Fetal Alcohol Spectrum Disorder is substantially more prevalent for people in five vulnerable groups including children in care, Indigenous populations and people in prison, according to a global study by Canadian researchers.
The lead author of the paper says the fluctuating prevalence rates in the study are further evidence that the idea women can safely have a glass of wine during dinner while pregnant is a myth.
The study, with lead author Svetlana Popova, who is a senior scientist in the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto, is being published in the medical journal Addiction.
Fetal Alcohol Spectrum Disorder, also known as FASD, is a disabling condition in children caused by the mother’s consumption of alcohol during pregnancy.
“When a mother-to-be consumes alcohol, it goes directly to the fetus through her bloodstream. Alcohol is poisonous to the developing fetus and can disrupt its normal development. FASD is a serious and lifelong condition,” Popova said in an interview.
“Alcohol is especially dangerous for the developing brain cells; that’s why people with FASD have difficulties with learning, attention, memory, reasoning, problem solving, language and communication.
While FASD can affect people from all racial, ethnic and sociological backgrounds, the data from 69 previously published studies of people in 17 countries — including Canada, the United States, South America, Europe, Asia and Australasia — shows prevalence rates are particularly devastating for certain subpopulation groups.
The study identified five high-prevalence groups: children in care; people in correctional service custody; people in special education services; people using specialized services for developmental disabilities or psychiatric care; and Indigenous populations.
The study was designed to help improve prevalence estimates and predictions with an eye to better public policy, and to allow for better planning and budgeting of health care, community and social services response.
“The first step in understanding the severity and impact of FASD in any country is to determine how many people have this condition. Once this information is available, policies and programs can be planned that will benefit those living with FASD and prevent additional children from being born with these conditions,” she said.
“Public policy and clinical care for people with FASD needs to change to respond to such predictable outcomes.”
Popova and her team estimated more than 400 disease conditions might be associated with fetal alcohol exposure, including impaired vision and hearing, heart problems, urinary and respiratory defects and joints problems. She estimates the annual cost of FASD in Canada is $1.8 billion.
In many ways, the results on subpopulation prevalence aren’t surprising.
Children are often placed in care because of unfortunate circumstances, including parental alcohol or drug problems, abuse, neglect or young marital age — circumstances associated with an increased probability of an unborn child being exposed to alcohol.
And without appropriate diagnosis and intervention early in life, many people with FASD are at high risk of being involved in the legal system, the researchers say. (It is estimated young people with FASD are 19 times more likely to be incarcerated than those without.)
People with FASD are likely to suffer from developmental delay, learning problems and mental-health problems, so they will have a higher representation among special education populations.
And the problem of high FASD prevalence among Aboriginal populations has long been noted: alcohol use during pregnancy among Aboriginals in Canada was found to be about four times higher compared to the general population. Alcohol use among Canada’s Indigenous peoples is attributed to a large degree to the historical and social context of colonization, the residential school system trauma and economic and social marginalization.
Worldwide, the study says nearly one in 10 women in the general population drink some alcohol during pregnancy.
The frustrating thing for Popova is that it is largely preventable.
“There is no safe amount of alcohol or safe type of alcohol or safe time to drink during pregnancy or when planning to become pregnant. By not consuming alcohol during pregnancy or while planning to get pregnant, you avoid the risk of your child developing FASD,” she said.
The researchers conducted a systematic literature review, seeking all published studies that contain meta-analysis of original, quantitative studies on FASD published in the past 45 years around the world.