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).

Lupton, Burd, and Harwood (2004)  have approximated the cost of a single individual with FASD to be US$2.0 million throughout the individual’s lifetime. More recently, the US National Task Force on FAS estimated the adjusted annual cost of FAS in the US to be approximately US$3.6 billion (Olson et al.,  2009).  Moreover,  as the cost of medical treatment, special education, psychosocial intervention and residential care for individuals with FASD increases, these costs will only continue to rise (Lupton, Burd, and Harwood,  2004). In Canada, the average annual cost per child with FASD in 2009 was estimated at $21   642, with the total annual cost of FASD being $5.3 billion (Stade   et al.,  2009). 

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Tanya T. Nguyen, Jennifer Coppens, and Edward P. Riley
Edited by Edward P. Riley, Sterling Clarren, Joanne Weinberg, and Egon Jonsson

Tanya T Nguyen practices as a Pediatrician in Alhambra, CA.
Jennifer Coppens, Medical Student, University of Alberta
Prof. Dr. Edward P. Riley San Diego State University Center for Behavioral Teratology

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REFERENCES

1. Abel,  E.L. (1999)  Was the fetal alcohol syndrome recognized by the Greeks and Romans?  Alcohol Alcohol.,  34 (6),  868 – 872.
2. Adnams,  C.M., Sorour,  P., Kalberg,  W.O., Kodituwakku,  P., Perold,  M.D., Kotze,  A., September,  S., Castle,  B., Gossage,  J.,  and   May,  P.A. (2007)  Language and literacy outcomes from a pilot intervention study for children with fetal alcohol spectrum disorders in South Africa.  Alcohol,  41 (6),  403 – 414.
3. Barry,  K.L., Caetano,  R., Chang,  G., DeJoseph,  M.C., Miller,  L.A., O’ Connor,  M.J., Olson,  H.C., Floyd,  R.L., Weber,  M.K., DeStefano,  F., Dolina,  S., Leeks,  K.,  and   National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect (March   2009)  Reducing Alcohol - Exposed Pregnancies: A Report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect,  Centers for Disease Control and Prevention,  Atlanta,  GA.
4. Bertrand,  J. (2009)  Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects.  Res. Dev.  Disabil.,  30 (5),  986 – 1006.

Full References  »