Prevalence Of Fetal Alcohol Syndrome Research Articles

A multi-year, multi-site study of the prevalence of fetal alcohol syndrome in South Africa.

South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. The cross-sectional epidemiological study used an active case-ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered-screening recruitment and diagnostic process. Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6-251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5-78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4-89.9). As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address.

Alcohol per capita and prevalence of alcohol exposed pregnancies: systematic review and meta-analysis

Abstract Background Alcohol is a teratogen that crosses the placenta. While studies have estimated the global burden of alcohol use in pregnancy, reliable and valid data on alcohol consumption during pregnancy in many countries is lacking. Alcohol consumption per capita (APC) data are available worldwide. This systematic review, by investigating the association between APC and alcohol consumption in pregnancy by country, aims to evaluate the accuracy of using APC data to predict the prevalence of prenatal alcohol exposure (PAE). Methods This study combines studies identified in a systematic review by Popova et al. 2017 and a systematic search of MEDLINE from 2015 through 6th October 2022, to identify additional papers. Papers identified in either search were on the prevalence of PAE or fetal alcohol syndrome (FAS). Two authors independently screened titles, abstracts, full-text articles and performed data extraction and quality assessment. APC data,per country, by year, was obtained from the World Health Organization (WHO) website. A meta-analysis, assuming a random effects model will be performed. Sensitivity analyses, including restricting by population, timing of exposure, time and method of ascertainment of alcohol consumption will be carried out. Results Of 24,935 PAE and 12,231 FAS prevalence articles identified, 400 PAE studies and 77 FAS studies met the inclusion criteria. Studies represent data from 1959-2020 from all 6 WHO regions, with APC between 0.012-14.78. Preliminary analysis suggests a statistically significant correlation between prevalence of alcohol consumption during pregnancy and APC. Conclusions Preliminary results from this study suggest that publicly available data on APC can be used to predict the population-based prevalence of alcohol use in pregnancy in different countries. Effective policies and interventions are required to reduce APC and thus, alcohol use in pregnancy and associated detrimental child health outcomes around the globe. Key messages • Knowing the prevalence of FAS and its main risk factor- prenatal alcohol use, will inform the setting of priorities for public health policy, public health initiatives, and health-care planning. • By investigating the association between alcohol intake in pregnancy and APC we will assess whether APC can predict alcohol intake in pregnancy.

Carl Bell, M.D., Honored for Work Advancing Correctional Health

Back to table of contents Previous article Next article MembersFull AccessCarl Bell, M.D., Honored for Work Advancing Correctional HealthMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Dec 2018https://doi.org/10.1176/appi.pn.2018.11b19AbstractBell has advocated for what he calls “bent nail” research—rudimentary research undertaken by mental health professionals in African-American communities as a solution to the paucity of knowledge about this population. The National Commission on Correctional Health Care (NCCHC) has awarded the 2018 Bernard P. Harrison Award of Merit to psychiatrist Carl Bell, M.D.Community psychiatrist Carl Bell, M.D., has focused his recent research on the prevalence of fetal alcohol syndrome among children on the south side of Chicago.David HathcoxThe award is NCCHC’s highest honor and is given annually to an individual or group that has demonstrated excellence and service advancing the correctional health care field, either through an individual project or a history of service. Bell, a longtime APA member, is a founding member of the NCCHC. He was the founder of the Community Mental Health Council on Chicago’s South Side, one of the largest community mental health clinics in the country. A prolific author, he is known for his work on black mental health and for advocating for ways to prevent mental illness. He is a distinguished life fellow of APA and is the recipient of many APA honors, including the Solomon Carter Fuller Award, Agnes Purcell McGavin Award, and the APA Special Presidential Commendation.Bell told Psychiatric News that he wants to encourage young psychiatrists to get involved with a professional organization such as the NCHHC. “Over time, take over the leadership of that organization and direct it in a way that would be helpful to people, such as I did with my side career in correctional health care,” he said. “It was the best public health, population-based work I have ever done.” Bell is a contributing author to the book Black Mental Health: Patients, Providers, and Systems, published this year by APA Publishing and edited by APA President Altha Stewart, M.D., Ezra Griffith, M.D., and Billy E. Jones, M.D., M.S. During APA’s IPS: The Mental Health Services Conference in Chicago, Bell joined Stewart, Jones, and others to talk about the book. Bell wrote the chapter titled “The Importance of ‘Bent Nail’ Research for African-American Populations,” in which he argued for African-American psychiatrists and other mental health professionals to conduct their own simple, empirical research in the communities where they work—what he called “bent nail” research. The term derived from Bell’s wanting to be a carpenter when he was a child but was too poor to buy the materials. He scoured alleys for wood and bent nails that he took home and hammered straight.“While recognizing the importance of pristine, formal academic research,” Bell wrote, “[I advocate] for ‘bent nail’ research, or rudimentary, basic clinical research as a solution to the paucity of knowledge about African-American mental health.” Most recently, Bell’s research has centered on the prevalence of fetal alcohol syndrome, which he believes is far more prevalent than is reported. In an analysis of school-aged children on the south side of Chicago using case ascertainment methods, he found that two-thirds to three-fourths of all youth sampled had symptoms that could be attributed to fetal alcohol exposure (Psychiatric News, March 1, 2018). APA leaders hailed Bell. “Congratulations to Dr. Bell for this well-deserved recognition,” said Stewart. “Dr. Bell is one of this nation’s leading psychiatrists, researchers, and mental health advocates. He has worked tirelessly for decades within the African-American community on the impact of trauma and violence on child development, prevention of neurocognitive disorders, and criminal and juvenile justice reforms, in addition to his efforts working with NCCHC to improve conditions in correctional health. Thanks to his pioneering ‘bent nail’ research and decades of advocacy in the U.S. and abroad, we know far more about how to prevent mental illness and provide appropriate care to underserved communities.”APA CEO and Medical Director Saul Levin, M.D., M.P.A., added: “Dr. Bell is a giant in our profession, a leader whose ground-breaking work is widely recognized by members in the medical community. Carl has been a mentor to many over his career, who today now serve in many leadership and clinical positions all across this country and internationally. He is highly deserving of this honor from the NCCHC.” ■ ISSUES NewArchived

