REVIEW OF: May PA et al, JAMA 2018;319(5):474–482

New evidence suggests that the prevalence of fetal alcohol spectrum disorder is higher than previously documented. In this study, prevalence estimates were derived from 13,146 first-grade children in four U.S. communities between 2010 and 2016. The authors provide both conservative estimates (1%–5%) and less conservative estimates (3%–10%) of fetal alcohol spectrum disorders, which are higher than previously reported (eg, 1%–2%).

The study used active-case ascertainment, which the authors assert is a more reliable approach for identifying this cluster of disorders (eg, fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopment disorder). With active-case ascertainment, surveillance personnel are trained to conduct research by reviewing data from all areas of a hospital that come in contact with a neonate, instead of limiting themselves to the neonatal intensive care and labor and delivery units.

Furthermore, standardized consensus criteria were employed to classify cases (see: https://www.cdc.gov/ncbddd/fasd/diagnosis.html). Assessments included four relevant domains: growth, dysmorphology, neurodevelopment, and prenatal alcohol exposure (the latter assessed during maternal interviews).

During this time period, 222 children were identified as having fetal alcohol spectrum disorder. Notably, only two of these children had been previously diagnosed. Using the more conservative approach, the prevalence rates of fetal alcohol spectrum disorders across the four sites ranged from 11.3 (95% CI, 7.8–15.8) to 50.0 (95% CI, 39.9–61.7) per 1,000 children. This corresponds to a range of approximately 1%–5%, the latter of which is higher than previous published estimates. The less conservative estimates that were reported in this study peaked at 98.5 per 1,000 children (nearly 10%) at one site.

CATR’s Take
According to this new research, fetal alcohol spectrum disorders are not rare events in the US, which suggests we need to improve our ability to detect these cases. Given the negative (and preventable) consequences associated with fetal alcohol spectrum disorders (eg, poor academic achievement, mental health disorders), CATR recommends proactive education on the adverse consequences of drinking alcohol during pregnancy, in addition to enhanced prevention and intervention efforts. Also, support services should be provided for individuals affected by this condition, with the goal of improving their long-term prognosis and enhancing their quality of life.