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.

(Abstracted from JAMA 2018;319(5):474–482) Several single-site, active-case ascertainment studies in the United States have shown widely varying prevalence estimates for fetal alcohol spectrum disorders, composed of fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder. Prevalence of fetal alcohol spectrum disorders are challenging to estimate using routine surveillance methods, and cases are often misdiagnosed or undiagnosed.

Objective To examine the distribution of birth weight in children with NAFLD compared with the general U.S. population and the relationship between birth weight and severity of NAFLD. Study design A multi-center, cross-sectional study of children with biopsy-proven NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network Database. Birth weights were categorized as low birth weight (LBW), normal birth weight (NBW), or high birth weight (HBW) and compared with distribution of birth weights in the general US population. The severity of liver histology was assessed by birth weight category. Results Children with NAFLD (n=538) had overrepresentation of both LBW and HBW compared with the general US population (LBW 9.3%, NBW 75.8%, HBW 14.9% vs. LBW 6.1%, NBW 83.5%, HBW 10.5%; p<0.0001). Children with HBW had significantly greater odds of having more severe steatosis (OR 1.82, 95% CI 1.15–2.88) and NASH (OR 2.03, 95% CI 1.21–3.40) than children with NBW. Additionally, children with NAFLD and LBW had significantly greater odds of having advanced fibrosis (OR 2.23; 95% CI 1.08–4.62). Conclusion Birth weight involves maternal and in utero factors which may have long-lasting consequences. Children with both LBW and HBW may be at increased risk for developing NAFLD. Among children with NAFLD, those with LBW or HBW appear to be at increased risk for more severe disease.

Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.