The Prevalence of Fetal Alcohol Syndrome and Its Impact on a Child's Classroom Performance: A Case Study of a Rural South African School.

Alcohol consumption is high among farm labourers in the Western and Northern Cape of South Africa. Excessive alcohol consumption during pregnancy is common, resulting in a high prevalence of Fetal Alcohol Syndrome (FAS) among children. FAS causes intellectual and behavioural problems, which create considerable obstacles to a child’s education. The aim of this study is to provide a prevalence estimate of FAS in a rural school and to examine the effects of FAS on learners’ educational outcomes. The study was conducted at a farm school near Clanwilliam in the Western Cape of South Africa. The sample comprises 166 learners from Grades 1 to 4. Educational outcomes include class scores (Afrikaans home language and mathematics), reading ability, and classroom behaviour. A physician diagnosed FAS using a three-stage process. We find FAS prevalence of 127 per 1000 (12.7%). Children with FAS score significantly lower (at the 10% level) for home language and behaviour than children who do not have FAS. Large-scale interventions in rural areas of the Western and Northern Cape that specifically target females of child-bearing age, as well as children with FAS, are necessary.

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

BackgroundThe prevalence and characteristics of fetal alcohol syndrome (FAS) and partial FAS (PFAS) in the United States (US) are not well known. MethodsThis 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. ResultsDirect parental (active) consent was obtained for 1278 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 2.9–7.5 per 1000, PFAS is 7.9–17.7 per 1000, and combined prevalence is 10.9–25.2 per 1000 or 1.1–2.5%. ConclusionsComprehensive, active case ascertainment methods produced rates of FAS and PFAS higher than predicted by long-standing, popular estimates.

Prevalence of fetal alcohol syndrome in a South African city with a predominantly Black African population.

