Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa

Abstract

Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.

Fetal Alcohol Spectrum Disorders in a Pacific Southwest City: Maternal and Child Characteristics

“…To the extent that these patterns of alcohol consumption directly translate to the incidence of FASD, previous studies in South Africa have also suggested that lower educational attainment and low socioeconomic status are associated with increased risk for FASD. In addition, these previous studies have found FASD to be associated with older maternal age, higher parity, lower body mass index, and tobacco use but not other drugs (May et al, ). U.S. survey data from the Behavioral Risk Factor Surveillance System 2015 to 2017 strongly correlated unmarried status with current drinking and binge drinking among pregnant women (Denny et al, ).…”

Four-year follow-up of a randomized controlled trial of choline for neurodevelopment in fetal alcohol spectrum disorder

“…Fetal alcohol spectrum disorders (FASDs) comprise a range of effects resulting from prenatal alcohol exposure (PAE) including neurological abnormalities, cognitive and behavioral impairments, growth retardation, and craniofacial anomalies [1]. FASD affects 0.8% of the world's population, 2.0 to 5.0% of the European and North American populations [2,3], and 13.6 to 28% of high-risk rural populations in South Africa [4,5]. Despite being more common than autism spectrum disorder, which has a prevalence of 0.6% [6], FASD remains under-recognized [7].…”

Ocular measurements in fetal alcohol spectrum disorders

“…We used the most recent data from the Fetal Alcohol Syndrome Epidemiologic Research (FASER) database (Hoyme et al, 2016;May et al, 2013b;May et al, 2017;May et al, 2018) to study the effects of alcohol on ocular measurements. This database comprises information compiled from a long-term epidemiological study of first grade students (ages 5 to 9 years) in five communities in South Africa.…”

“…Globally, the prevalence of FASD is estimated to be 7.7 per 1,000 children, and the prevalence of full FAS to be 1.5 per 1,000 children . In the United States, the prevalence of FASD is estimated to be 11.3 to 50.0 per 1,000 children (May et al, 2018), and the country with the highest prevalence of FASD is South Africa (Lange et al, 2017), which in recent general community studies has been found to be 23 to 28% among first grade children (May et al, 2016(May et al, , 2017. The annual cost of treatment for FASD in the United States was estimated at $6.5 billion in 2010 (Popova, Stade, Bekmuradov, Lange, & Rehm, 2011).…”