Mortality in Fetal Alcohol Spectrum Disorders

Abstract

Objective: Mortality in FASD has not been well studied. In this paper we review published reports of mortality in FASD. Method: We searched using Pub Med for all years in all languages for reports of all-cause mortality associated with any FASD. Results: We located 26 papers reporting on 57 deaths. Cause of death was reported for 49/57 cases (86%). The two most prevalent potential causes of death were malformations of the heart (37 of 49 cases, 75.5%) which varied from atrial septal defect or patent ductus arteriosus to tetralogy of Fallot, hypoplastic left heart, aortic arch interruption, etc. and brain malformations (25 of 49, 51%) including microcephaly, hydrocephalus, porencephaly, agenesis/absence of the corpus callosum and semilobar holoprosencephaly. In several cases potential causal findings overlapped. The three most frequent other causes of death were sepsis (7 cases, 14.3%), kidney malformations (7 cases, 14.3%), and cancer (4 cases, 8.2%). Over half the deaths (30/55, 54.5%) occurred in the first year of life. Discussion: We found that congenital heart disease was the most common cause of death in people with FASD. This may be due to an ascertainment bias since many of the published studies were focused on congenital heart disease in FASD. We conclude that FASD is frequently undetected in mortality events and could be a common finding in infant, child, adolescent and adult mortality.

Fetal Alcohol Spectrum Disorder: Risk for Diabetes and Congenital Heart Defects

“…Thus, several hundred thousand pregnancies have PAE exposure at levels increasing risk for FASD. Whilst PAE can result in damage to any of the organ systems, the heart and brain appear to be the two most commonly reported organ systems [20]. However, recently Patel et al have reported that they found no increase in risk for non-syndromic atrioventricular septal defects attributable to maternal alcohol consumption in a large data set from the National Birth Defects Prevention Study [22].…”

“…Case study reviews undertaken by Thompson et al relating to FASD and mortality indicate that there is an early age of death distribution which they found surprising given that a diagnosis of FASD is difficult in infancy and early childhood [20]. In fact, a diagnosis of FASD is often delayed until middle childhood and mortality rates in FASD are increased [23].…”

“…The study undertaken in the United States in 2013 and reported earlier, identified 57 deaths occurring in individuals with FASD and a potential cause of death for 49 (86%) [20]. It reported that the most common cause of death in individuals with FASD was CHD 37/49 (75.5%) with suspected or confirmed CHD including atrial septal defect, patent ductus arteriosus, tetralogy of Fallot, hypoplastic left heart, aortic arch interruption, etc.…”

“…The prevalence of alcohol exposure decreases from 50% prior to pregnancy recognition to around 10% upon recognition of pregnancy. About 3%-5% of women continue to drink throughout pregnancy and many drink heavily, more than five drinks per occasion and often several times per week [20,10]. Thus, several hundred thousand pregnancies have PAE exposure at levels increasing risk for FASD.…”

“…In essence, alcohol abuse in adolescence and young adults establishes a vicious cycle whereby impaired judgement and cognition increase the risk of causing PAE. Thus, the long-term consequences of PAE range from behavioural abnormalities to learning disabilities, ADHD to mental retardation [19,20] and FASD [10].…”