Fetal alcohol spectrum disorder (FASD) and fetal alcohol syndrome (FAS) are common in some South African populations, notably those of mixed ancestry descent in rural areas and small towns. Little is known about FAS/FASD prevalence in the majority of South Africans: city dwellers of Black African ethnicity. This study describes the prevalence of FAS in a South African city, comparing 2 suburbs with predominantly mixed ancestry (Roodepan) and Black African (Galeshewe) populations that house over 60% of the city population. We conducted a tiered, active case ascertainment study for the prevalence of FAS and also detected some less clinically specific FASD cases. All first-grade learners in the 2 suburbs were eligible for anthropometric screening, and screen-positive learners were assessed for dysmorphic features of FAS. Those with suggestive clinical features received neurocognitive assessment, and maternal or collateral interview. Final diagnosis was made following a case conference. Complete ascertainment of FAS status was made in 1,503 (94.7%) of 1,587 eligible learners (435 in Roodepan and 1,152 in Galeshewe). Overall, FAS was diagnosed in 83 (5.5%, 95% confidence interval [CI]=4.4 to 6.8) learners and FASD in 96 (6.4%, 95% CI=5.2 to 7.7). Levels of FAS were high in both areas: 26 (6.3%, 95% CI=4.2 to 9.2) learners from Roodepan, compared to 57 (5.2%, 95% CI=4.0 to 6.7) from Galeshewe (p=0.39). No cases were previously diagnosed. The mortality rate for mothers of FASD children from Galeshewe was 19 of 65 (29%), compared to 3 of 31 (9.7%; p=0.03) for Roodepan. Interviewed mothers in Galeshewe were older and had higher body mass index. Prevalence of FAS is high in both Galeshewe and Roodepan, and the lack of prior diagnoses indicates that awareness remains low. The maternal mortality rate was especially high in Galeshewe. The unexpectedly high burden of FAS in an urban area with predominantly Black African population mandates extension of surveillance and intervention measures in southern Africa.

Prevalence of fetal alcohol syndrome in a population-based sample of children living in remote Australia: the Lililwan Project.

Aboriginal leaders concerned about high rates of alcohol use in pregnancy invited researchers to determine the prevalence of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (pFAS) in their communities. Population-based prevalence study using active case ascertainment in children born in 2002/2003 and living in the Fitzroy Valley, in Western Australia (April 2010-November 2011) (n = 134). Socio-demographic and antenatal data, including alcohol use in pregnancy, were collected by interview with 127/134 (95%) consenting parents/care givers. Maternal/child medical records were reviewed. Interdisciplinary assessments were conducted for 108/134 (81%) children. FAS/pFAS prevalence was determined using modified Canadian diagnostic guidelines. In 127 pregnancies, alcohol was used in 55%. FAS or pFAS was diagnosed in 13/108 children, a prevalence of 120 per 1000 (95% confidence interval 70-196). Prenatal alcohol exposure was confirmed for all children with FAS/pFAS, 80% in the first trimester and 50% throughout pregnancy. Ten of 13 mothers had Alcohol Use Disorders Identification Test scores and all drank at a high-risk level. Of children with FAS/pFAS, 69% had microcephaly, 85% had weight deficiency and all had facial dysmorphology and central nervous system abnormality/impairment in three to eight domains. The population prevalence of FAS/pFAS in remote Aboriginal communities of the Fitzroy Valley is the highest reported in Australia and similar to that reported in high-risk populations internationally. Results are likely to be generalisable to other age groups in the Fitzroy Valley and other remote Australian communities with high-risk alcohol use during pregnancy. Prevention of FAS/pFAS is an urgent public health challenge.

"I drink": Mothers' alcohol consumption as both individualised and imposed occupation

INTRODUCTION: Occupational engagement is shaped by a person's history and the environment in which they live. Alcohol consumption as occupation may provide meaning for some, and may develop and change over a lifetime as shaped by environmental and historical context. The influence of contextual factors on alcohol consumption during pregnancy is explored in the current paper by exploring whether maternal alcohol consumption is an occupation of choice, or if the context presses for excessive alcohol consumption during pregnancy for certain communities. METHODOLOGY: A qualitative, instrumental case study was undertaken to focus on the occupational engagement of three black female participants within a rural community of low socio-economic status in the Western Cape, South Africa. Data were collected using extensive naturalistic observation and semi-structured interviews. A three-stage inductive thematic analysis was done. FINDINGS: Four themes emerged from the study; nothing comes easy, trying to make this life bearable, rekindling hope, and baking bread with little. These themes demonstrate the manner in which cultural, economic and political conditions play a pertinent role in the lives of these three women and how maternal alcohol consumption emerges within context, and as part of motherhood. CONCLUSIONS: The interplay between the context and occupation demonstrates how, through structural entrenchment, imposed occupations may arise. Historical, cultural, economic and socio-political factors perpetuate occupational inequities, and can translate into alcohol consumption during pregnancy. Generational poverty and the entrenchment of excessive drinking practices contribute equally to the prevalence of Fetal Alcohol Syndrome (FAS). Key words: generational poverty; maternal alcohol consumption as occupation; imposed occupations; Fetal Alcohol Syndrome

Exploring the feasibility of using electronic health records in the surveillance of fetal alcohol syndrome.

