Prevalence of Alcohol Consumption during Pregnancy and

Fetal Alcohol Spectrum Disorder

Presented by Svetlana (Lana) Popova, MD, PhDs, MPH

Centre for Addiction and Mental Health,

University of Toronto, PAHO/WHO Collaborating Centre

Toronto, Canada

15th INEBRIA Conference Santiago, Chile

September 27-28, 2018

OVERVIEW • Prevalence of alcohol consumption and binge

drinking during pregnancy in general population of different countries (including countries of Latin America and the Caribbean), World Health Organization (WHO) regions and globally.

• Prevalence of FAS/FASD in different populations in different countries (including countries of Latin America and the Caribbean), WHO regions and globally.

FASD is one of the leading known preventable cause of birth defects and developmental delay (PHAC, 2005)

• Alcohol => Harm to others! FASD is one of the most dramatic examples of such harm

• What is FASD? – An umbrella term describing the range of effects that

can occur in a person whose mother drank alcohol during pregnancy

• Primary disabilities: permanent brain injury, learning disorders, developmental disabilities, maladaptive behaviours, physical malformations, and growth restrictions

• Other common outcomes: early school dropout, addiction problems, poorly recognized mental health conditions, promiscuous sexual behaviour, and trouble

with the law • Irreversible and lifelong

Prenatal alcohol exposure can permanently damage the brain affecting important structures such as the cerebellum and corpus callosum

Source: Mattson et al. 1994. Alcohol Health & Research World

Normal FAS FAS Permanent loss of the tissue indicated by the arrows (portions of the corpus callosum).

Permanent Brain Damage

428 comorbid conditions, spanning across 18 (out of 22) chapters of the ICD-10

Percentage of conditions found to occur among individuals with FASD by ICD-10 chapter

Popova et al. 2016, The Lancet.

$378.3 M

$532 M - $1.2 B $128.5 M-$226.3 M

Popova et al. 2015. Available at: http://www.camh.ca/en/research/Pages/research.aspx

Total annual cost: $1.3B - $2.3B

FASD is costly!

Percentage of main cost components attributable to FASD in Canada in 2013

Prevalence of Alcohol Use During Pregnancy and FAS/FASD

1) Popova S, Lange S, Probst C, Gmel G, & Rehm J (2017). Lancet Global Health 2) Lange S, Probst C, Gmel G, Rehm J, Popova S (2017). JAMA, Pediatrics 3) Popova S, Lange S, Probst C, Gmel G, & Rehm J (2018). Biochemistry and Cell Biology, special issue on FASD

Objective: To estimate the prevalence of alcohol use and binge drinking during pregnancy and FAS/FASD by country, WHO region, and globally

Methodology: Comprehensive Literature search: not limited geographically/language Meta-analyses: Pooled prevalence for countries with 2+ studies, assuming a random-effects model Data prediction: For countries with one or no studies:

a) For AC: using fractional response regression modelling and; b) For FAS/FASD: based on the proportion of women who gave birth to a child

with FAS/FASD among women who consumed alcohol during pregnancy • Estimated WHO regional and global averages of FAS/FASD prevalence

weighted by the number of live births in each country

Prevalence of Any Amount of Alcohol Use During Pregnancy in General Population of Latin America

and the Caribbean in 2012 • Lange, Probst, Heer, Roerecke, Rehm, Monteiro, Shield, de

Oliveira & Popova. (2017). Rev Panam Salud Publica [Pan American Journal of Public Health]

• Data from published studies on the prevalence of alcohol consumption during pregnancy were available from 5 of the 33 countries in Latin America and the Caribbean:

• Brazil [n=17], Chile [n=2], Guatemala [n=1], Mexico [n=3], and Uruguay [n=1]; no studies from the Caribbean.

• Meta-analysis for Brazil and Mexico, based on the criterion of three available studies per country.

• The prevalence of alcohol consumption during pregnancy was predicted for 31 countries.

