Prevalence and characteristics of fetal alcohol syndrome and partial fetal alcohol syndrome in a Rocky Mountain Region City

Abstract

Background The prevalence and characteristics of fetal alcohol syndrome (FAS) and partial FAS (PFAS) in the United States (US) are not well known. Methods This active case ascertainment study in a Rocky Mountain Region City assessed the prevalence and traits of children with FAS and PFAS and linked them to maternal risk factors. Diagnoses made by expert clinical dysmorphologists in multidisciplinary case conferences utilized all components of the study: dysmorphology and physical growth; neurobehavior; and maternal risk interviews. Results Direct parental (active) consent was obtained for 1,278 children. Averages for key physical diagnostic traits and several other minor anomalies were significantly different among FAS, PFAS, and randomly-selected, normal controls. Cognitive tests and behavioral checklists discriminated the diagnostic groups from controls on 12 of 14 instruments. Mothers of children with FAS and PFAS were significantly lower in educational attainment, shorter, later in pregnancy recognition, and suffered more depression, and used marijuana and methamphetamine during their pregnancy. Most pre-pregnancy and pregnancy drinking measures were worse for mothers of FAS and PFAS. Excluding a significant difference in simply admitting drinking during the index pregnancy (FAS and PFAS = 75% vs. 39.4% for controls), most quantitative intergroup differences merely approached significance. This community’s prevalence of FAS is 2.9 to 7.5 per 1,000, PFAS is 7.9 to 17.7 per 1,000, and combined prevalence is 10.9 to 25.2 per 1,000 or 1.1% to 2.5%. Conclusions Comprehensive, active case ascertainment methods produced rates of FAS and PFAS higher than predicted by long-standing, popular estimates.

Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States

“…Similar plans of action have been proposed in the United States (Barry et al, 2009) Note. Please see Tables 1 and 3 (Burd et al, 1999;May et al, 2014May et al, , 2015Moberg et al, 2014;Poitra et al, 2003;Sokol et al, 1986;Weiss et al, 2004) 2 …”

Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders

“…Recent school-based studies in the United States estimate the prevalence of FASD to be much higher than previously thought. May et al 13 recently recorded combined rates of FAS and PFAS of 10.9 to 25.2 per 1000 (1.1%-2.5%) in a Rocky Mountain community, whereas the complete continuum of FASD (including ARND) was observed to be 24 to 48 per 1000 (2.4%-4.8%) in a community in the Northern Plains. 14 In the mixed race population of the Western Cape Province in South Africa, the highest prevalence rates of FASD in the world have been documented, 135.1 to 207.5 per 1000 (13.5%-20.8%).…”

“…Although the dysmorphology contribution to FASD diagnoses is derived from objective evaluation of the face, a number of other minor anomalies have been observed consistently and more commonly in children prenatally exposed to alcohol than in nonexposed controls. 4,13,14,92,93 The clinical assessment of the presence or absence of these features should be part of the dysmorphology evaluation of children with potential FASD. The overall dysmorphic variation in any individual child can be quantified by calculation of a dysmorphology score (an updated dysmorphology scoring system based on objective observations of growth and minor anomalies in 370 children with FAS is presented in Table 5).…”

“…This guide was produced by analysis of photographs of >800 white children from school-based studies in the United States. 13,14 Scores are assessed separately for the philtrum and vermilion border; scores of 4 or 5 are compatible with FAS or PFAS. These functional domains were selected based on the empirical evidence of deficits in children prenatally exposed to alcohol and/or who have been given a diagnosis of FASD.…”

“…26,31 Asking about use of other potential teratogens during pregnancy is also important because, in addition to their own potential teratogenicity, women who abuse drugs are more likely to use alcohol during pregnancy. 13,14,32 Because in many populations it is likely that prenatal alcohol use will be denied completely or be significantly underreported, 13,14,[33][34][35] biomarkers can assist in documenting prenatal alcohol exposure. Most frequently, alcohol exposure information is collected retrospectively.…”