Explore the use of electronic health records (EHRs) in fetal alcohol syndrome (FAS) surveillance systems. Using EHRs we identified diagnoses and anthropometric measurements related to the FAS criteria developed by the Fetal Alcohol Syndrome Surveillance Network (FASSNet) among children aged 0 to 12 years. There were 143,393 distinct children aged between 0 and 12 years enrolled in Kaiser Permanente, Georgia, during the study period. Based on diagnoses and anthropometric measurements, 20,101 children met at least one criterion of interest, and when grouped into combinations of different criteria there were 2285 who met GROWTH+CNS criteria, 76 children who met GROWTH+FACE criteria, 107 children who met CNS+FACE criteria, and 93 children who met GROWTH+CNS+FACE criteria. The prevalence of FAS as defined by FASSNet is 1.92 per 1000 children. We linked 17,084 (85.0%) children to their mothers in the health plan; only 3% of mothers of children in the GROWTH+CNS+FACE group had an indication of alcohol or drugs use, but they had the highest rate of depression (39%). Data of utility in identification of FAS are readily available in EHRs and may serve as a basis for intervention with at-risk children and in planning of future FAS surveillance programs.

The Diagnosis of Fetal Alcohol Syndrome

The estimated prevalence of fetal alcohol syndrome (FAS) is 8 for every 1000 live births. FAS has serious, lifelong consequences for the affected children and their families. A variety of professionals deal with persons who have FAS, including pediatricians, general practitioners, neurologists, gynecologists, psychiatrists, and psychotherapists. Early diagnosis is important so that the affected children can receive the support they need in a protective environment. A multidisciplinary guideline group has issued recommendations for the diagnosis of FAS after assessment of the available scientific evidence. This information was derived from pertinent literature (2001-2011) retrieved by a systematic search in PubMed and the Cochrane Library, along with the US-American and Canadian guidelines and additional literature retrieved by a manual search. Of the 1383 publications retrieved by the searches, 178 were analyzed for the evidence they contained. It was concluded that the fully-developed clinical syndrome of FAS should be diagnosed on the basis of the following criteria: Patients must have at least one growth abnormality, e.g., short stature, as well as all three characteristic facial abnormalities-short palpebral fissure length, a thin upper lip, and a smooth philtrum. They must also have at least one diagnosed structural or functional abnormality of the central nervous system, e.g., microcephaly or impaired executive function. Confirmation of intrauterine exposure to alcohol is not obligatory for the diagnosis. Practical, evidence-based criteria have now been established for the diagnosis of the fully-developed FAS syndrome. More research is needed in order to enable uniform, evidence-based diagnostic assessment of all fetal alcohol spectrum disorders and optimize supportive measures for the children affected by them.

Prevalence of Fetal Alcohol Syndrome and Maternal Characteristics in a Sample of Schoolchildren from a Rural Province of Croatia

Fetal alcohol syndrome (FAS) is a congenital syndrome caused by maternal alcohol consumption during pregnancy and is entirely preventable by abstinence from alcohol drinking during this time. Little is known about the prevalence of FAS and maternal alcohol consumption during pregnancy in Western countries. We present the results of FAS/partial fetal alcohol syndrome (PFAS) prevalence study and maternal characteristics in a sample of schoolchildren from a rural province of Croatia. This study involved seven elementary schools with 1,110 enrolled children attending 1st to 4th grade and their mothers. We used an active case ascertainment method with passive parental consent and Clarified IOM criteria. The investigation protocol involved maternal data collection and clinical examination of children. Out of 1,110 mothers, 917 (82.6%) answered the questionnaire. Alcohol exposure during pregnancy was admitted by 11.5%, regular drinking by 4.0% and binge drinking by 1.4% of questioned mothers. Clinical examination involved 824 (74.2%) schoolchildren and disclosed 14 (1.7%) with clinical signs of FAS and 41 (5.0%) of PFAS. The observed FAS prevalence, based on 74.2% participation rate, was 16.9, PFAS 49.7 and combined prevalence was 66.7/1,000 examined schoolchildren. This is the first FAS prevalence study based on active ascertainment among schoolchildren and pregnancy alcohol drinking analysis performed in a rural community of Croatia and Europe. High prevalence of FAS/PFAS and pregnancy alcohol consumption observed in this study revealed that FAS is serious health problem in rural regions as well as a need to develop future studies and preventive measures for pregnancy alcohol drinking and FASD.

