Category Archives: General Information

Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth A Systematic Review and Meta-analysis

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Shannon Lange, MPH1,2; Charlotte Probst, MSc1,3; Gerrit Gmel, MSc1,4; et alJürgen Rehm, PhD1,2,3,5,6; Larry Burd, PhD7; Svetlana Popova, PhD1,2,5,8
Author Affiliations
JAMA Pediatr. 2017;171(10):948-956. doi:10.1001/jamapediatrics.2017.1919

Key Points

Question  What is the prevalence of fetal alcohol spectrum disorder among children and youth in the general population?

Findings  In this meta-analysis of 24 unique studies and 1416 unique children and youth with fetal alcohol spectrum disorder, approximately 8 of 1000 in the general population had fetal alcohol spectrum disorder, and 1 of every 13 pregnant women who consumed alcohol during pregnancy delivered a child with fetal alcohol spectrum disorder. The prevalence of fetal alcohol spectrum disorder was found to be notably higher among special populations.

Meaning  The prevalence of fetal alcohol spectrum disorder among children and youth in the general population exceeds 1% in 76 countries, which underscores the need for universal prevention initiatives targeting maternal alcohol consumption, screening protocols, and improved access to diagnostic services, especially in special populations.

Abstract

Importance  Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD.

Objective  To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally.

Data Sources  MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions.

Study Selection  Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included.

Data Extraction and Synthesis  Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated.

Main Outcomes and Measures  Prevalence of FASD.

Results  A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population).

Conclusions and Relevance  Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.

Retrieved from: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2649225?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=101717#.Web6R23_fvc.twitter

Fetal Alcohol Spectrum Disorder: A Significant Global Problem

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fetal-acohol-spectrum-disorder-minA study of the global prevalence of fetal alcohol spectrum disorder (FASD) estimates that it affects as many as 8 out of 10,000 children, highlighting the need to improve public education about the potential harm of drinking alcohol during pregnancy.

Drinking alcohol during pregnancy may harm the developing fetus. A wide range of resulting health problems have been observed including defects of the heart, kidneys or bones, problems with brain development, low IQ, and hyperactivity. This group of conditions is known as fetal alcohol spectrum disorder (FASD). Affected children may have mild to severe health problems. However, it is not possible to predict the severity from the amount or timing of their mother’s alcohol consumption. There is no safe amount or safe time of alcohol consumption for a pregnant woman.

It is important to know the prevalence of a condition in order to look at patterns of occurrence.  This helps to direct the focus of resources for prevention and treatment. Researchers in Toronto have completed a comprehensive analysis of the available data on FASD to estimate its global prevalence in children and young people. They recently published their findings in JAMA Pediatrics.

The research team reviewed the medical literature to identify high-quality studies that reported the prevalence of FASD among children and youth in the general population. A total of 24 studies including 1,416 children and youth (0-16 years) were included in the analysis.

They found that the global prevalence of FASD among children and youth in the general population was estimated to be around eight affected children per 1000 people. The WHO European Region had the highest prevalence, approximately 20 per 1000 people, and the WHO Eastern Mediterranean Region had the lowest, approximately 0.1 per 1000 people. At a country level, South Africa had the highest prevalence of FASD (111 per 1000 population), followed by Croatia (55.3 per 1000 population), and Ireland (47 per 1000 population).

Using selected studies, the team also looked at the prevalence of FASD amongst special populations, compared to the general population. They estimated that FASD was 15.6-24.6 times higher in Aboriginal populations, 5.2-67.7 times higher among children in care, 30.3 times higher in a correctional population, 23.7 times higher in a population with low socioeconomic status and 18.5 times higher among a population in psychiatric care.

The estimates of the global prevalence of FASD show that it is a significant health problem. It has an impact on large numbers of children and youth and a high cost of health services. Fetal alcohol spectrum disorder is a largely preventable condition. The researchers suggest there is a need for wider public education about the potential harm of drinking during pregnancy. They also suggest a screening system to identify problem drinking before and during pregnancy. These strategies could be widely implemented at relatively little cost.

Written by Julie McShane, Medical Writer

Reference:

Lange S, Probst C, Gmel G, et al. Global prevalence of fetal alcohol spectrum disorder among children and youth. A systematic review and meta-analysis. JAMA Pediatrics, published online August 21, 2017. Doi:10.1001/jamapediatrics.2017.1919.

