Prevalence of fetal alcohol spectrum disorder among special subpopulations: a systematic review and meta‐analysis

AIM: To collate prevalence estimates of fetal alcohol spectrum disorder (FASD) among special subpopulations (defined by service use). DESIGN: Systematic literature review and meta-analysis of original, quantitative studies published between 1 November 1973 and 1 December 2018. The PRISMAGATHER were adhered to. The review protocol [includes FASD prevalence in (a) general and (b) special populations] is available on PROSPERO (registration number: CRD42016033837). Prevalence estimates were collated for all included studies with country-, disorder- [FASD and fetal alcohol syndrome (FAS)] and population-specific random-effects meta-analyses conducted. SETTING AND PARTICIPANTS: A number of service-defined subpopulations globally (see Findings). MEASUREMENTS: The main outcome was the prevalence of FASD among special subpopulations. The critical appraisal of each study was conducted using the Joanna Briggs Institute tool. FINDINGS: We identified 69 studies, comprising 6177 individuals diagnosed with FASD from 17 countries: Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), eastern Europe (Moldova, Romania and Ukraine; n = 1), Germany (n = 1), Israel (n = 1), Lithuania (n = 1), the Netherlands (n = 1), Poland (n = 1), Russia (n = 9), South Korea (n = 1), Spain (n = 1), Sweden (n = 1) and United States (n = 25). FAS and FASD prevalence rates were collated for the following five subpopulations: children in care, correctional, special education, specialized clinical and Aboriginal populations. The estimated prevalence of FASD in these special subpopulations was 10-40 times higher compared with the 7.7 per 1000 (95% confidence interval = 4.9-11.7) global FASD prevalence in the general population. CONCLUSIONS: Global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations have a significantly higher prevalence of fetal alcohol spectrum disorder compared with the general population, which poses a substantial global health problem.