Burden of fetal alcohol syndrome in a rural West Coast area of South Africa

Fetal alcohol syndrome (FAS) is common in parts of South Africa; rural residence is a frequently cited risk factor. We conducted a FAS school prevalence survey of an isolated rural community in a West Coast village of Western Cape Province, so obtaining the first directly measured rate, focusing specifically on a South African rural area, of FAS and partial FAS (PFAS). The study area (Aurora village), a community of about 2 500 people in a grain-producing region, has one primary school. All learners were eligible for study inclusion. Initial anthropometry screening was followed by a diagnostic stage entailing examination by a dysmorphologist for features of FAS, neurodevelopmental assessment, and an interview assessing maternal alcohol consumption. Of 160 learners screened, 78 (49%) were screen-positive, of whom 63 (81%) were clinically assessed for FAS. The overall FAS/PFAS rate among the screened learners was 17.5% (95% confidence interval 12.0 - 24.2%), with 16 (10.0%) children having FAS and 12 (7.5%) PFAS. High rates of stunting, underweight and microcephaly were noted in all learners, especially those with FAS or PFAS. Five (18%) mothers of affected children were deceased by the time of assessment. We describe very high rates of FAS/PFAS in an isolated rural part of the Western Cape that is not located in a viticultural region. Our study suggests that the prevalence of FAS may be very high in isolated communities, or in particular hot-spots. It adds to the growing evidence that FAS/PFAS is a significant, and underestimated, health problem in South Africa. Expanded screening and surveillance programmes, and preventive interventions, are urgently needed.

Vitamin A, folate, and choline as a possible preventive intervention to fetal alcohol syndrome

It is recognized that alcohol consumption during pregnancy is associated with fetal alcohol syndrome (FAS). Alcohol can trigger a pattern of neurodegeneration in rat brains similar to other known gamma-aminobutyric acid (GABA) specific agonists. However this does not seem to explain FAS entirely, as impoverished care-giving environments have been shown to increase the risk of FAS. Individuals living under the poverty level are at risk for micronutrient deficiencies due to insufficient intake. In particular, three nutrients commonly found to be deficient are folate, choline and vitamin A. There is evidence to suggest that ethanol alone may not explain the entire spectrum of anomalies seen in individuals with FAS. It is hypothesized that FAS may be caused more by the nutritional deficiencies that are exacerbated by alcohol than by direct alcoholic neurotoxicity.It is known that ethanol inhibits folate, choline, and vitamin A/retinoic acid metabolism at multiple steps. Additionally, mice exposed to ethanol demonstrated epigenetic changes, or variations in the methylation of DNA to control gene expression. Folate is important in the production of methyl groups, which are subsequently used to create and methylate DNA. Choline (which is metabolized to acetylcholine) is important in neurotransmission and neurodevelopment. It is also involved in an alternative pathway in the production of methyl groups. In fact a study by Thomas et al. in 2009 found that nutritional supplementation with choline in rats exposed to ethanol in utero almost completely mitigated the degenerative effects of ethanol on development and behaviour. Lastly, vitamin A and retinoic acid metabolism is associated with the regulation of one sixth of the entire proteome. Thus supplementation of folate, choline and vitamin A to mothers may mitigate the effects of the alcohol and reduce the severity or prevalence of FAS.

A survey of Italian and Spanish neonatologists and paediatricians regarding awareness of the diagnosis of FAS and FASD and maternal ethanol use during pregnancy

