The consequences of prenatal alcohol exposure have been highlighted by three new reports on fetal alcohol spectrum disorders (FASD) in a virtual issue of the journal Alcoholism: Clinical & Experimental Research. FASD is the umbrella term for the continuum of effects caused by prenatal drinking, encompassing the most severe form, fetal alcohol syndrome (FAS), and less severe forms including partial fetal alcohol syndrome (pFAS) and alcohol-related neurodevelopmental disorder (ARND). Children with FAS have poor growth, atypical facial features, and central nervous system problems, and all three conditions require evidence of neurobehavioral impairment for diagnosis.
The Collaboration on FASD Prevalence (CoFASP) study used the best available methods to estimate rates of FASD in four communities representative of different US regions—the Midwest, Rocky Mountains, Southeast, and Pacifc Southwest. Summary data published in 2018 showed that overall prevalence of FASD varied across the four communities, with the lowest possible estimates ranging from 1.1% to 5.0% and higher, yet still conservative estimates ranging from 3.1% of the population in a Southeastern sample to 9.9% in a Rocky Mountain sample; however, the prevalence in each location was higher than the previously accepted U.S. population estimate of around 1%. The latest reports describe the range of characteristics of children with FASD diagnoses in the Midwest, Rocky Mountain, and Southeastern communities, and maternal risk factors for FASD at each site. A fourth report, of data from a Pacific Southwest community, was published in late 2019*.
The CoFASP study in each location sought to actively identify cases of FASD among first-grade children in local schools, with parental consent. Children who showed poor growth or parent-reported developmental concerns in an initial screening stage underwent a full evaluation for FASD, as did random samples of children. Full evaluation involved detailed physical and facial assessments, neurobehaviorial tests, and parental/ teacher reports on behavior and functioning. The children’s mothers also provided information on alcohol use in pregnancy.
In all three locations in these papers, the racial and ethnic distribution of children with FASD reflected the composition of the overall school population; there were also no clear differences in socioeconomic status between those with and without an FASD diagnosis. As expected, pFAS and ARND were diagnosed more frequently than FAS in each community. By definition, children who qualified for an FASD diagnosis differed from those without FASD in relation to the specific diagnostic criteria for each condition, but other variations in characteristics were also apparent, both across and within each diagnostic category. Of note, children with FASD performed significantly worse across a range of neurobehavioral tests than children without FASD, with those with ARND consistently performing the most poorly.
Mothers of children with FASD in each location were more likely to report drinking before and during pregnancy, although it is likely that drinking during pregnancy itself was under-reported. Compared with non-drinking mothers, those who reported having 3 or more drinks per drinking day before they became pregnant had up to 17 times the odds of having a child with FASD. Other maternal risk factors for FASD included later recognition of pregnancy, later initiation of prenatal care, and use of drugs in addition to alcohol.
The data enhance understanding of the variable effects of FASD on children in different US communities, and of the women who may be particularly at risk of having alcohol-exposed pregnancies that result in harm. The findings will inform efforts to prevent, identify and manage FASD in these regions, and thereby help reduce the enormous burden of FASD on affected children, their parents, and communities.
*Chambers CD, et al. Fetal Alcohol Spectrum Disorders in a Pacific Southwest City: Maternal and Child Characteristics. Alcohol Clin Exp Res 2019;43(12):2578-90.
Fetal Alcohol Spectrum Disorders in a Rocky Mountain Region City: Child Characteristics, Maternal Risk Traits, and Prevalence. P.A. May, J. M. Hasken, R. Bozeman, J.-V. Jones, M.K. Burns, J. Goodover, W.O. Kalberg, D. Buckley, M. Brooks, M.A. Ortega, A.J. Elliott, D.M. Hedrick, B.G. Tabachnick, O. Abdul-Rahman, M.P. Adam, T. Jewett, L.K. Robinson, M. Manning, H.E. Hoyme (pages xxx).
ACER-19-4068.R1.
Fetal Alcohol Spectrum Disorders in a Midwestern City: Child Characteristics, Maternal Risk Traits, and Prevalence. P.A. May, J. Hasken, A. Baete, J. Russo, A.J.
Elliott, W.O. Kalberg, D. Buckley, M. Brooks, M.A. Ortega, D.M. Hedrick, B.G. Tabachnick, O. Abdul-Rahman, M.P. Adam, T. Jewett, L.K. Robinson, M. Manning, H.E. Hoyme (pages xxx).
ACER-19-4069.R1.
Fetal Alcohol Spectrum Disorders in a Southeastern County of the United States: Child Characteristics and Maternal Risk Traits, P.A. May, J. Hasken, J. Stegall, H. Mastro, W.O. Kalberg, D. Buckley, M. Brooks, D.M. Hedrick, M.A. Ortega, A.J. Elliott, B. Tabachnick, O. Abdul-Rahman, M.P. Adam, L.K. Robinson, M.A. Manning, T. Jewett, H.E. Hoyme (pages xxx).
ACER-19-4070.R1.
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