Screening prevalence of fetal alcohol spectrum disorders in a region of the United Kingdom: A population-based birth-cohort study
McQuire C, Mukherjee R, Hurt L, Higgins A, Greene G, Farewell D, Kemp A, Paranjothy S (2018) Preventative Med Nov 2018; doi.org/10.1016/j.ypmed.2018.10.013
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Abstract:
- Up to 79% of women consumed alcohol while pregnant.
- Up to 17% of children screened positive for a fetal alcohol spectrum disorder (FASD).
- Alcohol-related neurodevelopmental disorder was the most common FASD subtype.
- Screening is not equivalent to formal diagnosis. Follow-up studies required.
- A positive FASD screen was more common following unplanned pregnancy.
We applied novel screening algorithms to existing data to estimate the screening prevalence of FASD. Data were from a population-based cohort study (ALSPAC), which recruited pregnant women with expected delivery dates between 1991 and 1992 from the Bristol area of the UK. We evaluated different missing data strategies by comparing results from complete case, single imputation (which assumed that missing data indicated no exposure and no impairment), and multiple imputation methods.
6.0% of children screened positive for FASD in the analysis that used the single imputation method (total N = 13,495), 7.2% in complete case analysis (total N = 223) and 17.0% in the analysis with multiply imputed data (total N = 13,495). A positive FASD screen was more common among children of lower socioeconomic status and children from unplanned pregnancies. Our analyses showed that the complete case and single imputation methods that are commonly used in FASD prevalence studies are likely to underestimate FASD prevalence.
Although not equivalent to a formal diagnosis, these screening prevalence estimates suggest that FASD is likely to be a significant public health concern in the UK. Given current patterns of alcohol consumption and recent changes in prenatal guidance, active case ascertainment studies are urgently needed to further clarify the current epidemiology of FASD in the general population of the UK.
FAB RESEARCH COMMENT:
The neurodevelopmental disorders that can result from prenatal exposure to alcohol occur on a spectrum, with only the more severe cases showing the classic physical features of 'Foetal Alcohol Syndrome' (FAS), and therefore being recognised as such.Milder FASD symptoms often resemble those of ADHD, DCD/dyspraxia or other common 'neurodevelopmental disorders', and although the contribution of parental alcohol consumption to these conditions has received relatively little formal research attention, data from this UK birth cohort study suggest that, of those born in the early 1990s:
- milder forms of FASD probably affect 1 in 14, and possibly as many as 1 in 6 UK children
For more information on this research and its important implications, please see the associated news article and FAB comment:
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