BackgroundEthanol is the most widely used drug in the world and a human teratogen whose consumption among women of childbearing age has been steadily increasing. There are no Italian or Spanish statistics on ethanol consumption during pregnancy nor any information regarding prevalence of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD). There is also a reasonable suspicion that these two diseases are underdiagnosed by professionals from the above-reported countries. The objectives of this study were: 1) to evaluate the experience, knowledge and confidence of Italian and Spanish neonatologists and paediatricians with respect to the diagnosis of FAS and FASD, and 2) to evaluate professionals awareness of maternal drinking patterns during pregnancy.MethodsA multiple-choice anonymous questionnaire was e-mailed to Italian neonatologists registered in the mailing list of the corresponding Society and administered to Italian and Spanish paediatricians during their National Congress.ResultsThe response rate was 16% (63/400) for the Italian neonatologists of the National Society while a total of 152 Spanish and 41 Italian paediatricians agreed to complete the questionnaire during National Congress. Over 90% of the surveyed physicians declared that FAS is an identifiable syndrome and over 60% of them identified at least one of the most important features of FAS. Although over 60% Italian responders and around 80% Spanish responders were aware that ethanol use in pregnancy is dangerous, approximately 50% Italian responders and 40% Spanish ones allowed women to drink sometimes a glass of wine or beer during pregnancy.Neonatologists and paediatricians rated confidence in the ability to diagnosis FAS and FASD as low, with over 50% responders feeling they needed more information regarding FAS and FASD identification in newborn and child.ConclusionsItalian and Spanish neonatologists and paediatricians do not feel confident about diagnosing FAS and FASD. More training is needed in order to accurately diagnose ethanol use during pregnancy and correctly inform pregnant women on the consequences on the newborn.

Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in‐school studies

Researching the epidemiology and estimating the prevalence of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) for mainstream populations anywhere in the world has presented a challenge to researchers. Three major approaches have been used in the past: surveillance and record review systems, clinic-based studies, and active case ascertainment methods. The literature on each of these methods is reviewed citing the strengths, weaknesses, prevalence results, and other practical considerations for each method. Previous conclusions about the prevalence of FAS and total FASD in the United States (US) population are summarized. Active approaches which provide clinical outreach, recruitment, and diagnostic services in specific populations have been demonstrated to produce the highest prevalence estimates. We then describe and review studies utilizing in-school screening and diagnosis, a special type of active case ascertainment. Selected results from a number of in-school studies in South Africa, Italy, and the US are highlighted. The particular focus of the review is on the nature of the data produced from in-school methods and the specific prevalence rates of FAS and total FASD which have emanated from them. We conclude that FAS and other FASD are more prevalent in school populations, and therefore the general population, than previously estimated. We believe that the prevalence of FAS in typical, mixed-racial, and mixed-socioeconomic populations of the US is at least 2 to 7 per 1,000. Regarding all levels of FASD, we estimate that the current prevalence of FASD in populations of younger school children may be as high as 2-5% in the US and some Western European countries.

Intrauterine environment-genome interaction and Children's development (1): Ethanol: a teratogen in developing brain

Exposure to ethanol during prenatal development can have devastating consequences on developing fetuses, the so-called fetal alcohol spectrum disordres (FASD). Among FASD, cases that exhibit all of three criterion; 1) central nervous system dysfunction, 2) prenatal and postnatal growth deficiency, and 3) characteristic cranial/facial abnormalities, referred as fetal alcohol syndrome (FAS). Children born to drinking mothers may suffer from severe brain damage that is expressed by a variety of behavioral alterations. We examined the effects of ethanol exposure during brain development on brain morphogenesis and circadian rhythm using a rat model. Pregnant Sprague-Dawley (SD) rats were fed a liquid diet containing 2.5-5.0% (w/v) ethanol during gestational days 10 to 21. Mean daily ethanol consumption by these dams was 11.53 +/- 2.54 g/kg/day. In rats prenatally exposed to ethanol, ectopias on the cerebral cortex, aberrant distribution of hippocampal mossy fibers, and fusion of cerebellar folia were found. Rats exposed to ethanol during the prenatal or postnatal period suffered from a fragile synchronizing system of circadian rhythms in adulthood. Although the prevalence of FAS in Japan is lower than in the United States, the increasing number of Japanese women with the drinking habit are cause for great concern. However, the preventive action of FAS/FASD has been advanced recently, and now alcoholic beverages carry labels warning of the risk of drinking during pregnancy and breastfeeding of babies. Although little is still known about how ethanol affects brain development, the only and most certain way to prevent FAS/FASD is total abstinence from alcohol during pregnancy and breastfeeding.

