary school students in the GTA in Ontario, Canada.ConclusionsThis study provides the first population-based estimate of the prevalence of FASD in Canada. The estimate is approximately double or possibly even triple previous crude estimates. FASD prevalence exceeds that of other common birth defects such as Down’s syndrome, spina bifida, trisomy 18, as well as autism spectrum disorder in Canada. More effective prevention strategies targeting alcohol use during pregnancy, surveillance of FASD, and timely interventions and support to individuals with FASD and their families are urgently needed.
Highlights
Fetal alcohol spectrum disorder (FASD) is one of the most disabling potential outcomes of prenatal alcohol exposure
A significant number of pregnancies are alcohol-exposed in Canada; it was recently estimated that approximately 10.0% of women in the Canadian general population consume alcohol while they are pregnant [1]
Approval was sought from 71 school principals, of whom 40 allowed their school to participate
Summary
Fetal alcohol spectrum disorder (FASD) is one of the most disabling potential outcomes of prenatal alcohol exposure. The population-based prevalence of FASD among the general population of Canada was unknown. FASD is associated with a wide range of effects, including permanent brain damage, congenital anomalies, prenatal and/or postnatal growth restriction and characteristic sentinel facial features, along with cognitive, behavioral, emotional and adaptive functioning deficits [2, 3]. A recent systematic review identified over 400 disease conditions associated with FASD [3]. Some of these comorbid conditions (e.g., language, auditory, visual, developmental/cognitive, mental and behavioral problems) are highly prevalent among individuals with FAS, ranging from 50 to 91%, and significantly exceed the rates in the general population [3]. FASD is recognized to impart a significant economic burden on society [5, 6]
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