Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is related to many comorbidities because of the permanent effects of prenatal alcohol exposure on the fetus. We aimed to identify the comorbid conditions that co-occur in individuals with FASD and estimate the pooled prevalence of comorbid conditions occurring in individuals with fetal alcohol syndrome (FAS). METHODS: We did a systematic literature search of studies reporting on the comorbidity and cause of death in individuals with FASD using multiple electronic bibliographic databases, searching for studies published up to July, 2012. We included original research published in a peer-reviewed journal in the English language. We used the following criteria for determining study quality: use of an established FASD diagnostic guideline, study setting, method of data collection, and sample size. All comorbid disease conditions were coded according to the International Classification of Diseases, tenth revision (ICD-10). To estimate the pooled prevalence of comorbid conditions found to co-occur in individuals with FAS, we did meta-analyses assuming a random-effects model. FINDINGS: Of 5068 studies found, 127 met eligibility criteria for data extraction. From those studies, we identified 428 comorbid conditions co-occurring in individuals with FASD, spanning across 18 of 22 chapters of the ICD-10. The most prevalent disease conditions were within the sections of congenital malformations, deformities, and chromosomal abnormalities, and mental and behavioural disorders. 33 studies reported data for frequency in a total of 1728 participants with FAS. The five comorbid conditions with the highest pooled prevalence (between 50% and 91%) included abnormal results of function studies of peripheral nervous system and special senses, conduct disorder, receptive language disorder, chronic serous otitis media, and expressive language disorder. INTERPRETATION: The high prevalence of comorbid conditions in individuals with FASD highlights the importance of assessing prenatal alcohol exposure as a substantial clinical risk factor for comorbidity. The harmful effects of alcohol on a developing fetus represent many cases of preventable disability, and thus, alcohol use during pregnancy should be recognised as a public health problem globally. FUNDING: Public Health Agency of Canada.

Fetal alcohol spectrum disorder prevalence estimates in correctional systems: a systematic literature review.

OBJECTIVES: The objective of this study was to conduct a systematic search of the literature for studies that estimated the prevalence/incidence of Fetal Alcohol Spectrum Disorder (FASD) in correctional systems in different countries and, based on these data, to estimate a) the number of people with Fetal Alcohol Syndrome (FAS)/FASD within the criminal justice system population, and b) the relative risk of becoming imprisoned for individuals with FAS/FASD compared with those without FAS/FASD. METHOD: A systematic world literature review of published and unpublished studies concerning the prevalence/incidence of FASD in correctional systems was conducted in multiple electronic bibliographic databases. SYNTHESIS: Very little empirical evidence is available on the prevalence of FASD in correctional systems. There were no studies estimating the prevalence/incidence of FASD in correctional systems found for any country other than Canada and the USA. The few studies that have identified incarcerated individuals with FASD estimate that the number of undiagnosed persons in correctional facilities is high. Based on available Canadian data, this study estimates that youths with FASD are 19 times more likely to be incarcerated than youths without FASD in a given year. CONCLUSION: More studies investigating the prevalence/incidence of alcohol-affected people in the criminal justice system are required. There is an urgent need to raise awareness about the prevalence and disabilities of individuals with FASD in the criminal justice system and about appropriate responses. The criminal justice system is an ideal arena for intervention efforts aimed at the rehabilitation and prevention or reduction of recidivism in this unique population.

What do we know about the economic impact of fetal alcohol spectrum disorder? A systematic literature review.

AIMS: The objective of this study was to conduct a systematic review of the literature related to the measurement of the economic impact of Fetal Alcohol Spectrum Disorder (FASD) in different countries and to categorize the available literature. METHODS: A systematic literature search of the studies concerning the economic impact of FASD was conducted using multiple electronic bibliographic databases. RESULTS: The literature on the economic burden of FASD is scarce. There are a limited number of studies found in Canada and the USA, and data from the rest of the world are absent. Existing estimates of the economic impact of FASD demonstrate significant cost implications on the individual, the family and society. However, these estimates vary considerably due to the different methodologies used by different studies. CONCLUSION: Limitations and gaps in the existing methodologies of calculating the economic costs of FASD are discussed. It is evident that there is an urgent need to develop a comprehensive and sound methodology for calculating the economic impact of FASD to the society.

Hours and days of sale and density of alcohol outlets: impacts on alcohol consumption and damage: a systematic review.

AIMS: The aim of this study was to examine recent research studies published from 2000 to 2008 focusing on availability of alcohol: hours and days of sale and density of alcohol outlets. METHODS: Systematic review. RESULTS: Forty-four studies on density of alcohol outlets and 15 studies on hours and days of sale were identified through a systematic literature search. The majority of studies reviewed found that alcohol outlet density and hours and days of sale had an impact on one or more of the three main outcome variables, such as overall alcohol consumption, drinking patterns and damage from alcohol. CONCLUSIONS: Restricting availability of alcohol is an effective measure to prevent alcohol-attributable harm.