Table Of ContentEdited by
Sterling Clarren,
Amy Salmon, and
Egon Jonsson
Prevention of Fetal Alcohol
Spectrum Disorder FASD
Titles of the series “ Health Care and Disease Management ”
Riley, E.P., Clarren, S., Weinberg, J., Rapoport, J., Jacobs, P., Jonsson, E. (eds.)
Jonsson, E. (eds.)
Cost Containment and
Fetal Alcohol Spectrum
Effi ciency in National
Disorder
Health Systems
Management and Policy A Global Comparison
Perspectives of FASD
2009
2011 ISBN: 978 - 3 - 527 - 32110 - 0
978 - 3 - 527 - 32839 - 0
Rashiq, S., Schopfl ocher, D.,
Martin, W., Suchowersky, O., Taenzer, P., Jonsson, E. (eds.)
Kovacs Burns, K., Jonsson, E. (eds.)
Chronic Pain
Parkinson Disease
A Health Policy Perspective
A Health Policy Perspective
2008
2010 ISBN: 978 - 3 - 527 - 32382 - 1
ISBN: 978 - 3 - 527 - 32779 - 9
Lu, M., Jonsson, E. (eds.)
Financing Health Care
New Ideas for a Changing Society
2008
ISBN: 978 - 3 - 527 - 32027 - 1
Related Titles
Riley, E.P., Clarren, S., Weinberg, J., Miller, N.S., Gold, M.S. (eds.)
Jonsson, E. (eds.)
Addictive Disorders in Medical
Fetal Alcohol Spectrum Populations
Disorder
2010
Management and Policy Perspectives
ISBN: 978 - 0 - 470 - 74033 - 0
of FASD
2011 Mitcheson, L., Maslin, J., Meynen, T.,
978 - 3 - 527 - 32839 - 0 Morrison, T., Hill, R., Wanigaratne, S.,
Padesky, C.A. (Foreword by)
Applied Cognitive and
Behavioural Approaches to
the Treatment of Addiction:
A Practical Treatment Guide
2010
ISBN: 978 - 0 - 470 - 51062 - 9
Edited by Sterling Clarren, Amy Salmon, and Egon Jonsson
Prevention of Fetal Alcohol Spectrum
Disorder FASD
Who is responsible?
The Editors Limit of Liability/Disclaimer of Warranty: While the
publisher and author have used their best efforts in
Prof. Sterling Clarren preparing this book, they make no representations
University of British Columbia or warranties with respect to the accuracy or
Faculty of Medicine completeness of the contents of this book and
L408 – 4480 Oak Street specifi cally disclaim any implied warranties of
Vancouver, BC V6H 3V4 merchantability or fi tness for a particular purpose.
Canada No warranty can be created or extended by sales
representatives or written sales materials. The
Dr. Amy Salmon Advice and strategies contained herein may not be
University of British Columbia suitable for your situation. You should consult with
Faculty of Medicine a professional where appropriate. Neither the
E202 – 4500 Oak Street publisher nor authors shall be liable for any loss of
Vancouver, BC V6H 3N1 profi t or any other commercial damages, including
Canada but not limited to special, incidental, consequential,
or other damages.
Prof. Dr. Egon Jonsson
University of Calgary Library of Congress Card No.: applied for
Department of Public
British Library Cataloguing-in-Publication Data
Health Sciences
A catalogue record for this book is available from
CEO Institute of Health
the British Library.
Economics
1200 10405 Jasper Avenue
Bibliographic information published by the
Edmonton, AB T5J 3N4
Deutsche Nationalbibliothek
Canada
The Deutsche Nationalbibliothek lists this
publication in the Deutsche Nationalbibliografi e;
Series Editor
detailed bibliographic data are available on the
Internet at <http://dnb.d-nb.de>.
Prof. Dr. Egon Jonsson
University of Calgary
© 2011 Wiley-VCH Verlag & Co. KGaA,
Department of Public
Boschstr. 12, 69469 Weinheim, Germany
Health Sciences
Institute of Health Economics Wiley-Blackwell is an imprint of John Wiley &
1200 10405 Jasper Avenue Sons, formed by the merger of Wiley’s global
Edmonton, AB T5J 3N4 Scientifi c, Technical, and Medical business with
Canada Blackwell Publishing.
Cover All rights reserved (including those of translation
Oil painting on canvas by into other languages). No part of this book may be
Egon Jonsson reproduced in any form – by photoprinting,
microfi lm, or any other means – nor transmitted or
translated into a machine language without written
permission from the publishers. Registered names,
trademarks, etc. used in this book, even when not
specifi cally marked as such, are not to be
considered unprotected by law.
