A Revised Conservative Estimate of the Incidence of FAS and its Economic Impact

Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 07/1991; 15(3):514-24. DOI: 10.1111/j.1530-0277.1991.tb00553.x
Source: PubMed


We have conducted a new analysis of the incidence of fetal alcohol syndrome (FAS) and its economic impact based on prospectively gathered data of consecutive pregnancies. This more conservative analysis reflects our concern over possible inclusion of "false positives" in our previous estimate and now puts the overall rate in the western world at 0.33 cases per 1000. The estimate among whites is 0.29 per 1000 compared with 0.48 per 1000 for blacks. We did not include estimates for native Americans owing to the absence of prospectively gathered data on FAS for this group. Retrospective studies suggest larger disparities. Both prospective and retrospective studies may be influenced by examiner bias especially for minorities since minorities are often evaluated against standards derived from whites. Based on our estimates and the number of black and white children born each year, we estimate that about 1200 children are born with FAS each year in the United States. This is a probable lower limit based on considerations of ascertainment and absence of relevant information for other minorities such as native Americans. In calculating economic costs, we have now adjusted our estimates to take into account costs that would be incurred whether cases were FAS or not, and also have now included estimated costs for anomalies in FAS cases not considered in previous estimates. Based on these considerations, we now estimate the incremented annual cost of treating this disorder at $74.6 million. About three-quarters of this economic burden is associated with care of FAS cases with mental retardation.(ABSTRACT TRUNCATED AT 250 WORDS)

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    • "Prenatal alcohol exposure has been associated with inauspicious effects like developmental delays and infant mortality, leading known cause of mental retardation in human fetuses (Abel and Sokol 1991). "
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    ABSTRACT: The objective of the present study is to evaluate the effect of ethanol on developing zebra fish heart. Male and female fishes are allowed to breed normally and the fertilized eggs were collected and it was exposed to 3 % of ethanol (EtOH) for one hour once in 24 hours for 96 hours. The embryos were subjected to various analyses related to heart development like external morphology, heart morphology, heart rate, heart looping formation, heart length and ventricular stand still. The data showed significant alteration in the length of whole embryo or larva, heart length and heart rate of EtOH exposed embryo when compared to control. The looping also altered like string-like or straight tube appearance, with the ventricle located distinctly anterior to the atrium. Further, the ventricle appeared smaller than normal, the atrium is elongated, and both chambers having a narrow width. The incidence of ventricular standstill and valvular regurgitation is occurring in EtOH treated embryo when compared to control. Taken together, the steady decrease in heart size coupled with the severe defects in ventricular function, failure of cardiac looping formation, heart rate, ventricular standstill and retrograde blood flow would be expected to have a substantial impact on the ability of zebra fish to circulate blood. From the present study it is concluded that EtOH exposure during development results in structural and functional impairment in heart that mimic malformations that occur in patients with fetal alcohol syndrome.
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    • "There are only a few studies in Canada and the USA that have attempted to estimate the cost associated with FASD (no studies exist in any other country; Popova et al. 2011b, c, 2012b). In the existing FASD-cost analyses (Abel and Sokol 1987, 1991a, b; Harwood 2000, 2003; Harwood et al. 1984, 1998; Harwood and Napolitano 1985; Rice et al. 1990, 1991; Rice 1993; Weeks 1989), the cost of children in care with FASD was not included in the overall estimates. In these studies, the total cost associated with FASD might be underestimated based on the fact that children with FASD are overrepresented in child care systems (Farris-Manning and Zandstra 2003; Hutson 2006; Popova et al. 2012c, d). "
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    ABSTRACT: A high prevalence of prenatal alcohol exposure has been reported among children in care and thus, the risk of fetal alcohol spectrum disorder (FASD) in this population is high. The purpose of the current study was to estimate the number of children (0-18 years) in care with FASD and to determine the associated cost by age group, gender, and province/territory in Canada in 2011. The prevalence of children in care by province/territory was obtained from the Canadian Child Welfare Research Portal, and the number of children in care with FASD for each province/territory was estimated from available epidemiological studies. In order to calculate the total cost per province/territory, the cost per individual per day, by age group, was applied to the respective number of children in care with FASD. The estimated number of children in care with FASD ranged from 2,225 to 7,620, with an annual cost of care ranging from $57.9 to $198.3 million Canadian dollars (CND). The highest overall cost ($29.5 to $101.1 million CND) was for 11-15 year-olds. The study findings can be used to demonstrate the substantial economic burden that FASD places on the child welfare system. Attention towards the needs of this population and prevention efforts to reduce FASD incidence in Canada, and other countries are urgently needed.
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    • "About 10% of pregnant women in the United States use alcohol and 2% engage in binge or frequent use of alcohol (Centers for Disease Control and Prevention, 2004), a pattern that increases the risk for FASD (Jacobson et al., 1998; May et al., 2005). Alcohol is now generally acknowledged as the leading human teratogen and, if the estimates of prevalence of FASD are correct, is one of the leading known causes of neurodevelopmental disorders in Western society (Abel and Sokol, 1991; Caetano et al., 2006). The magnitude of this health burden (Lupton et al., 2004), combined with the unchanging incidence of FAS despite efforts to educate the public about the risk of alcohol abuse during pregnancy, makes early diagnosis of prenatal alcohol exposure and damage to the developing braindtogether with intervention strategies that can be implemented as early as is feasibleda high research priority. "
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