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Research from the University of California San Diego School of Medicine finds a significant number of children across four regions in the United States have fetal alcohol spectrum disorders (FASD). The new findings represent more accurate prevalence estimates of FASD among the general population than prior studies.
The study is published online in the Journal of the American Medical Association.
More than 6,000 first-graders in the Pacific, Southwest, Midwest, Rocky Mountain and Southeast regions of the U.S. were evaluated.
"Our comprehensive approach reflects estimates that more closely resemble the prevalence of FASD in the United States and further highlights the burden of the disorders," explains Christina Chambers, PhD, MPH, co-principal investigator of the study, and professor of pediatrics at UC San Diego School of Medicine and co-director of the UC San Diego Center for Better Beginnings.
FASD stands for Fetal Alcohol System Disorder and is an umbrella term describing the range of effects that can occur to a child whose mother drank alcohol during pregnancy. Some of the features include a small head, below average weight, height, difficulty learning and behavioral problems.
Chambers explained historically estimating FASD prevalence was complex due to challenges obtaining information on a mother's prenatal alcohol use — as well as identifying physical and neurologic behavior characteristics in the child. At each site in the new study, first-graders were recruited for two academic years and evaluated based on current FASD criteria. Prenatal alcohol exposure was assessed by interviewing children's mothers or close relatives.
Frequency of FASD in the study ranged from about 11 to 50 children per 1,000 per region, the lowest estimate in one Midwestern region, and the highest in one Rocky Mountain region.
Of the 222 children diagnosed with FASD in the study, only two had been previously diagnosed, although many parents and guardians were aware of the children's learning and behavioral challenges.
"Our findings suggest that FASD is a critical health problem that often goes undiagnosed and misdiagnosed," said Chambers. "Prenatal alcohol exposure is the leading preventable cause of birth defects and neurological abnormalities in the United States. It can cause a range of developmental, cognitive and behavioral problems, which may be recognized at any time during childhood and can last a lifetime."
The cause of FASD is prenatal exposure to alcohol. In a survey by the U.S. Behavioral Risk Factor Surveillance System of more than 8,000 pregnant women, 10 percent reported recent drinking and 3 percent reported at least one "binge" episode within the previous 30 days. A pattern of binge drinking during pregnancy is thought to present the highest risk for FASD.
Chambers: "Although our findings from the four regions may not represent the nation overall, our goal is for these estimates to contribute to strategies expanding screening, prevention and treatment options for FASD. It is imperative we find a solution to this devastating health issue."
Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples.
To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States.
Design, Setting, and Participants
Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled..
Alcohol consumption during pregnancy.
Main Outcomes and Measures
Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation.
A total of 6639 children were selected for participation from a population of 13?146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children.
Conclusions and Relevance
Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.
Authors: Philip A. May PhD, Julie M. Hasken MPH, Wendy O. Kalberg LED, David Buckley, MA, Jennifer Zellner PhD, Haruna Feldman PhD, David Kopald, Ronghui Xu PhD, Gordon Honerkamp-Smith MS, Howard Taras MD, Keith Vaux MD, Natacha Akshoomoff PhD, Kenneth Lyons Jones MD, Melanie A. Manning MD, Luther K. Robinson MD, Margaret P. Adam MD, Omar Abdul-Rahman MD, Tamison Jewett, MD, Amy J. Elliott PhD, Julie A. Kable PhD, Claire D. Coles PhD, Daniel Falk PhD, Judith A. Arroyo PhD, Dale Hereld MD PhD, Kenneth R. Warren PhD, Edward P. Riley, PhD, San Diego State University, Michael Charness MD, H. Eugene Hoyme MD.
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THINK BEFORE YOU DRINK!
The occurance of Fetal ALcohol Syndrome Disease in USA children is at 14.6% per 1,000 births.
Image credit: USA Center for Disease Control