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

Abstract

Background: There are limited data on the characteristics of children with fetal alcohol spectrum disorders (FASD) and their mothers from the general population in the United States.Methods: During the 2012 and 2013 academic years, first-grade children in a large urban Pacific Southwest city were invited to participate in a study to estimate the prevalence of FASD. Children who screened positive on weight, height, or head circumference ≤25th centile or on parental report of developmental concerns were selected for evaluation, along with a random sample of those who screened negative. These children were examined for dysmorphology and neurobehavior and their mothers or collateral sources were interviewed. Children were classified as fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), or No FASD.Results: A total of 854 children were evaluated; 5 FAS, 44 pFAS, 44 ARND, and 761 No FASD. Children with FAS or pFAS were more likely to have dysmorphic features, and 32/49 (65.3%) of those met criteria for neurobehavioral impairment on cognitive measures with or without behavioral deficits. In contrast, 28/44 (63.6%) of children with ARND met criteria on behavioral measures alone. Mothers of FASD children were more likely to recognize pregnancy later, be unmarried, and report other substance use or psychiatric disorders, but did not differ on age, socioeconomic status, education, or parity. Mothers of FASD children reported more drinks/drinking day each trimester. The risk of FASD was elevated with increasing number of drinks/drinking day prior to pregnancy recognition, even at the level of 1 drink per day (adjusted odds ratio 3.802, 95% confidence interval 1. 634, 8.374).Conclusions: Data from this general population sample in a large urban region in the United States demonstrate the variability of expression of FASD and point to risk and protective factors for mothers in this setting.

Altered Maternal Plasma Fatty Acid Composition by Alcohol Consumption and Smoking during Pregnancy and Associations with Fetal Alcohol Spectrum Disorders

“…Since alcohol consumption can aggravate nutrient deficiencies, it has been suggested that maternal nutritional status plays a role in the risk for FASD (3)(4)(5). In addition, rates of cigarette smoking during pregnancy are often higher among women who consume alcohol creating additional consequences to nutritional status, as well as increasing odd ratios for preterm birth, low birth weight, and growth restriction beyond either alcohol or cigarette use alone (6)(7)(8)(9)(10)(11).…”

Fetal Alcohol Spectrum Disorder: Can We Change the Future?

“…In this issue of Alcoholism: Clinical and Experimental Research, 3 additional papers examining the prevalence of fetal alcohol spectrum disorders (FASDs; May et al, 2020a, 2020b, 2020c) follow the earlier paper by Chambers and colleagues (2019). These studies present state‐of‐the‐art FASD active case ascertainment (ACA) of prevalence among school‐age children conducted in the United States and demonstrate the importance of the behind‐the‐scenes intensive fieldwork necessary to complete studies of this size in community settings.…”

“…The data also improve our understanding of the lower threshold of teratogenic exposure, which increases the risk for FASD. Chambers and colleagues have found the threshold to be very low, showing 1 drink per drinking day during pregnancy to increase the risk of FASD by over 3‐fold (Chambers et al, 2019).…”

Epigenetic Clock Analysis in Children With Fetal Alcohol Spectrum Disorder

“…Another systematic review estimated that FASD affects 7.7 per 1,000 children and youth in the general population (Lange et al, 2017). More recently, a series of studies involving a large sample size examining the prevalence of FASD among school‐age children in 4 regions of the Unites States (Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern) has confirmed that at least 2% of children in first grade had FASD (Chambers et al, 2019; May et al, 2018, 2020a, 2020b, 2020c; Popova et al, 2020). The burden of FASD on society is a severe global medical issue (Lange et al, 2018).…”