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. 2018 Feb 6;319(5):474-482.
doi: 10.1001/jama.2017.21896.

Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities

Philip A May  1   2 , Christina D Chambers  3   4 , Wendy O Kalberg  2 , Jennifer Zellner  3 , Haruna Feldman  3 , David Buckley  2 , David Kopald  3 , Julie M Hasken  1 , Ronghui Xu  3 , Gordon Honerkamp-Smith  3 , Howard Taras  3 , Melanie A Manning  5 , Luther K Robinson  6 , Margaret P Adam  7 , Omar Abdul-Rahman  8 , Keith Vaux  3 , Tamison Jewett  9 , Amy J Elliott  10 , Julie A Kable  11 , Natacha Akshoomoff  3 , Daniel Falk  12 , Judith A Arroyo  12 , Dale Hereld  12 , Edward P Riley  13 , Michael E Charness  14   15   16 , Claire D Coles  11 , Kenneth R Warren  12 , Kenneth Lyons Jones  3   4 , H Eugene Hoyme  17   18
Affiliations

Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities

Philip A May et al. JAMA. .

Abstract

Importance: 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.

Objective: 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.

Exposures: 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.

Results: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Riley reported grant support from the National Institute on Alcohol Abuse and Alcoholism and personal fees and honorarium from the Alcohol Center for grant reviews. No other disclosures were reported.

Figures

Figure.
Figure.. Sampling Methods, Evaluations, and Review of First-Graders for Diagnosing Fetal Alcohol Syndrome Disorders
aCollateral interviews were conducted with close relatives or others when the biological mother was not available.
See this image and copyright information in PMC

Comment in

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