What are the challenges in estimating the prevalence of Fetal Alcohol Spectrum Disorders (FASD)?

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Last updated: April 25, 2025View editorial policy

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From the Research

Estimating the prevalence of Fetal Alcohol Spectrum Disorders (FASD) is challenging due to several key factors, including underreported maternal alcohol consumption during pregnancy, varying symptoms and severity, lack of specialized training among healthcare providers, and inadequate surveillance systems 1, 2, 3. The diagnosis of FASD requires confirmation of maternal alcohol consumption during pregnancy, which is often underreported due to stigma, recall issues, or lack of awareness about consumption before pregnancy recognition. FASD presents with varying symptoms and severity, creating a spectrum that ranges from subtle neurodevelopmental issues to more obvious physical features, making consistent identification difficult. Many healthcare providers lack specialized training in FASD diagnosis, and diagnostic criteria have evolved over time, leading to inconsistent application across different regions and time periods. Some key factors that contribute to the difficulty in estimating FASD prevalence include:

  • Underreported maternal alcohol consumption during pregnancy
  • Varying symptoms and severity of FASD
  • Lack of specialized training among healthcare providers
  • Inadequate surveillance systems for tracking FASD
  • Limited access to diagnostic services in resource-limited settings According to a study published in JAMA in 2018, the estimated prevalence of FASD among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach 1. Another study published in JAMA Pediatrics in 2017 estimated the global prevalence of FASD among children and youth in the general population to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population) 2. The most recent and highest quality study, published in JAMA in 2018, provides the most accurate estimate of FASD prevalence, highlighting the need for improved surveillance and diagnostic services to address this public health issue 1.

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