Typesetting Toppan Best-set Premedia Limited,
Hong Kong
Printing and Binding betz-druck GmbH, Darmstadt
Cover Design Adam-Design, Weinheim
Printed in the Federal Republic of Germany
Printed on acid-free paper
ISBN Print: 978-3-527-32997-7
ISBN oBook: 978-3-527-63548-1
ISBN ePDF: 978-3-527-63550-4
ISBN ePub: 978-3-527-63549-8
ISBN Mobi: 978-3-527-63551-1
ISSN: 1864-9947
V
Contents
Preface XI
List of Contributors XIII
1 Introduction 1
Sterling Clarren, Amy Salmon, and Egon Jonsson
1.1 The Content of This Book 2
1.2 What is FASD? 4
1.3 How Common is FASD? 5
1.4 What is the Economic Burden of FASD? 6
1.4.1 Annual Cost Per Person with FASD 6
1.4.2 Comparing Costs 7
1.4.3 Cost of Prevention versus Cost of Inaction 8
1.5 Approaches to FASD Prevention 9
1.5.1 Universal Prevention 9
1.5.2 Screening for Prenatal Alcohol Exposure in Obstetric Settings 11
1.5.2.1 Meconium Testing 12
1.5.2.2 Maternal Self-Reporting 12
1.5.3 Selective Prevention 13
1.5.4 Indicated Prevention 14
1.6 FASD Prevention in Aboriginal Communities 16
1.7 Main obstacles to Preventing FASD 17
1.8 Challenges in Measuring Effectiveness of FASD Prevention
Initiatives 18
1.9 Who is Responsible for the Prevention of FASD? 19
References 21
2 An Overview of Systematic Reviews on the Prevention, Diagnosis, and
Treatment of Fetal Alcohol Spectrum Disorder 27
Maria Ospina, Carmen Moga, Liz Dennett, and Christa Harstall
2.1 Introduction 32
2.2 Objective and Scope 34
2.3 Methodological Approach 34
2.3.1 Elements of Assessment 34
VI Contents
2.4 Results 35
2.4.1 Search Results 35
2.4.1.1 Characteristics of Systematic Reviews Included in the Overview 36
2.4.2 Systematic Reviews on Prevention of FASD and Prenatal
Alcohol Use 37
2.4.2.1 General Characteristics 37
2.4.2.2 Methodological Characteristics of Systematic Reviews on Prevention
of FASD and Prenatal Alcohol Use 40
2.4.3 Methodological Quality of Systematic Reviews on Prevention of FASD
and Prenatal Alcohol Use 42
2.4.3.1 Characteristics of the Evidence Presented in the Systematic Reviews
on Prevention Approaches to FASD and Prenatal Alcohol Use 43
2.4.3.2 Qualitative Synthesis of the Evidence on the Effectiveness of
Prevention Approaches to FASD and Prenatal Alcohol Use 44
2.4.3.3 Highlights of the Overall Results 51
2.4.4 Systematic Reviews on the Diagnosis of FASD 54
2.4.4.1 General Characteristics 54
2.4.4.2 Methodological Characteristics of the Systematic Review on
Diagnosis of FASD 55
2.4.4.3 Methodological Quality of Systematic Reviews on Diagnosis
of FASD 55
2.4.4.4 Characteristics of the Evidence Presented in the Systematic Review on
the Effectiveness of Diagnostic Approaches to FASD 56
2.4.4.5 Qualitative Synthesis of the Evidence on the Effectiveness of
Diagnostic Approaches to FASD 57
2.4.4.6 Highlights of the Overall Results 59
2.4.5 Systematic Reviews on the Treatment of FASD 59
2.4.5.1 General Characteristics 59
2.4.5.2 Methodological Characteristics of Systematic Reviews on Therapeutic
Approaches to FASD 61
2.4.5.3 Methodological Quality of Systematic Reviews on Therapeutic
Approaches to FASD 62
2.4.5.4 Characteristics of the Evidence Presented in the Systematic Reviews
on Therapeutic Approaches to FASD 62
2.4.5.5 Qualitative Synthesis of the Evidence on the Effectiveness of
Therapeutic Approaches to FASD 64
2.4.5.6 Highlights of the Overall Results 69
2.5 Discussion 69
2.5.1 FASD Prevention 71
2.5.2 FASD Diagnosis 72
2.5.3 FASD Treatment 73
2.5.4 Methodological Quality of the Overview of Systematic Reviews 73
2.5.4.1 Strengths and Limitations 73
2.6 Conclusions 74
Appendix 2.A: Methodology 74
Contents VII
Search Strategy 74
Study Selection Process 74
Data Extraction 78
Methodological Quality Assessment 78
Data Analysis and Synthesis of the Results 81
Appendix 2.B: Excluded Studies and Multiple Publications 81
Excluded Research Studies 81
Multiple Publications of Studies Included in the Review 83
Appendix 2.C: Summary Tables of Overall Characteristics of
Systematic Reviews on Prevention, Diagnosis, and Treatment of
FASD 84
Appendix 2.D: Methodological Quality of Systematic Reviews Included
in the Overview 93
References 96
3 A Systematic Review of the Effectiveness of Prevention Approaches for
Fetal Alcohol Spectrum Disorder 99
Maria Ospina, Carmen Moga, Liz Dennett, and Christa Harstall
3.1 Introduction 105
3.2 Objective and Scope 108
3.3 Methodological Approach 108
3.3.1 Elements of Assessment 108
3.4 Studies on the Effectiveness of FASD Preventive Approaches 109
