Comorbidities associated with fetal alcohol spectrum disorders in the United States

The detrimental effects of prenatal alcohol exposure on the development of humans are well understood and include fetal alcohol spectrum disorders (FASD), a broad set of conditions referring to the adverse physical and behavioral health impairments associated with exposure to alcohol in utero. Using a case-control study design, the purpose of this study was to better understand the complex comorbidity patterns associated with FASD (N = 3,248) and to examine how they differ with the general patient population (N = 16,240) and a cohort of behavioral health controls (N = 16,240). Employing a novel unsupervised machine learning algorithm applied to a nationally representative hospital discharge database, we found 57 distinct comorbidities that frequently occurred among FASD cases, in addition to a set of 144 complex overlapping comorbidity patterns. The identified comorbidities were generally more likely to occur in the FASD cases compared to the general patient population control group, while differences with behavioral health controls were less readily apparent. This study adds to a small but growing body of research on comorbidities experienced by individuals with FASD. We discuss the implications of the identified comorbidity patterns on the ongoing identification, treatment, and surveillance of FASD in the US.