Prevalence and Impact of FAS and FASD

Unfortunately, the prevalence of FAS and FASD is not as well understood as might be hoped. Today, epidemiological research into FAS and FASD is constantly challenged by issues related to methodology and questions regarding the diagnostic criteria used (May and Gossage, 2001). In the United States, the overall estimated prevalence of FAS is approximately 0.5 to 2 per 1000 births (May and Gossage, 2001), although within certain groups the prevalence is estimated to be much higher. For example, among the Plain and Plateau culture tribes in the United Sates, the average FAS rate is 9 per 1000 children between the ages of one and four years (May, McCloskey, and Gossage, 2002).

Elsewhere, rates among the Southwestern tribes varied from 0.0 to 26.7 per 1000 over the time period of 1969 – 1982, depending on the specific community studied (May et al., 1983). These high risk communities are typically of low socioeconomic status, and include a significant proportion of individuals who binge-drink on a frequent basis. The rate of FAS in children aged between five and nine years in the Cape Colored community of the Western Cape Province of South Africa is proposed to be as high as 46.4 per 1000 (May et al., 2000), while Canadian FAS data have estimated a range of prevalence which varies from 0.52 to 14.8 per 1000 (Habbick et al., 1996, Williams, Odaibo, and McGee, 1999). In one county in Washington, USA, the number of first graders with FAS was reported as 3.1 per 1000 (Clarren et al., 2001).

When considering the entire range of prenatal alcohol effects, the incidence of FASD has been estimated to be 9.1 per 1000 births (Sampson et al., 1997), which is approximately one out of every 100 births (May and Gossage, 2001). Health Canada has estimated the incidence of FASD at 9 per 1000 births (Health Canada, 2006).

Perhaps one of the most important rates that must be addressed is the prevalence of FAS in families who already have a child with FAS. Women who have already given birth to a child with FAS are at extremely high-risk of having another affected child if they continue to abuse alcohol, and typically later-born children are more impacted than the older children in the family.

Given these numbers, it is not surprising that FASD is associated with significant social and economic ramifications. FASD can cause longlasting medical and psychological problems, and result in economic costs of billions of dollars. Moreover, individuals with FASD suffer from many physical, mental, behavioral, and educational problems which affect daily functioning and have lifelong implications. As a result, individuals with FASD often experience mental health issues, problems in school and work environments, trouble with the law, substance abuse, inappropriate sexual behavior, and difficulties with independent living, among other challenges (Bertrand et al., 2004 ; Streissguth et al., 2004).

While entirely accurate figures of the prevalence of FAS are unavailable, most studies have found that full blown FAS occurs in 1-3 out of 1000 births in developed countries with a worldwide average of 1.9/1000 live births which makes FAS the leading cause of mental retardation (Warren and Bast, 1980). The rate among mothers who drank is obviously much higher. In one study conducted in Sweden, researchers found a 33% prevalence rate for the full syndrome and a 76% prevalence rate for its partail effects (Streissguth et al., 1980). It is also important to note that the critical issue is not the exact amount of alcohol consumed during pregnancy, but rather the chronicity of her alcoholism. Other factors that increase ones susceptibility to FAS are black race, frequent beer drinking, lower maternal weight and weight gain, and low socioeconomic status (Warren and Bast, 1980).