3.4.1 Search Results 109
3.4.2 Characteristics of Included Studies 110
3.4.2.1 General Characteristics 110
3.4.2.2 Characteristics of the Populations 111
3.4.2.3 Characteristics of the Interventions 112
3.4.2.4 Components of the Interventions 113
3.4.2.5 Characteristics of the Outcomes 115
3.4.2.6 Types of Result Reported in the Individual Studies 115
3.4.3 Methodological Quality of the Studies 118
3.4.4 Highlights of the Overall Results 119
3.4.4.1 Populations 120
3.4.4.2 Interventions 120
3.4.4.3 Outcomes 120
3.4.4.4 Methodological Quality 121
3.5 Evidence on the Effectiveness of Universal Prevention Approaches for
FASD 121
3.5.1 Characteristics of Included Studies 121
3.5.1.1 General Characteristics 121
3.5.1.2 Characteristics of the Populations 122
3.5.1.3 Characteristics of the Interventions 122
3.5.1.4 Components of the Interventions 125
3.5.1.5 Characteristics of the Outcomes 125
VIII Contents
3.5.1.6 Types of Result Reported in the Individual Studies 125
3.5.2 Methodological Quality of the Studies 128
3.5.3 Results of Qualitative Synthesis of the Evidence 130
3.5.3.1 Clinical Trials 130
3.5.3.2 Observational Studies 131
3.5.4 Summary of the Overall Results 137
3.5.4.1 General Characteristics 137
3.5.4.2 Populations 137
3.5.4.3 Interventions 137
3.5.4.4 Outcomes 137
3.5.4.5 Methodological Quality of the Studies 138
3.5.4.6 Evidence on the Effectiveness of Universal Prevention
Approaches 138
3.6 Evidence on the Effectiveness of Selective Prevention Approaches
for FASD 145
3.6.1 Characteristics of Included Studies 145
3.6.1.1 General Characteristics 145
3.6.1.2 Characteristics of the Populations 145
3.6.1.3 Characteristics of the Interventions 146
3.6.1.4 Components of the Interventions 147
3.6.1.5 Characteristics of the Outcomes 149
3.6.1.6 Types of Result Reported in the Individual Studies 149
3.6.2 Methodological Quality of the Studies 152
3.6.3 Results of Qualitative Synthesis of the Evidence 154
3.6.3.1 Clinical Trials 154
3.6.3.2 Observational Studies 161
3.6.4 Summary of the Overall Results 164
3.6.4.1 General Characteristics 164
3.6.4.2 Populations 165
3.6.4.3 Interventions 165
3.6.4.4 Outcomes 165
3.6.4.5 Methodological Quality of the Studies 165
3.6.4.6 Evidence on the Effectiveness of Selective Prevention
Approaches 165
3.7 Evidence on the Effectiveness of Indicated Prevention Approaches
for FASD 173
3.7.1 Characteristics of Included Studies 173
3.7.1.1 General Characteristics 173
3.7.1.2 Characteristics of the Populations 174
3.7.1.3 Characteristics of the Interventions 174
3.7.1.4 Components of the Interventions 175
3.7.1.5 Characteristics of the Outcomes 176
3.7.1.6 Types of Result Reported in the Individual Studies 178
3.7.2 Methodological Quality of the Studies 178
Contents IX
3.7.3 Results of Qualitative Synthesis of the Evidence 180
3.7.3.1 Clinical Trials 181
3.7.3.2 Observational Studies 182
3.7.4 Summary of the Overall Results 184
3.7.4.1 General Characteristics 184
3.7.4.2 Populations 185
3.7.4.3 Interventions 185
3.7.4.4 Outcomes 185
3.7.4.5 Methodological Quality of the Studies 185
3.7.4.6 Evidence on the Effectiveness of Indicated
Prevention Approaches 185
3.7.5 Analysis of Publication Bias 189
3.8 Discussion 189
3.8.1 Characteristics of the Study Populations 189
3.8.2 Characteristics of the Interventions 191
3.8.3 Characteristics of Study Outcomes 191
3.8.4 Methodological Quality of the Studies 192
3.8.5 Main Findings 193
3.8.6 Universal Prevention Approaches 193
3.8.7 Selective Prevention Approaches 194
3.8.8 Indicated Prevention Approaches 195
3.8.9 Strengths and Limitations 195
3.8.10 Methodological Issues and Research Directions in the Evaluation of
FASD Prevention Interventions 196
3.9 Conclusions 198
Acknowledgments 199
Competing Interest 200
Appendix 3.A: Methodology 200
Search Strategy 200
Study Selection Process 207
Data Extraction 208
Methodological Quality Assessment 208
Data Analysis and Synthesis of the Results 213
Appendix 3.B: Excluded Studies, Multiple Publications and Studies
Pending Full Publication 213
Excluded Research Studies 213
Multiple Publications of Studies Included in the Review 222
Studies Pending Full Publication 223
Appendix 3.C: Summary Tables of Overall Characteristics of Studies
on Prevention Approaches to FASD 224
Appendix 3.D: Operational Defi nitions of Prevention Approaches
to FASD 235
Appendix 3.E: Study Evidence Tables 240
Appendix 3.F: Characteristics of the Interventions 304
