Fetal alcohol spectrum disorder far more common in Canada than other common birth defects

What you need to know

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes a wide range of effects that exposure to alcohol during pregnancy has on the fetus. This includes permanent brain damage, physical, behavioural and learning problems. FASD is a preventable disorder, but about 10% of pregnant women in Canada consume alcohol during pregnancy. Researchers conducted the first population-based study conducted on FASD prevalence in elementary school students in the Greater Toronto Area (GTA). They found the overall prevalence of FASD among the general population of the GTA to be between 2% and 3%. This is likely to be similar to the prevalence in other urban areas of Canada.

 

This Research Snapshot looks at the article, "Population-based prevalence of fetal alcohol spectrum disorder in Canada” which was published in BMC Public Health in 2019. Read it below or download the PDF.

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What is this research about? 

Before this study, the population-based prevalence of FASD was unknown in Canada.  Knowing the prevalence of FASD can help early detection, diagnosis, intervention and prevention initiatives in Canada. To fill this gap, the researchers conducted a study to estimate the prevalence of FASD among elementary school students.

What did the researchers do?

The researchers invited all students 7-9 years of age in 40 elementary schools in the GTA to participate in this study with parental consent. In Phase 1, students were pre-screened for growth deficits, characteristic facial features, and behaviour/learning difficulties. Those who met certain criteria proceeded to Phase 2 for a neurodevelopmental assessment. 

Mothers of control children and those with some deviations from the norms in neurodevelopmental status were invited for an interview. A multidisciplinary team of FASD experts reviewed each case to decide whether or not it could be classified a suspected diagnosis, based on the 2005 Canadian guidelines on diagnosis.

What did the researchers find? 

In Phase 1, the researchers assessed 2,555 students (about half were boys). Of these, 31.0% were eligible for Phase 2. The researchers also randomly selected 87 children who were developing typically to have a full assessment. In Phase 2, 762 children had neurodevelopmental assessments and the researchers found deficits in 323 (42.4%) of them. About 40% of biological mothers participated in the phone interview. 

Overall, 21 children met criteria for a FASD diagnosis and five were deferred cases. The researchers found a prevalence rate of 2% to 3%, far exceeding the prevalence in Canada of other common birth defects, such as Down’s syndrome, spina bifida, trisomy 18, as well as autism spectrum disorder.

Limitations of the research

The prevalence of FASD found in this study is conservative (underestimated due to several reasons). These estimates likely reflect the prevalence of FASD of the general population of Canada and they don’t apply to populations in remote northern communities, children in care, people in prison or psychiatric care facilities, which have shown much higher rates of FASD.

How can you use this research? 

This study shows that FASD is a serious public health problem in Canada and that there is a need to improve prevention of alcohol use during pregnancy, develop surveillance for prenatal alcohol exposure and FASD, and provide timely support to people with FASD and their families.

About the researchers

Svetlana Popova,1,2,3,4 Shannon Lange,1,4 Vladimir Poznyak,5 Albert E. Chudley,6 Kevin D. Shield,1,2 James N. Reynolds,7 Margaret Murray,8 and Jürgen Rehm1,2,4,9,10

  1. Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy, Toronto, Ontario
  2. Dalla Lana School of Public Health, University of Toronto (U of T), Toronto, Ontario
  3. Factor-Inwentash Faculty of Social Work, U of T, Toronto, Ontario
  4. Institute of Medical Science, U of T, Faculty of Medicine, Toronto, Ontario
  5. Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. 
  6. Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
  7. Department of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Kingston, Ontario
  8. National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. 
  9. Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany. 
  10. Department of Psychiatry, U of T, Toronto, Ontario

Keywords

Fetal alcohol spectrum disorder, Fetal alcohol syndrome, prevalence, prenatal alcohol exposure, Canada

This study was supported by Public Health Agency of Canada and guided by the World Health Organization

This Research Snapshot is based on the article, “Population-based prevalence of fetal alcohol spectrum disorder in Canada” which was published in BMC Public Health in 2019. https://doi.org/10.1186/s12889-019-7213-3. This summary was written by Rupinder Chera.