EPIDEMIOLOGY OF FETAL ALCOHOL SYNDROME IN AMERICAN-INDIANS, ALASKAN NATIVES, AND CANADIAN ABORIGINAL PEOPLES - A REVIEW OF THE LITERATURE

A critical review of available reports on the epidemiology of fetal al cohol syndrome among American Indians, Alaskan Natives, and Aboriginal peoples of Canada was completed. A search of Medline, the National In stitute on Alcohol Abuse and Alcoholism Database, and other relevant d ata bases was conducted. The reference lists of several publications o n fetal alcohol syndrome were reviewed, and four prominent researchers and four government agencies were contacted to identify unpublished a rticles. This search identified 10 studies, 8 of them cross-sectional. Four of these studies used primary data from the authors' evaluations of children suspected of having fetal alcohol syndrome; the other six used secondary data. The prevalence of fetal alcohol syndrome in the American Indians of the United States and Aboriginal peoples of Canada was consistently high across the 10 studies. These studies have signi ficant restrictions which limit both the confidence in the rates repor ted and the generalizability of the results. Three studies used data f rom the province of British Columbia. No study evaluated all children in the study area. Only two studies reviewed death certificates. In on ly one study were examiners blinded to maternal alcohol use, and no st udy presented evidence on the sensitivity and specificity of either th e screening efforts or diagnostic criteria. Such evidence is especiall y important in studies of secondary data and in studies that report ra tes for newborn populations. Studies of the sensitivity and specificit y of both the screening and diagnostic criteria for fetal alcohol synd rome would be useful areas for further study. Other study designs, inc luding longitudinal cohort studies, are needed. Additional studies of populations of the American Indians, Alaskan Natives, and Aboriginal p eoples of Canada, where low rates of fetal alcohol syndrome are suspec ted, should be completed. Reviews of death certificates may also be a potentially important source of cases.