Prevalence rates of FASD higher than previous popular estimates, study finds

November 4, 2014

 A recent study in the journal Pediatrics found the rate of fetal alcohol spectrum disorder (FASD) among US children in grade one to be considerably higher than previously thought. According to the authors, prevalence of  FASD in the population studied ranges from 6 to 9 per 1000 live births, in contrast to earlier findings that estimated rates between 0.2 to 3 per 1000 live births.

“What this suggests to all of us is that the true prevalence of FASD is higher than generally assumed,” says Dr. James Reynolds, co-lead of NeuroDevNet’s FASD research group, “and that most cases of FASD in Canada are either unrecognized, not diagnosed, or misdiagnosed.”

The study, entitled “Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders,” was led by Dr. Philip A. May (University of North Carolina) and published online October 27, 2014. A consented sample of grade one children (6 to 7 years of age) in the Midwestern US community was examined for physical growth, development, uncommon facial features, cognition, and behaviour. The authors used active case ascertainment methodology, where behavioural and cognitive testing was done as well as interviews with the mothers and fathers regarding their drinking habits surrounding the time of pregnancy.

“Prevalence studies will always underestimate the real extent of the problem because of ascertainment bias and the lack of a biomarker for diagnosis,” adds Dr. Albert Chudley, co-lead investigator for NeuroDevNet’s FASD research group.

Although FASD prevalence rates have not been determined for the general population in Canada, there is study currently being conducted among children in the Greater Toronto area, which uses the same active case ascertainment methodology.

These findings shed light on the magnitude of FASD and the urgent need for better approaches to prevention. Unfortunately, women receive mixed messages from experts on alcohol consumption during pregnancy. Two recent articles from the UK press discuss the rise in abortion requests from women who found out they were pregnant after they had binged on alcohol, and were aware of the possible consequences.

The article from BBC News cites the prevalence rates as 0.2 to 1.5 cases in every 1000 live births, a significantly lower rate in comparison to the study in Pediatrics. A spokesperson from the Royal College of Obstetricians and Gynaecologists reported to the media that alcohol consumed during the early stages of pregnancy “tends to cause a miscarriage or it has no harmful effect.”

“This is the old mantra from teratology (all or nothing effect) and there is some truth to it,” Dr. Chudley responds, “but in the context of alcohol the more correct statement based on newer knowledge is either leads to a miscarriage or if the embryo survives the exposure, this can lead to significant and variable developmental defects.”

In the article from the Independent, the British Pregnancy Advisory Service (BPAS) chief executive, Ann Furedi, states that the risk of FASD is incredibly small, and that women can be “reassured that the odd night of heavy drinking before they found out they were pregnant is extremely unlikely to have caused their baby harm.” The BPAS normalizes binge drinking by reporting that occasional binges are “facts of life” for women of reproductive age.

Dr. Emily Bell, a member of the Neuroethics Core at NeuroDevNet, is leading a project examining prevention campaigns and the ethical challenges in trying to select the right messages, images, targets, and approaches. Primary prevention messages are currently being examined and analyzed in an upcoming publication by Dr. Bell and her group.

Although popular media continues to portray the potential harm associated with consuming alcohol during pregnancy as inconclusive, there is no question about the real effects of alcohol on a fetus. NeuroDevNet’s FASD Research Group remains steadfastly committed to the position that no known amount of alcohol is safe to consume during pregnancy.

“We clearly haven’t gotten the message out strongly enough,” says NeuroDevNet FASD research group co-lead Dr. Joanne Weinberg. “Babies are still being born with FASD, and women are still drinking.”