Abstract
Objective: Children with fetal alcohol spectrum disorder (FASD) are overrepresented in early intervention programs, foster care, special education, juvenile corrections, and mental health services. In this study, we examine relationships between FASD and non-FASD controls for adverse childhood experiences (ACEs), and neurodevelopmental disorders. Methods: A chart review was conducted among patients seen at our clinic from 2010-2017 with data on FASD, ACEs, neurodevelopmental diagnoses, and foster or residential care placement available. Results: Relative risk for FASD was increased in patients with increased ACE scores (RR = 5.08), increased numbers of neurodevelopmental diagnoses (RR = 2.36), and patients who have been in foster or residential care (RR = 9.53). FASD risk increased as ACE scores or the number of neurodevelopmental diagnoses increased. Patients with any ACEs were 3.96 times more likely to have FASD, and those with eight or more ACEs were 6.31 times more likely to have FASD than those with no ACEs. Patients with three or more neurodevelopmental diagnoses were 6.55 times more likely to have FASD than those with two or fewer diagnoses. Nine or more diagnoses increased the risk for FASD ten-fold (RR = 10.91). Conversely, patients diagnosed with FASD were more likely to have at least three ACEs (RR = 3.71), at least five neurodevelopmental diagnoses (RR = 1.61), and high rates of previous foster or residential care placement (RR = 5.39). Conclusion: This study demonstrates that all children being considered for placement in foster care or residential should be screened for FASD.
Highlights
Alcohol use among women of childbearing age in the United States continues to rise despite its well-established teratogenic effects and widespread recommendations against alcohol use during pregnancy [1]
A chart review was conducted among patients seen at our clinic from 2010-2017 with data on fetal alcohol spectrum disorder (FASD), adverse childhood experiences (ACEs), neurodevelopmental diagnoses, and foster or residential care placement available
This study demonstrates that all children being considered for placement in foster care or residential should be screened for FASD
Summary
Alcohol use among women of childbearing age in the United States continues to rise despite its well-established teratogenic effects and widespread recommendations against alcohol use during pregnancy [1]. More than half of all nonpregnant women of childbearing age report alcohol use during the previous month, and more than one in six report binge drinking in that time [2]. Another study reported that rates of prenatal alcohol exposure were 8.5% in the second month of pregnancy, decreased to 5.5% in the third month, and increased to 7.4% and 7.9% during the second and third trimesters respectively [3] Considering these findings and the typical period of time during which a woman may be unaware she is pregnant, it is estimated that first-trimester exposure rates may be as high as 56% for all women and 78.9% for women with recent alcohol dependence [4]
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