title: Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis.
abstract: BACKGROUND
  Fetal alcohol spectrum disorder (FASD) is related to many comorbidities because of the permanent effects of prenatal alcohol exposure on the fetus. We aimed to identify the comorbid conditions that co-occur in individuals with FASD and estimate the pooled prevalence of comorbid conditions occurring in individuals with fetal alcohol syndrome (FAS).
  
  
  METHODS
  We did a systematic literature search of studies reporting on the comorbidity and cause of death in individuals with FASD using multiple electronic bibliographic databases, searching for studies published up to July, 2012. We included original research published in a peer-reviewed journal in the English language. We used the following criteria for determining study quality: use of an established FASD diagnostic guideline, study setting, method of data collection, and sample size. All comorbid disease conditions were coded according to the International Classification of Diseases, tenth revision (ICD-10). To estimate the pooled prevalence of comorbid conditions found to co-occur in individuals with FAS, we did meta-analyses assuming a random-effects model.
  
  
  RESULTS
  Of 5068 studies found, 127 met eligibility criteria for data extraction. From those studies, we identified 428 comorbid conditions co-occurring in individuals with FASD, spanning across 18 of 22 chapters of the ICD-10. The most prevalent disease conditions were within the sections of congenital malformations, deformities, and chromosomal abnormalities, and mental and behavioural disorders. 33 studies reported data for frequency in a total of 1728 participants with FAS. The five comorbid conditions with the highest pooled prevalence (between 50% and 91%) included abnormal results of function studies of peripheral nervous system and special senses, conduct disorder, receptive language disorder, chronic serous otitis media, and expressive language disorder.
  
  
  CONCLUSIONS
  The high prevalence of comorbid conditions in individuals with FASD highlights the importance of assessing prenatal alcohol exposure as a substantial clinical risk factor for comorbidity. The harmful effects of alcohol on a developing fetus represent many cases of preventable disability, and thus, alcohol use during pregnancy should be recognised as a public health problem globally.
  
  
  BACKGROUND
  Public Health Agency of Canada.
authors.affiliation: Social and Epidemiological Research Department, 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, University of Toronto, Toronto, ON, Canada. Electronic address: lana.popova@camh.ca.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Popova
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Lange
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Shield
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors.forename: Alanna
authors.initials: A
authors.lastname: Mihic
authors.affiliation: Program in Genetics and Metabolism, Children's Hospital, Departments of Pediatrics and Child Health and Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Albert E
authors.initials: AE
authors.lastname: Chudley
authors.affiliation: FASD Specialist Behaviour Clinic, Surrey and Border's Partnership NHS Foundation Trust, Oxted, UK.
authors.forename: Raja A S
authors.initials: RAS
authors.lastname: Mukherjee
authors.affiliation: School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bekmuradov
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Epidemiological Research Unit, Klinische Psychologie and Psychotherapie, Technische Universität Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D015897:Comorbidity; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence