In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 to 6 in 1000 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of developmental and cognitive disabilities among Canadian children and its effects are life lasting. This study examined the necessity of allocating funds to FASD prevention and treatment programs by articulating the economic costs of prenatal exposure to alcohol. The current research addressed a gap in knowledge as analyses of costs to-date have calculated only partial costs associated with the disorder, reflecting gross underestimates of the true cost of FASD, and no study has been conducted in a Canadian setting. To estimate direct and indirect costs associated with FASD at the individual level. Research Design: A cross-sectional study design was used. Sample and Setting: One-hundred and forty-eight (148) parents of children with FASD, ages 1 to 21 years, living in urban and rural communities throughout Canada participated in the study. Procedure: Participants completed the Health Services Utilization Inventory (HSUI). The interviewer administered HSUI is a 25 page inventory designed to elicit direct and indirect costs associated with FASD. Key cost components were measured: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total costs were calculated at the patient level by summing the costs for each child in each cost component, and dividing by the sample size. A stepwise multiple regression analysis was used to identify factors that impacted on cost, and to calculate the adjusted annual costs associated with FASD. Total adjusted annual costs associated with FASD per child were $14,342 (95% CI, $12,986; $15,698). Severity of the child's condition, age of the child, and geographical setting significantly impacted on costs (p<0.001). The cost of FASD annually to Canada of those 1 to 21 years old, was $344,208,000 (95% CI $311,664,000; $376,752,000). The study results demonstrated that the profound cost burden of prenatal exposure to alcohol. Implications for practice, policy, and research are discussed.