Estimating the prevalence of fetal alcohol syndrome in Victoria using routinely collected administrative data

To establish the prevalence of fetal alcohol syndrome (FAS) in Victoria through the Victorian Birth Defects Register (VBDR). A sample of live births from 1995-2002 was selected from the Victorian Perinatal Data Collection and VBDR based on reported microcephaly, FAS or maternal use of alcohol during pregnancy. Following ethics approval, medical records of mother and child were requested for 117 births. One hundred and nine of these were accessed and examined for factors related to FAS. Records were categorised as FAS, possible FAS, unable to categorise, or not FAS. From the VBDR the prevalence was calculated at 0.006 per 1,000 live births. Four additional possible cases of FAS increased this to 0.014 per 1,000 live births. Six cases were defined as 'unable to categorise' as alcohol use was unknown but other features of FAS were evident. Including these cases, plus five where some low-level alcohol use was reported, increased the prevalence to 0.03 per 1,000 live births. Twenty-eight per cent of the audit population and 39% of the microcephalic cases had no information about maternal alcohol use recorded in the antenatal or babies' records. The audit of medical records provided additional information regarding FAS prevalence in Victoria. This prevalence ranges from 0.01 to 0.03 per 1,000 live births. To accurately assess the extent of the problem, there needs to be improved reporting of alcohol use in pregnancy and a system in place to report cases diagnosed during and beyond the perinatal period to the VBDR.

Issues in Estimating the Prevalence of Fetal Alcohol Syndrome: Examination of 2 Counties in New York State

Two demographically similar counties included in the New York Fetal Alcohol Syndrome Surveillance Network had very different prevalence rates. This study examined the components of the surveillance in an attempt to discover the reasons for this discrepancy. Erie County and Monroe County were the 2 most populous counties included in the New York Fetal Alcohol Syndrome Surveillance Network. Erie County includes Buffalo, the second largest city in New York State, and Monroe County includes Rochester, the third largest city. Multiple sources of ascertainment included birth defect surveillance systems, genetic clinics, and early intervention programs. The case definition was based on the Institute of Medicine criteria of an abnormality in each of the following 3 areas: facial features, central nervous system, and growth. Children born in Erie County or Monroe County between 1995 and 1999 were included. The fetal alcohol syndrome prevalence rates in these 2 counties were 0.90 cases per 1000 births and 0.21 cases per 1000 births, respectively. The 2 counties were demographically similar and had similar rates of binge drinking among women of childbearing age. There was less participation in the surveillance system by sources in Monroe County. Erie County had a very active clinician with a specialized fetal alcohol syndrome clinic. The participation of clinicians in one county, especially one with expertise in fetal alcohol syndrome, was the most likely explanation for the differences in prevalence rates between the counties.

Estimating the prevalence of fetal alcohol syndrome in Victoria using routinely collected administrative data

Estimating the prevalence of fetal alcohol syndrome in Victoria using routinely collected administrative data

Comparison of the 4-Digit Diagnostic Code and the Hoyme Diagnostic Guidelines for Fetal Alcohol Spectrum Disorders

The 4-Digit Diagnostic Code for fetal alcohol spectrum disorders and the Hoyme fetal alcohol spectrum disorders diagnostic guidelines differ markedly. The performances of the 2 diagnostic systems were compared. The fetal alcohol syndrome diagnostic criteria from the 4-Digit Code and Hoyme guidelines were applied to 952 patients who had received an interdisciplinary, fetal alcohol spectrum disorders, diagnostic evaluation at the University of Washington with the 4-Digit Diagnostic Code and 16 children with confirmed absence of prenatal alcohol exposure. The prevalence of fetal alcohol syndrome was 3.7% with the 4-Digit Code and 4.1% with the Hoyme guidelines. Although the prevalences were similar, the patients identified were not. Only 17 individuals met the fetal alcohol syndrome criteria for both systems. An extraordinary number of patients (35%) met the Hoyme criteria for the fetal alcohol syndrome facial phenotype, but only 39 of those 330 patients met the Hoyme criteria for fetal alcohol syndrome. Even some children with no alcohol exposure (25%) had the Hoyme fetal alcohol syndrome face. The specificities of the Hoyme fetal alcohol syndrome face for the Hoyme fetal alcohol syndrome diagnosis and prenatal alcohol exposure were low in these populations. Without a specific facial phenotype, a valid diagnosis of fetal alcohol syndrome cannot be rendered for patients with prenatal alcohol exposure, because a causal link between their outcomes and exposure cannot be established, and a valid diagnosis of fetal alcohol syndrome cannot be rendered for patients with unknown alcohol exposure, because the face cannot serve as a valid proxy measure for alcohol exposure. Diagnostic guidelines must confirm the specificity of their fetal alcohol syndrome facial criteria to validate their diagnostic criteria.