INCIDENCE OF FETAL ALCOHOL SYNDROME AND PREVALENCE OF ALCOHOL-RELATEDNEURODEVELOPMENTAL DISORDER

We critique published incidences for fetal alcohol syndrome (FAS) and present new estimates of the incidence of FAS and the prevalence of al cohol-related neurodevelopmental disorder (ARND). We first review crit eria necessary for valid estimation of FAS incidence, Estimates for th ree population-based studies that best meet these criteria are reporte d with adjustment for underascertainment of highly exposed cases. As a result, in 1975 in Seattle, the incidence of FAS can be estimated as at least 2.8/1000 live births, and for 1979-81 in Cleveland, similar t o 4.6/1,000. In Roubaix, France (for data covering periods from 1977-1 990), the rate is between 1.3 and 4.8/1,000, depending on the severity of effects used as diagnostic criteria. Utilizing the longitudinal ne urobehavioral database of the Seattle study, we propose an operational ization of the Institute of Medicine's recent definition of ARND and e stimate its prevalence in Seattle for the period 1975-1981. The combin ed rate of FAS and ARND is thus estimated to be at least 9.1/1,000. Th is conservative rate-nearly one in every 100 live births-confirms the perception of many health professionals that fetal alcohol exposure is a serious problem. (C) 1997 Wiley-Liss, Inc.