Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Lancet Glob Health. 2017 Mar;5(3):e290-e299. doi: 10.1016/S2214-109X(17)30021-9. Epub 2017 Jan 13.
Alcohol use during pregnancy is the direct cause of fetal alcohol syndrome (FAS). We aimed to estimate the prevalence of alcohol use during pregnancy and FAS in the general population and, by linking these two indicators, estimate the number of pregnant women that consumed alcohol during pregnancy per one case of FAS.
We began by doing two independent comprehensive systematic literature searches using multiple electronic databases for original quantitative studies that reported the prevalence in the general population of the respective country of alcohol use during pregnancy published from Jan 1, 1984, to June 30, 2014, or the prevalence of FAS published from Nov 1, 1973, to June 30, 2015, in a peer-reviewed journal or scholarly report. Each study on the prevalence of alcohol use during pregnancy was critically appraised using a checklist for observational studies, and each study on the prevalence of FAS was critically appraised by use of a method specifically designed for systematic reviews addressing questions of prevalence. Studies on the prevalence of alcohol use during pregnancy and/or FAS were omitted if they used a sample population not generalisable to the general population of the respective country, reported a pooled estimate by combining several studies, or were published in iteration. Studies that excluded abstainers were also omitted for the prevalence of alcohol use during pregnancy. We then did country-specific random-effects meta-analyses to estimate the pooled prevalence of these indicators. For countries with one or no empirical studies, we predicted prevalence of alcohol use during pregnancy using fractional response regression modelling and prevalence of FAS using a quotient of the average number of women who consumed alcohol during pregnancy per one case of FAS. We used Monte Carlo simulations to derive confidence intervals for the country-specific point estimates of the prevalence of FAS. We estimated WHO regional and global averages of the prevalence of alcohol use during pregnancy and FAS, weighted by the number of livebirths per country. The review protocols for the prevalence of alcohol use during pregnancy (CRD42016033835) and FAS (CRD42016033837) are available on PROSPERO.
Of 23 470 studies identified for the prevalence of alcohol use, 328 studies were retained for systematic review and meta-analysis; the search strategy for the prevalence of FAS yielded 11 110 studies, of which 62 were used in our analysis. The global prevalence of alcohol use during pregnancy was estimated to be 9·8% (95% CI 8·9-11·1) and the estimated prevalence of FAS in the general population was 14·6 per 10 000 people (95% CI 9·4-23·3). We also estimated that one in every 67 women who consumed alcohol during pregnancy would deliver a child with FAS, which translates to about 119 000 children born with FAS in the world every year.
Alcohol use during pregnancy is common in many countries and as such, FAS is a relatively prevalent alcohol-related birth defect. More effective prevention strategies targeting alcohol use during pregnancy and surveillance of FAS are urgently needed.
Centre for Addiction and Mental Health (no external funding was sought).
怀孕期间饮酒是胎儿酒精综合征（FAS）的直接原因。我们旨在评估一般人群中怀孕期间饮酒和 FAS 的流行情况，并通过将这两个指标联系起来，估计每例 FAS 孕妇怀孕期间饮酒的数量。
我们首先使用多个电子数据库进行了两次独立的全面系统文献检索，以查找 1984 年 1 月 1 日至 2014 年 6 月 30 日期间发表的、各自国家的一般人群中怀孕期间饮酒流行情况的原始定量研究，或 1973 年 11 月 1 日至 2015 年 6 月 30 日期间发表的 FAS 流行情况的同行评审期刊或学术报告。使用针对观察性研究的检查表对每个关于怀孕期间饮酒流行情况的研究进行批判性评估，使用专门针对系统综述的方法对每个关于 FAS 流行情况的研究进行批判性评估，该方法用于解决流行率问题。如果研究样本人群不能推广到各自国家的一般人群、报告了几个研究的综合估计值或在迭代中发表，则将关于怀孕期间饮酒流行情况或 FAS 的研究排除在外。对于排除了戒酒者的研究，我们也排除了怀孕期间饮酒的流行率。然后，我们对每个国家进行了特定的随机效应荟萃分析，以估计这些指标的汇总流行率。对于有一个或没有经验研究的国家，我们使用分数反应回归建模预测怀孕期间饮酒的流行率，并使用每例 FAS 孕妇饮酒的平均数量的商来预测 FAS 的流行率。我们使用蒙特卡罗模拟为 FAS 的国家特定点估计值的置信区间。我们使用按每个国家的活产婴儿数加权的方法，估计了世界卫生组织（WHO）各区域和全球怀孕期间饮酒和 FAS 的流行率。
在确定的 23470 项关于饮酒的研究中，有 328 项研究被保留用于系统评价和荟萃分析；针对 FAS 流行率的搜索策略产生了 11110 项研究，其中 62 项被用于我们的分析。全球怀孕期间饮酒的流行率估计为 9.8%（95%CI 8.9-11.1），一般人群中 FAS 的估计流行率为每 10000 人中有 14.6 人（95%CI 9.4-23.3）。我们还估计，每 67 名饮酒的孕妇中就有 1 名会分娩出患有 FAS 的儿童，这意味着全球每年约有 11.9 万名儿童患有 FAS。
怀孕期间饮酒在许多国家都很常见，因此，FAS 是一种相对常见的酒精相关出生缺陷。迫切需要更有效的针对怀孕期间饮酒的预防策略和 FAS 的监测。
成瘾与心理健康中心（未寻求外部资金）。
