Source:

May
PA
,
Chambers
CD
,
Kalberg
WO
, et al
.
Prevalence of fetal alcohol spectrum disorders in 4 US communities
.
JAMA
.
2018
;
319
(
5
):
474
482
. doi:
https://doi.org/10.1001/jama.2017.21896

Investigators from multiple institutions conducted an active surveillance study to estimate the prevalence of fetal alcohol spectrum disorders (FASDs), including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in first graders from 4 geographically disparate sites in the United States. Study participants were children in the first grade during 2 academic years. Study sites included a community in the Midwest, Rocky Mountain and Southeast sites, and a large city in the Pacific Southwest (the exact locations were not disclosed to preserve confidentiality). At each site, first graders from public and private schools were recruited for the study. Case ascertainment was based on facial features, growth, and neurodevelopmental testing results. Before conducting the study, the investigators developed specific criteria for classification of FASD on the basis of current guidelines. A history of maternal alcohol use was required for categorizing a child as having alcohol-related neurodevelopmental disorder but not as having fetal alcohol syndrome or partial fetal alcohol syndrome.

Sampling designs varied across study sites. At some sites, a random sample of recruited children underwent anthropometric measurement, neurodevelopmental testing, and examination of facial features by dysmorphologists or geneticists (blinded to maternal alcohol use and neurodevelopmental test results). At other sites, all enrolled participants were screened for height, weight, and head circumference, with additional testing performed in those with measurements <25th percentile for age and/or those with possible neurodevelopmental issues. Maternal alcohol use during pregnancy was determined by interviewing the mothers of the study children. Based on this testing, children were classified with a specific FASD or no FASD. Two estimates of prevalence at each site were calculated. For the conservative estimate, the denominator included all eligible children, and for the weighted estimate the denominator was based on the number of children with testing results.

A total of 13,146 children were eligible for enrollment; the average consent rate for participation across all sites was 59.9%. In total, 6,054 children were screened for growth and/or neurodevelopment, and an additional 585 were randomly selected for the dysmorphology examination. Based on predetermined criteria, 222 children were classified with FASD: 27 with fetal alcohol syndrome, 104 with partial fetal alcohol syndrome, and 91 with alcohol-related neurodevelopmental disorder. Conservative estimates of FASD across sites ranged from 11.3 per 1,000 children (95% CI, 7.8–15.8) to 50.0 per 1,000 children (95% CI, 39.9–61.7). With use of the weighted approach, the estimated prevalence ranged from 31.1 (95% CI, 16.1–54.0) to 98.5 (95% CI, 57.5–139.5).

The authors conclude that the estimated prevalence of FASD among first graders from 4 US communities ranged from 1.1% to 5.0% by using a conservative approach.

Dr Doherty has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Severe FASDs...

You do not currently have access to this content.