A South African mixed race lip/philtrum guide for diagnosis of fetal alcohol spectrum disorders

et al. 2017

IJERPH

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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.

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

IJERPH

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“…The IOM diagnostic criteria of the four FASD diagnoses are presented in Figure 2 and described in more detail elsewhere (Hoyme et al, 2005, 2015). Significant growth retardation and significant dysmorphia are present in children with FAS, less growth restriction is present in children with PFAS, but at least two of the three cardinal facial features and a constellation of other minor anomalies are present in both FAS and PFAS.…”

Section: Methodsmentioning

confidence: 99%

The continuum of fetal alcohol spectrum disorders in four rural communities in south africa: Prevalence and characteristics

Drug and Alcohol Dependence

et al. 2016

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Background Prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in previously unstudied rural, agricultural, lower socioeconomic populations in South Africa (ZA). Methods Using an active case ascertainment approach among first grade learners, 1354 (72.6%) were consented into the study via: height, weight, and/or head circumference ≤25th centile and/or random selection as normal control candidates. Final diagnoses were made following: examination by pediatric dysmorphologists/geneticists, cognitive/behavioral testing, and maternal risk factor interviews. Results FASD children were significantly growth deficient and dysmorphic: physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories from severe to mild to normal in a consistent, linear fashion. Neurodevelopmental delays were also significantly worse for each of the FASD diagnostic categories, although not as consistently linear across groups. Alcohol use is well documented as the proximal maternal risk factor for each diagnostic group. Significant distal maternal risk factors in this population are: low body weight, body mass, education, and income; and high gravidity, parity, and age at birth of the index child. In this low SES, highly rural region, FAS occurs in 93 – 128 per 1,000 children, PFAS in 58 – 86, and, ARND in 32 – 46 per 1,000. Total FASD affect 182 to 259 per 1,000 children or 18% to 26%. Conclusions Very high rates of FASD exist in these rural areas and isolated towns where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development.

“…The IOM criteria for the specific diagnoses in the FASD continuum are presented in Figure 2 and described in more detail elsewhere (Hoyme et al, 2005, 2015). Significant growth restriction and marked dysmorphia are present in children with FAS, and less growth restriction and dysmorphia in children with PFAS; however, at least two of three cardinal facial features and a constellation of other minor anomalies are present with both FAS and PFAS.…”

Section: Methodsmentioning

confidence: 99%

The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample

Drug and Alcohol Dependence

et al. 2016

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Background The prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in a fifth sample in a South African community. Methods An active case ascertainment approach was employed among all first grade learners in this community (n=862). Following individual examination by clinical geneticists/ dysmorphologists, cognitive/behavioral testing, and maternal interviews, final diagnoses were made in multidisciplinary case conferences. Results Physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories in a consistent, linear fashion, from severe to mild. Neurodevelopmental delays and behavioral problems were significantly worse for each of the FASD diagnostic categories, although not as consistently linear across diagnostic groups. Alcohol use was documented by direct report from the mother in 71% to 100% of cases in specific diagnostic groups. Significant distal maternal risk factors in this population are: advanced maternal age at pregnancy; low height, weight, and body mass index (BMI); small head circumference; low education; low income; and rural residence. Even when controlling for socioeconomic status, prenatal drinking correlates significantly with total dysmorphology score, head circumference, and five cognitive and behavioral measures. In this community, FAS occurs in 59 – 79 per 1,000 children, and total FASD in 170 – 233 per 1,000 children, or 17% to 23%. Conclusions Very high rates of FASD continue in this community where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development in a significant portion of the population.