The continuum of fetal alcohol spectrum disorders in four rural communities in south africa: Prevalence and characteristics

Abstract

Background Prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in previously unstudied rural, agricultural, lower socioeconomic populations in South Africa (ZA). Methods Using an active case ascertainment approach among first grade learners, 1354 (72.6%) were consented into the study via: height, weight, and/or head circumference ≤25th centile and/or random selection as normal control candidates. Final diagnoses were made following: examination by pediatric dysmorphologists/geneticists, cognitive/behavioral testing, and maternal risk factor interviews. Results FASD children were significantly growth deficient and dysmorphic: physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories from severe to mild to normal in a consistent, linear fashion. Neurodevelopmental delays were also significantly worse for each of the FASD diagnostic categories, although not as consistently linear across groups. Alcohol use is well documented as the proximal maternal risk factor for each diagnostic group. Significant distal maternal risk factors in this population are: low body weight, body mass, education, and income; and high gravidity, parity, and age at birth of the index child. In this low SES, highly rural region, FAS occurs in 93 – 128 per 1,000 children, PFAS in 58 – 86, and, ARND in 32 – 46 per 1,000. Total FASD affect 182 to 259 per 1,000 children or 18% to 26%. Conclusions Very high rates of FASD exist in these rural areas and isolated towns where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development.

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…While FASD is not yet in ICD, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders included ‘Neurobehavioral disorder associated with prenatal alcohol exposure’ under ‘conditions for further study’ as the first step before including it as a formal diagnosis for clinical use (see Supporting information, Appendix, Section III 58). Studies by May and co‐workers 59, 60, 61 give some indication of the full spectrum of FASD.…”

The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample

“…Significant growth restriction and marked dysmorphia are present in children with FAS, and less growth restriction and dysmorphia in children with PFAS; however, at least two of three cardinal facial features and a constellation of other minor anomalies are present with both FAS and PFAS. The clinical traits of FAS and PFAS have been clearly linked with prenatal alcohol exposure in thousands of cases and multiple correlation studies (May et al, 2011b, 2013b, 2016b); and these two diagnoses can be made by experienced physicians without direct documentation of alcohol exposure, after ruling out other malformation syndromes with similar phenotypes. In previous studies in WCP communities, it has rarely been necessary to diagnose a child with FAS or PFAS without strong evidence of prenatal alcohol use (May et al, 2008, 2013b).…”

Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders

“…In the study communities women have proven to be very candid in reporting their alcohol use, and heavy binge drinking is common and practiced regularly each weekend among large subsets of the population, even among many pregnant women [15]. Furthermore, FASD are more prevalent in these communities than in any other general population in the world [34,35]. Therefore we sought to determine if alcohol delivered to developing children via breastfeeding has any measureable independent effect on development.…”