23% 22%

18% 18%

15% 15% 15% 15% 15% 13% 13% 12% 12% 12%

11% 11% 11% 10% 10% 10% 10% 10% 9% 9% 9% 9% 9% 8% 8% 7%

6% 5%

1%

10%

0%

5%

10%

15%

20%

25%

Gre

nada

St. L

ucia

Guy

ana

Para

guay

Braz

il†

Haiti

St. V

ince

nt a

nd G

rena

dine

sBa

rbad

osDo

min

ica

Arge

ntin

aPe

ruDo

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ican

Rep

ublic

Baha

mas

Pana

ma

Chile

Hond

uras

Boliv

iaSu

rinam

eVe

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ela

Antig

ua a

nd B

arbu

daBe

lize

St. K

itts a

nd N

evis

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icar

agua

Uru

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Cost

a Ri

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Sal

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rG

uate

mal

aTr

inid

ad a

nd T

obag

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baM

exic

o†

Glo

bal

Lange, Probst, Heer, … & Popova. 2017. Rev Panam Salud Publica

Prevalence of Any Amount of Alcohol Use During Pregnancy in General Population of Latin

America and the Caribbean in 2012

†Estimate of alcohol use (any amount) during pregnancy based on a meta-analysis of the current literature

Prevalence of Any Amount of Alcohol Use During Pregnancy in General Population of Latin America and the Caribbean in 2012

Lange, Probst, Heer … & Popova. 2017. Rev Panam Salud Publica

13.9%

6.7%

3.6% 3.6%

3.3% 3.0%

3.0%

2.7% 2.7%

2.7% 2.4%

2.4% 2.3%

2.3%

2.3% 2.3%

2.2% 2.2%

2.0%

2.0% 1.9%

1.9% 1.9%

1.9% 1.8%

1.6% 1.6%

1.5%

1.5% 1.4%

1.4% 1.2%

1.2%

2.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

*Estimate of binge drinking during pregnancy based on a meta-analysis of the current literature

Prevalence of Binge Drinking During Pregnancy in General Population of Latin America and the

Caribbean in 2012

Prevalence of FAS/FASD in General Population Flow chart for systematic literature search on prevalence of FAS/FASD

11,089 records identified through database searching

21 additional records identified through other sources

11,110 records found 5,145 duplicates removed

5,965 records screened

430 full-text articles assessed for eligibility

368 full-text articles excluded; lack of relevant data or did not meet

the inclusion criteria

62 articles identified as including relevant data from 19 countries [African Region (South Africa, 9 studies), European

Region (Croatia, 2 studies; Denmark, 1 study; France, 7 studies; Germany, 1 study; Ireland, 1 study; Italy, 3 studies;

Netherlands, 1 study; Portugal, 1 study; Spain, 1 study; Sweden, 2 studies; Switzerland, 1 study; and United

Kingdom, 3 studies), Region of the Americas (Canada, 2 studies; United States, 24 studies; and Uruguay, 1 study), and Western Pacific Region (Australia, 7 studies; New Zealand, 1

study; and Republic of Korea, 1 study)]

5,535 records excluded

Prevalence of FAS in General Population by WHO Region and Globally, 2012

Prev

alen

ce (p

er 1

0,00

0)

37.4

16.6 14.8 12.7

2.7 0.2

14.6

0

5

10

15

20

25

30

35

40

AFR=African R, AMR=R of the Americas, EMR=Eastern-Mediterranean R, EUR=European R, SEAR=South-East Asia R, WPR=Western Pacific R

0.15%

Prevalence of FASD in General Population by WHO Region and Globally, 2012

Prev

alen

ce (p

er 1

0,00

0) 198.2

87.9 78.3 67.4

14.1 1.3

77.3

0.0

50.0

100.0

150.0

200.0

250.0

EUR AMR AFR WPR SEAR EMR Global

AFR=African Region, AMR=Region of the Americas, EMR=Eastern-Mediterranean Region, EUR=European Region, SEAR=South-East Asia Region, WPR=Western Pacific Region

