Authors' recommendations: The review conclusions are based on the current evidence available from this report‟s critical appraisal of literature published on the effectiveness of FASD prevention strategies, screening tools, diagnostic systems and management strategies.A detailed evaluation of FASD prevention programs and prenatal screening was performed. However, the interventions assessed varied widely, and the studies were generally of poor to fair methodological quality. While a small number of prevention strategies appear to have shown a beneficial effect on the reduction of alcohol consumption in pregnant women (e.g., alcohol prohibition and intensive alcohol rehabilitation), there are issues surrounding the interpretation of these results with regards to potential biases and the implementation of these strategies to the New Zealand setting. However, although many of the reviewed studies did not detect asignificant difference between the intervention of interest and a control group (who were typically given information about drinking during pregnancy), a reduction in alcohol consumption was commonly observed in women in the control group. A valid interpretation may be that simple interventions are effective, but that more intensive interventions do not necessarily add to that effectiveness. The simple interventions described in the literature involved the women being told about the effects of alcohol during pregnancy by their health care provider or via a letter or pamphlet. Two screening tools, the TWEAK and T-ACE have been specifically designed for use in the prenatal setting. All identified publications reported that the T-ACE and TWEAK were at least as effective as other general screening tools and were generally shorter and easier to administer. The combined evidence from the literature indicates that these are the most appropriate screening tools to use in the clinical setting. A limited review of high level evidence was carried out for postnatal screening and diagnosis, and management of FASD. There was very little high level evidence available for these strategies and as such it was not possible to identify which may be suitable for implementation in New Zealand. A review by Peadon 2008 found that the 4-Digit Diagnostic code was the most commonly used diagnostic criteria worldwide. There was broad agreement in the literature of the need for a multidisciplinary team (comprising of paediatricians, psychologists, psychiatrists, occupational therapists, speech therapists etc) in order to ensure optimal management of individuals with FASD. The specific disabilities experienced by individuals with FASD can vary significantly and consequently each individual requires a personalised management programme. The assessment of the published economic evidence suggests that FASD represents a significant economic burden (NZ$1.6-2.4 million per child over their lifetime); however, it is not appropriate to comment on the costs of the individual strategies assessed in the identified studies as the effectiveness of these strategies was not formally assessed in this review. That said, given the extent of the economic burden of FASD, it is more than likely that simple, relatively low cost prevention strategies would represent significant value for money from a societal perspective.

Project Status: Completed

URL for project: http://www.healthsac.net/downloads/publications/HSAC07_FASD_FINALv3.pdf

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: Health Services Assessment Collaboration

Contact Address: University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand

Contact Name: hsac@canterbury.ac.nz

Contact Email: hsac@canterbury.ac.nz

Copyright: Health Services Assessment Collaboration (HSAC)