Unreliable estimation of prevalence of fetal alcohol syndrome
Authors: Katrine Strandberg-Larsen, Anne-Marie Nybo Andersen, Ulrik S Kesmodel
Journal: The Lancet Global Health (2017)

Svetlana Popova and colleagues (March, 2017)1Popova S Lange S Probst C Gmel G Rehm J Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e290-e299Summary Full Text Full Text PDF PubMed Scopus (429) Google Scholar estimated that about one quarter of pregnant women in Europe drink alcohol. The authors state that this estimate is 2·6 times higher than the global prevalence and estimate that Europe has the world's highest fetal alcohol syndrome (FAS) prevalence of 37·4 per 10 000 people. If true, these numbers are alarming and require urgent action; however, we are not convinced that they are valid for contemporary Europe. The estimated drinking prevalence of 45·8% for Denmark is based on six Danish studies, five of which describe pregnant women in the 1980s and 1990s. This prevalence is much higher than reported in surveillance data,2Iversen ML Sorensen NO Broberg L et al.Alcohol consumption and binge drinking in early pregnancy. A cross-sectional study with data from the Copenhagen pregnancy cohort.BMC Pregnancy Childbirth. 2015; 15: 327Crossref PubMed Scopus (21) Google Scholar, 3Kesmodel US Petersen GL Henriksen TB Strandberg-Larsen K Time trends in alcohol intake in early pregnancy and official recommendations in Denmark, 1998–2013.Acta Obstet Gynecol Scand. 2016; 95: 803-810Crossref PubMed Scopus (11) Google Scholar which showed that, in Denmark's two most urbanised areas, 3% and 15% of pregnant women consumed alcohol in 2012. Drinking during pregnancy has reduced markedly in Denmark—eg, from 70% in 1998 to 15% in 2013 in the Aarhus area.3Kesmodel US Petersen GL Henriksen TB Strandberg-Larsen K Time trends in alcohol intake in early pregnancy and official recommendations in Denmark, 1998–2013.Acta Obstet Gynecol Scand. 2016; 95: 803-810Crossref PubMed Scopus (11) Google Scholar We therefore consider the estimation of alcohol use in pregnancy and consequently prevalence of FAS to be seriously overestimated. We are concerned that a similar overestimation could apply to other countries. According to the National Danish Patient Registry4Petersen GL Kesmodel US Strandberg-Larsen K Alcohol consumption among pregnant women and women of childbearing age in Denmark—assignment for the Danish Health Authority. University of Copenhagen, Copenhagen2015Google Scholar, which covers all inpatient and outpatient contacts in Denmark, approximately 12 children are diagnosed with FAS every year, corresponding to two per 10 000 children; although record-based ascertainment is known to be underestimated,5Fox DJ Pettygrove S Cunniff C O'Leary LA et al.Fetal alcohol syndrome among children aged 7–9 years—Arizona, Colorado, and New York, 2010.Morb Mort Wkly Rep. 2015; 64: 54-57PubMed Google Scholar this is still considerably lower than the estimated 68 per 10 000 children reported by Popova and colleagues. FAS is one of few preventable congenital diseases, and we highly appreciate the efforts of the authors. Still, we believe that more critical reflections on the validity of the estimations would have benefitted their work. We declare no competing interests. Introducing The Lancet Global Health Commission on High-Quality Health Systems in the SDG EraThe Millennium Development Goals on health have expanded access to basic health interventions to millions of people in low-income and middle-income countries (LMICs). However, access alone will not be sufficient to meet the Sustainable Development Goals (SDGs) if health systems cannot provide high quality care—ie, care that improves health outcomes and provides value to people. Emerging data show that many LMIC health systems struggle to consistently provide good quality of care.1,2 Yet change is possible. Full-Text PDF Open AccessUnreliable estimation of prevalence of fetal alcohol syndromeSvetlana Popova and colleagues (March, 2017)1 sought to estimate the global, regional, and national prevalence of alcohol use during pregnancy and fetal alcohol syndrome (FAS). The authors reviewed international literature from 1984 for country-specific quantitative studies and for countries with one or no studies they predicted gestational alcohol use prevalence by fractional response regression modelling and prevalence of FAS by an estimated quotient for the average number of women consuming alcohol during pregnancy per one case of FAS. Full-Text PDF Open AccessUnreliable estimation of prevalence of fetal alcohol syndrome – Authors' replyWe thank Katrine Strandberg-Larsen and colleagues from Denmark and Simona Pichini and colleagues from Italy for their comments on our paper.1 Both comments underline the immense interest in the related public health problems of alcohol use during pregnancy and fetal alcohol syndrome (FAS). Full-Text PDF Open Access