title: Prevalence of fetal alcohol spectrum disorders in child care settings: a meta-analysis.
abstract: BACKGROUND
  Children often enter a child-care system (eg, orphanage, foster care, child welfare system) because of unfavorable circumstances (eg, maternal alcohol and/or drug problems, child abuse/neglect). Such circumstances increase the odds of prenatal alcohol exposure, and thus this population can be regarded as high risk for fetal alcohol spectrum disorders (FASD). The primary objective was to estimate a pooled prevalence for fetal alcohol syndrome (FAS) and FASD in various child-care systems based on data from existing studies that used an active case ascertainment method.
  
  
  METHODS
  A systematic literature review, using multiple electronic bibliographic databases, and meta-analysis of internationally published and unpublished studies that reported the prevalence of FAS and/or FASD in all types of child-care systems were conducted. The pooled prevalence estimates and 95% confidence intervals (CIs) were calculated by using the Mantel-Haenszel method, assuming a random effects model. Sensitivity analyses were performed for studies that used either passive surveillance or mixed methods.
  
  
  RESULTS
  On the basis of studies that used active case ascertainment, the overall pooled prevalence of FAS and FASD among children and youth in the care of a child-care system was calculated to be 6.0% (60 per 1000; 95% CI: 38 to 85 per 1000) and 16.9% (169 per 1000; 95% CI: 109 to 238 per 1000), respectively.
  
  
  CONCLUSIONS
  The results confirm that children and youth housed in or under the guardianship of the wide range of child-care systems constitute a population that is high-risk for FASD. It is imperative that screening be implemented in these at-risk populations.
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell St, Toronto ON Canada M5S 2S1. lana.popova@camh.ca.
authors.forename: Shannon
authors.initials: S
authors.lastname: Lange
authors.forename: Kevin
authors.initials: K
authors.lastname: Shield
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.forename: Svetlana
authors.initials: S
authors.lastname: Popova
mesh_terms: D002648:Child; D002654:Child Care / Q000639:trends; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic / Q000639:trends
keywords: adoption; child-care settings; fetal alcohol spectrum disorder(s); fetal alcohol syndrome; meta-analysis; orphanages; prevalence; systematic literature review