Counting Fetal Alcohol Spectrum Disorder in Australia: the evidence and the challenges

Abstract

Issues: Alcohol exposure in utero is associated with a range of adverse outcomes in pregnancy and can cause long-term disability. Fetal alcohol spectrum disorder (FASD) is an umbrella term to describe a range of effects from prenatal alcohol exposure including fetal alcohol syndrome (FAS). Determining the prevalence of FASD is challenging.Approach: This narrative review collates information on the prevalence of FASD in Australia and documents the various methods used for attaining estimates and the limitations of the available data.Key Findings: Birth prevalence of FASD is most commonly measured through clinic-based studies, passive surveillance systems and active case ascertainment. Alcohol use in pregnancy and FAS in Australia is predominantly monitored through passive surveillance systems and under-ascertainment of cases is likely. State- and territory-based studies have reported birth prevalence rates of FAS of between 0.01 and 0.68 per 1000 live births. Prevalence rates of FASD have not been estimated in Australia. As reflected in the international data, Australian studies have found higher rates of FAS among some Indigenous communities. This likely reflects patterns of alcohol use and other socioeconomic risk factors.Implications: Under-recognition of FASD reflects incomplete and inconsistent data collections recording alcohol use in pregnancy, lack of awareness among health professionals and a lack of diagnostic and support services.Conclusion: Accurate measurement of FASD prevalence is crucial to inform policy, resource and service development in the areas of health, education, justice and community. There is a need for consensus on the collection and best use of data.