0.77%

2%

Prevalence of FAS and FASD in Latin America and the Caribbean in 2012

18.4

17.2

14.3 14.1

12.0 11.7

11.7 11.5

11.5 10.2

9.8 9.5

9.5 9.2

8.4 8.3

8.3 8.0

7.8 7.6

7.5 7.5 7.4 7.1 7.0 7.0 6.9 6.5 6.5 5.1

4.4 3.8

2.7

1.0

7.7

0

2

4

6

8

10

12

14

16

18

20

Gre

nada

St L

ucia

Guy

ana

Para

guay

Braz

ilHa

itiSt

Vin

cent

and

Gre

nadi

nes

Barb

ados

Dom

inic

aAr

gent

ina

Peru

Baha

mas

Dom

inic

an R

epub

licPa

nam

aHo

ndur

asBo

livia

Chile

Surin

ame

Vene

zuel

aAn

tigua

and

Bar

buda

Beliz

eSt

Kitt

s and

Nev

isJa

mai

caCo

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bia

Ecua

dor

Nic

arag

uaU

rugu

ayCo

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Rica

El S

alva

dor

Gua

tem

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Trin

idad

and

Tob

ago

Cuba

Puer

to R

ico

Mex

ico

Glo

bal

FAS FASD

Prev

alen

ce (p

er 1

,000

)

521.13

285.19 233.45

189.66 182.4 170.21 142.39 120.37

40 7.73

0.0

100.0

200.0

300.0

400.0

500.0

600.0

8Adoptees fromEastern Europe,

Sweden(Landgren et

al.64)

_Foster and adopted youth referred to a

children’s mental health centre,

USA (Chasnoff et al.65)

/Correctionalpopulation,

Canada (Fast etal.66)

1Aboriginalpopulation,

Canada(Robinson et

al.67)

RRuralpopulation with a

lowsocioeconomicstatus, South

Africa (de Vrieset al.68)

>Childrenresiding in an

orphanage, Brazil(Strömland et

al.69)

3Psychiatric carepopulation, USA

(Bell &Chimata70)

7Aboriginalpopulation,Australia

(Fitzpatrick etal.71)

@Pre-adoption &foster care

children, Israel(Tenenbaum et

al.72)

�Generalpopulation,

Globally

Prev

alen

ce (p

er 1

,000

)

As compared to the global FASD prevalence among the general population: 5 to 68 times higher among children in care 16 to 25 times higher among Aboriginal populations 19 times higher among a psychiatric care population 24 times higher in a low socioeconomic status population 30 times higher in a correctional population

Comparison FASD prevalence among special populations, based on select studies, to the global prevalence among the general population

Popova et al. (submitted)

Discussion • FASD is a prevalent alcohol-related developmental

disability globally • Establish a universal public health message about

the potential harm of prenatal alcohol exposure • Establish routine screening protocols • Provide brief interventions, where appropriate, to

all pregnant women • Special attention has to be paid to high-risk

populations where the impact of FASD is especially severe

References 1) Popova, S., Lange, S., Probst, C., Gmel, G., & Rehm, J. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health, 5(3), e290–e299. Available from: http://dx.doi.org/10.1016/S2214-109X(17)30021-9 2) Lange, S., Probst, C., Gmel, G., Rehm, J., & Popova, S. (2017). Global prevalence of fetal alcohol spectrum disorder among children and youth: a systematic review and meta-analysis. JAMA Pediatrics, 171(10), 948-956. 3) Popova, S., Lange, S., Probst, C., Gmel, G., & Rehm, J. (2018). Global prevalence of alcohol use and binge drinking during pregnancy and Fetal Alcohol Spectrum Disorder. Biochemistry and Cell Biology, special issue on FASD, 96(2), 237-240. doi: 10.1139/bcb-2017-0077. 4) Lange, S., Probst, C., Heer, N., Roerecke, M., Rehm, J., Monteiro, M. G., Shield, K., de Oliveir, C., & Popova, S. (2017). Actual and predicted prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean: systematic review and meta-analysis. Rev Panam Salud Publica [Pan American Journal of Public Health], 41, e89.

Contact Information Svetlana (Lana) Popova Senior Scientist, Associate Professor Institute for Mental Health Policy Research Centre for Addiction & Mental Health, University of Toronto, WHO Collaborating Centre 33 Russell Street, room T507 Toronto, ON, Canada M5S 2S1 Tel. (416) 535-8501 ext. 34558 e-mail: lana.popova@camh.ca

Remember: When you drink, so does your child