This systematic review of the literature on Fetal Alcohol Spectrum Disorders (FASD) evaluates the relative effectiveness of various prevention strategies aimed at reducing the burden of FASD. The document also provides a less detailed review of the diagnosis and management literature, and provides information on the economic burden of FASD.
Purpose
This systematic review of the literature on Fetal Alcohol Spectrum Disorders (FASD) evaluates the relative effectiveness of various prevention strategies aimed at reducing the burden of FASD. The document also provides a less detailed review of the diagnosis and management literature, and provides information on the economic burden of FASD.
Methodology
A systematic method of literature searching, study selection, data extraction and appraisal was employed. The literature was searched using the Medline, EMBASE, Scopus and PsychInfo databases and the Cochrane Library. The bibliographies of included papers were also examined for relevant studies. NHMRC dimensions of evidence, levels of evidence and quality assessment criteria were used to evaluate each of the included studies.
Key Results
The literature search for prenatal screening and prevention strategies identified 3,655 publications. All publications were reviewed using the pre-defined study selection criteria and subsequently 67 publications were identified as being eligible for inclusion. This comprised of two systematic reviews, six primary prevention publications, 13 secondary prevention publications, 13 tertiary prevention publications, 27 screening publications and six guidelines. The literature search for level I evidence for postnatal screening, diagnosis and management publications identified 812 publications. All publications were reviewed using the pre-defined study selection criteria and subsequently six publications (all guidelines) were identified as being eligible for inclusion in the postnatal screening and diagnosis review and six publications (two systematic reviews and four guidelines) were identified as being eligible for inclusion in the review of management strategies. Because few citations met the inclusion criteria, key narrative review articles were also included. One article which reviewed FASD diagnosis strategies and two articles which reviewed FASD management strategies were summarised. The literature search for studies examining the economics of FASD identified six relevant studies. One of these represented a cost-effectiveness analysis of a universal or targeted screening tool for identifying FASD in children, three estimated the economic burden of FASD and two estimated the cost of specific strategies to reduce the burden of FASD. Prenatal screening and prevention strategies
Prevention of FASD should consist of a primary prevention strategy (aimed at the general population), as well as more focussed strategies directed at specific subgroups of women. Primary prevention strategies aim to educate the general public about the risks of drinking during pregnancy and can include wide ranging, population interventions such as mass media campaigns, pregnancy health advisory labels and increased taxes. Secondary prevention strategies are aimed at pregnant women and include screening, early detection and treatment of pregnant women or women with an increased risk of having a child with FASD. Tertiary prevention strategies are targeted to women considered to be at a higher risk of having a child with FASD and aim to change their drinking behaviour. The key outcome in all identified studies was a reduction in alcohol consumption during pregnancy. This has been used as a proxy outcome for a reduction in the number of children born with FASD. This outcome must be interpreted with care: although a study may report a small reduction in alcohol consumption, this may not be a meaningful, clinically relevant effect. For example, an intervention which reduces alcohol consumption by 1/10th of a standard drink per week is unlikely to reduce the number of children born with FASD, even though this reduction may be statistically significant when compared with a control group. Although a small number of studies reported the number of children born with FAS or FASD, none were powered to detect a statistically significant difference There are a number of screening tools that could be used to identify women who would benefit from a secondary/tertiary prevention strategy. The advantage of screening tools is that they are quick to administer and can be easily incorporated into a prenatal visit.