Prevalence of fetal alcohol spectrum disorder and its relationship with levels and patterns of alcohol consumption: a scoping review

OBJECTIVE: To explore prevalence estimates of fetal alcohol spectrum disorder (FASD) in high-income countries and the relationships between levels and patterns of alcohol consumption during pregnancy and FASD. METHODS: Two scoping reviews of observational studies. We searched Medline, EMBASE, Maternity and Infant Care, and the Incidence and Prevalence Database until June 2024. Two reviewers screened studies independently using predefined criteria to address our two questions and extracted data on study design, diagnostic criteria, methods of collecting drinking history and details about levels and drinking patterns. RESULTS: We identified 41 relevant studies. Most were conducted in the Americas region (n=15) and had a cross-sectional design (n=26). The US Institute for Medicine diagnostic criteria were most frequently used for case ascertainment (n=22). Prevalence ranged from 5.8 (95% CI 4.6 to 7.1) to 170 000 (95% CI 161 000 to 178 000) per 1 000 000 general population. Estimates of associations between drinking levels/patterns and having a child diagnosed with FASD varied substantially. The lowest OR (95% CI) was 1.8 (0.3 to 12.2) for women who drank 1-1.9 drinks per drinking day compared with no alcohol and the highest was 61 (18.9 to 195.5) for women who drank any amount of alcohol during pregnancy compared with women who did not drink at all. CONCLUSIONS: FASD prevalence estimates in high-income countries and the risk of different levels and drinking patterns varied widely due to the use of different diagnostic criteria, sampling and alcohol consumption collection methods. Improving alcohol consumption collection methods will help enhance diagnostic certainty and the identification of at-risk groups.