Retrieved from: https://www.medicalnewsbulletin.com/fetal-alcohol-spectrum-disorder-global-problem/

Your developing baby: Building the brain is like building a house

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Your baby’s growth and development is guided by the brain. Brain development begins during pregnancy and continues into the adult years. In the developing embryo, neurons start to form by 6 weeks of pregnancy. By 16 weeks of pregnancy, 250,000 neurons are being created every minute.

Building the brain is like building a house:

In a house…

  • The structure is built starting on the ground.
  • The base or foundation is set, the walls are built and the electrical system is wired—all in an exact order.
  • The electrical wiring allows all parts of the house to work together.
  • A strong foundation supports everything that is built on top of it.

In the brain…

  • The brain’s basic structure forms during pregnancy.
  • The ‘wiring’ of the brain starts as the brain’s neurons begin to connect with each other.
  • Connections in the brain continue to develop through an ongoing process until the early adult years.
  • These connections are how the brain communicates. Communication happens between neurons in the brain, and between the brain and the rest of the nervous system.
  • Early brain development lays the foundation for future learning, behaviour and health.

Your newborn’s brain is like a house that has just been built. The walls and doors are up but the wiring isn’t all in place. There are still a lot of changes to come.

Caring for yourself during pregnancy is important because it supports your child’s brain development, which affects all parts of your child’s growth and development.

The quickly developing brain is very sensitive to harmful environments such as too much stress, certain illnesses and being exposed to harmful chemicals.

This site suggests ways to create healthy environments to help your baby’s developing brain during pregnancy. More information on helping to build your child’s brain through the early years.

  • When stress becomes too much

    Everyone has some amount of stress. But some things cause so much stress it can be harmful to your health, and your baby’s developing brain and overall health. If you are going through something stressful that isn’t going away or for which you have no support, it’s important to get help. Talk to your health care provider or call Health Link toll-free in Alberta at 8-1-1.

Retrieved from: http://www.healthyparentshealthychildren.ca/pregnancy-overview/your-developing-baby/

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Alcohol or Drug Use During Pregnancy

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During pregnancy, everything you eat, drink, or take into your body affects you and your growing baby (fetus). Pregnant women often need to make changes to have a healthy pregnancy, such as eating better or exercising. But one of the most important things you can do when you are pregnant is to avoid alcohol and drugs.

Alcohol and drugs can cause problems for you during your pregnancy and when it is time for your baby to be born. They can also affect your baby both before and after he or she is born. They can:

  • Affect your baby’s size.
  • Affect how your baby’s heart, lungs, and brain work.
  • Cause lifelong learning, emotional, and physical problems for your child.

Using alcohol and illegal drugs is not safe for you or your baby.

If you use alcohol or drugs, the best time to stop is before you get pregnant. But sometimes pregnancy is unexpected. Since drugs and alcohol can harm your baby in the first weeks of pregnancy, the sooner you can stop, the better.

Even some over-the-counter and prescription medicines aren’t safe to take when you’re pregnant. Tell your doctor about all the drugs and supplements you take. He or she can help you decide what medicines are safe to take during pregnancy.

How do alcohol and drugs affect pregnancy?

Substance Possible effect on mother Possible effect on fetus, newborn, and child
Alcohol
Cocaine
Ecstasy
  • Effects not known
  • Long-term memory problems
  • Learning problems
Heroin
  • Seizures
  • Addiction, withdrawalsymptoms after birth
  • Breathing problems
  • Small size at birth
  • Physical and mental development problems
Inhalants
  • Life-threatening breathing problems
  • Convulsions or seizures
  • Coma
  • Low birth weight
  • Problems with how bones form
  • Learning problems
Marijuana
Methamphetamine
  • Low birth weight
  • Heart and lung problems
PCP/LSD
  • Confusion
  • Delusions
  • Hallucinations
  • Risk of overdose
  • Withdrawalsymptoms after birth
  • Learning problems
  • Emotional problems
  • Behaviour problems

Alcohol or drug misuse: How to stop

You may already know that alcohol and drugs can harm you and your baby. But it can still be hard to stop. Changing your behaviours isn’t easy. Some people need treatment to help them quit using drugs or alcohol. Here are some things you can do:

Take the first step. Admitting that you need help can be hard. You may feel ashamed or have doubts about whether you can quit. But your treatment can be successful only if you make the choice to stay sober. Remember that many people have struggled with these same feelings and have recovered from substance use problems. Quitting now will help you and your baby.

