Estimated incidence and number of new cases with prenatal alcohol exposure and fetal alcohol spectrum disorders in Finland 1990–2025
8 affiliations
- 1Faculty of Medicine, The University of Helsinki, Helsinki, Finland.
- 2Division of Child Neurology, Päijät-Häme Central Hospital, Lahti, Finland.
- 3Faculty of Science, The University of Helsinki, Helsinki, Finland.
- 4Department of Environmental and Biological Sciences, The University of Eastern Finland, Joensuu, Finland.
- 5Department of Data and Analytics, THL Finnish Institute for Health and Welfare, Helsinki, Finland.
- 6Department of Molecular Medicine and Surgery, Karolinska Institute and Academic Primary Health Care Centre, Stockholm, Sweden.
- 7Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
- 8Division of Child Neurology, University of Helsinki, New Children's hospital, Helsinki, Finland.
Abstract
Background: Fetal alcohol spectrum disorders (FASD) arising from prenatal alcohol exposure (PAE) are the leading preventable cause of neurobehavioral disorders. Early pregnancy is particularly vulnerable to ethanol toxicity, yet alcohol use often continues until pregnancy recognition. In Finland, national incidence estimates of PAE and FASD remain limited. Objective: To estimate the incidence of any PAE and heavy PAE in Finland between 1990 and 2025, and to model the annual number of children with FASD born in Finland. Methods: We developed a mathematical modelling framework integrating studies on alcohol use during pregnancy in Finland, biomarker-based estimates of heavy PAE, national population statistics, and international active case ascertainment studies on FASD prevalence. Incidence of any PAE was estimated from self-reported alcohol use, including pre-recognition exposure. Heavy PAE was estimated by combining binge-drinking prevalence, delayed pregnancy recognition, biomarker data and anonymous self-reports. FASD incidence was modelled using two approaches: 1) an international multiplier linking FASD prevalence to heavy episodic drinking prevalence among women (Model M), and 2) a conventional epidemiological ratio between any PAE and FASD (Model L). Results: Self-reported alcohol use during pregnancy declined following abstinence recommendations in the early 2000s, while pre-recognition use remained relatively stable. Heavy PAE decreased from 9% (uncertainty range 7–11%) in the 1990s to 6% (4–8%) in the early 2020s. Any PAE declined from 75% (60–85%) to 32% (26–38%). Modelled FASD incidence showed similar decreasing trends, ranging from 6.8% to 5.6% (Model M), and from 6% to 3% (Model L). Conclusion: PAE remains common in Finland, and the burden of FASD is substantial despite declining trends. Additional biomarker-based studies of PAE and active case ascertainment of FASD are needed to refine current estimates. Strengthened public health efforts to reduce PAE, including the efforts before recognition of pregnancy, are essential.
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BibTeX
@article{jolma2026estimated,
title = {{Estimated incidence and number of new cases with prenatal alcohol exposure and fetal alcohol spectrum disorders in Finland 1990–2025}},
author = {Mirjami Jolma and Mikko Koivu-Jolma and Mika Gissler and Anne Sarajuuri and Ilona Autti-Rämö},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0349964},
url = {https://doi.org/10.1371/journal.pone.0349964},
note = {CC BY},
}
RIS
TY - JOUR
TI - Estimated incidence and number of new cases with prenatal alcohol exposure and fetal alcohol spectrum disorders in Finland 1990–2025
AU - Mirjami Jolma
AU - Mikko Koivu-Jolma
AU - Mika Gissler
AU - Anne Sarajuuri
AU - Ilona Autti-Rämö
PY - 2026
DA - 2026/10/21
JO - PLOS One
DO - 10.1371/journal.pone.0349964
UR - https://doi.org/10.1371/journal.pone.0349964
AB - Background: Fetal alcohol spectrum disorders (FASD) arising from prenatal alcohol exposure (PAE) are the leading preventable cause of neurobehavioral disorders. Early pregnancy is particularly vulnerable to ethanol toxicity, yet alcohol use often continues until pregnancy recognition. In Finland, national incidence estimates of PAE and FASD remain limited. Objective: To estimate the incidence of any PAE and heavy PAE in Finland between 1990 and 2025, and to model the annual number of children with FASD born in Finland. Methods: We developed a mathematical modelling framework integrating studies on alcohol use during pregnancy in Finland, biomarker-based estimates of heavy PAE, national population statistics, and international active case ascertainment studies on FASD prevalence. Incidence of any PAE was estimated from self-reported alcohol use, including pre-recognition exposure. Heavy PAE was estimated by combining binge-drinking prevalence, delayed pregnancy recognition, biomarker data and anonymous self-reports. FASD incidence was modelled using two approaches: 1) an international multiplier linking FASD prevalence to heavy episodic drinking prevalence among women (Model M), and 2) a conventional epidemiological ratio between any PAE and FASD (Model L). Results: Self-reported alcohol use during pregnancy declined following abstinence recommendations in the early 2000s, while pre-recognition use remained relatively stable. Heavy PAE decreased from 9% (uncertainty range 7–11%) in the 1990s to 6% (4–8%) in the early 2020s. Any PAE declined from 75% (60–85%) to 32% (26–38%). Modelled FASD incidence showed similar decreasing trends, ranging from 6.8% to 5.6% (Model M), and from 6% to 3% (Model L). Conclusion: PAE remains common in Finland, and the burden of FASD is substantial despite declining trends. Additional biomarker-based studies of PAE and active case ascertainment of FASD are needed to refine current estimates. Strengthened public health efforts to reduce PAE, including the efforts before recognition of pregnancy, are essential.
SN - 1932-6203
ER -