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. 2015 Oct 1:155:118-27.
doi: 10.1016/j.drugalcdep.2015.08.006. Epub 2015 Aug 14.

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

Philip A May  1 , Carol Keaster  2 , Rosemary Bozeman  2 , Joelene Goodover  3 , Jason Blankenship  4 , Wendy O Kalberg  5 , David Buckley  6 , Marita Brooks  7 , Julie Hasken  8 , J Phillip Gossage  9 , Luther K Robinson  10 , Melanie Manning  11 , H Eugene Hoyme  12
Affiliations

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

Philip A May et al. Drug Alcohol Depend. .

Abstract

Background: The prevalence and characteristics of fetal alcohol syndrome (FAS) and partial FAS (PFAS) in the United States (US) are not well known.

Methods: This 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.

Results: Direct 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%.

Conclusions: Comprehensive, active case ascertainment methods produced rates of FAS and PFAS higher than predicted by long-standing, popular estimates.

Keywords: Alcohol use and abuse; Children with FAS and PFAS; Fetal alcohol spectrum disorders; Maternal risk factors; Prenatal alcohol use; Prevalence; United States.

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Conflict of interest statement

Conflict of interests

None of the authors have any conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagnostic Guidelines for Specific Fetal Alcohol Spectrum Disorders (FASD), According to the Institute of Medicine, as Clarified by Hoyme et al., 2005 1Stratton KR, Howe CJ & Battaglia FC (1996) Fetal alcohol syndrome diagnosis, epidemiology, prevention, and treatment. Institute of Medicine. National Academy Press, Washington, D.C. 2Hoyme HE, May PA, Kalberg WO, Kodituwakku P, Gossage JP, Trujillo PM, Buckley DG, Miller J, Khaole N, Viljoen DL, Jones KL, Robinson LK (2005) A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: clarification of the 1996 Institute of Medicine criteria. Pediatrics 115:39–47. 3Astley SJ, Clarren, SK (2000) Diagnosing the full spectrum of fetal alcohol-exposed individuals: introducing the 4-digit diagnostic code. Alcohol Alcohol 35:400–10.
Figure 2
Figure 2
Methodology of the Rocky Mountain Region City (USA) FASD Pilot Studies with Sampling Procedures and Numbers
Figure 3
Figure 3
Comparison of Developmental Tests and Behavioral Indicators of Children with FAS, PFAS, and Normal Controls: Rocky Mountain Region City, USA. #All scores standardized for age of child at time of testing. *Wechsler Abbreviated Scale of Intelligence - (WASI). (Mean score of 100 with Standard Deviation of 15). +Wide Range Achievement Test Revision 3 - (WRAT). (Mean score = 100 with a Standard Deviation of 15). ^d. Vineland Adaptive Behavior Scales (Classroom Edition). (Mean score = 100 with a Standard Deviation of 15). **Wechsler Intelligence Scale for Children 3rd edition coding, mazes and digit span subtests - (WISC). (Score range: 0–20). **Personal Behavior Checklist (PBCL-36). Higher scores indicate more behavioral problems.
Figure 4
Figure 4
Final Prevalence of FAS, PFAS, and the Two Diagnoses Combined among First Grade Children in a Rocky Mountain Region City
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