Tell someone. If you can’t stop drinking or using drugs on your own, tell someone that you need help. There are people and programs to help you. Your doctor is a good place to start. He or she can talk to you about treatment options. Your doctor may be able to give you medicines that can ease withdrawal symptoms. Or he or she may be able to find a hospital or clinic that you can go to for treatment.

You might also want to tell a friend or loved one. Having someone on your side that you know well, telling you that you can do this for yourself and your baby, is a very important part of recovery.

Make changes to your life. It can be hard to stop using alcohol or drugs when it has become a part of your life. You may need to make changes to your routine, like not being around certain people, or not going to places where you used to drink or use drugs. Ask friends and family to support your changes.

Consider counselling. Counselling helps you make changes in your life so you can stay sober. You learn to cope with tough emotions and make good choices. You may get counselling in a group or one-on-one.

Join a support group. Groups like Alcoholics Anonymous (AA) and Narcotics Anonymous were formed to help people who want to stop doing things that add no value to their lives. You may have more success quitting if you share your story, hear the stories of those who may be struggling and those who have successfully quit, and find someone to partner with.

Retrieved from: https://myhealth.alberta.ca/health/Pages/conditions.aspx?hwid=ae1198&#ae1199

Violence, Trauma, and Substance Use

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Background on the Connections
I have come to believe that trauma is the problem, and substance use the solution . . . until the solution becomes the problem. 
~ Addictions counsellor

 

Evidence is building on the contribution of abuse and trauma to mental illness and substance use problems in women, and in turn, the benefits of trauma-informed approaches in reaching and assisting them. A recent Canadian study involving six women’s treatment centres from across Canada found that 90% (n=55/61) of the women interviewed reported childhood or adult abuse histories in relation to their problematic use of alcohol 1. In general it has been noted in the literature that as many as 2/3 of women with substance misuse problems report a concurrent mental health problem such as anxiety and depression, and they also commonly report surviving physical and sexual abuse either as children or adults 2.

The implications of these interconnections are significant and affect not only emotional health and well-being, but all areas of women’s lives including their physical health and mothering. Experiences of violence and trauma are linked to central nervous system changes, sleep disorders, cardiovascular problems, gastrointestinal and genito-urinary problems, as well as reproductive and sexual problems. A study of birth mothers of children with Fetal Alcohol Syndrome found that 100% had histories of serious sexual, physical and/or emotional abuse and 80% had a major unaddressed mental illness 3. Yet, surprisingly little attention has been given to the needs of mothers with co-occurring mental health disorders and trauma. The image below illustrates how trauma can be central to women’s experience of substance use, mental health problems and experience of ongoing violence.

  1. Brown, C. The pervasiveness of trauma among Canadian women in treatment for alcohol use. in Looking Back, Thinking Ahead: Using Research to Improve Policy and Practice in Women’s Health. 2009.
  2. Logan, T., et al., Victimization and substance abuse among women: Contributing factors, interventions and implications. Review of General Psychology, 2002. 6(4): p. 325-397.
  3. Astley, S.J., et al., Fetal Alcohol Syndrome (FAS) primary prevention through FAS Diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol & Alcoholism, 2000. 35(5): p. 509-519.

 

For more information please visit: http://coalescing-vc.org/virtualLearning/section1/connecting-substance-use/ 

New Infographic for FASD Awareness Day – Prevention means supporting pregnant women

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For International FASD Awareness Day on September 9th, the CanFASD Research Network, through its Prevention Network Action Team (pNAT) and the Centre of Excellence for Women’s Health, developed this infographic on what we know about alcohol use and preventing FASD. You can download a PDF version here.

CanFASD focuses on all aspects of FASD that impact women, individuals, caregivers, and service providers through its network action teams, each with a different focus – prevention, intervention, research, and policy and service providers. These teams aim to put forth knowledge in a way that is useful to communities and organizations in Canada in developing effective programs and policies.

You can search hashtags #FASDay2017 #CanFASD on Twitter to see examples of what others in Canada, or visit some of our pNAT partners.

 

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