Prevalence of Children with Severe Fetal Alcohol Spectrum Disorders in Communities Near Rome, Italy: New Estimated Rates Are Higher than Previous Estimates

Abstract

Objective:To determine the population-based epidemiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) in towns representative of the general population of central Italy.Methods:Slightly revised U.S. Institute of Medicine diagnostic methods were used among children in randomly-selected schools near Rome. Consented first grade children (n = 976) were screened in Tier I for height, weight, or head circumference and all children ≤10th centile on one of these measurements were included in the study. Also, teachers referred children for learning or behavioral problems. Children meeting either of these two criteria, along with randomly-selected controls, advanced to Tier II which began with a dysmorphology examination. Children with a possible FASD, and controls, advanced to Tier III for neurobehavioral testing, and their mothers were interviewed for maternal risks. Final diagnoses using indicators of dysmorphology, neurobehavior, and maternal risk were made in formally-structured, interdisciplinary case conferences.Results:Case control comparisons of physical, neurobehavioral, and maternal risk variables are presented for 46 children with an FASD and 116 randomly-selected controls without a diagnosis on the FASD continuum. Rates of diagnoses within the FASD continuum are then estimated from these in-school data via three different methods. The range of rates of FAS produced by these methods is between 4.0 to 12.0 per 1,000; Partial FAS ranges from 18.1 to 46.3 per 1,000; and an FASD was found in 2.3% to 6.3% of the children.Conclusions:These rates are substantially higher than previous estimates of FAS and overall FASD for the general populations of Western Europe and the U. S., and raise questions as to the total impact of FASD on mental deficit in mainstream populations of Western Europe and the United States where the majority are middle class and are not believed to be characterized by heavy episodic drinking.

Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders

“…Not only the cardinal facial features, but other facial measurements and minor anomalies are also important discriminators of FASD. Based on this study and other population-based studies, [10][11][12][13]15,16 other minor anomalies, such as those shown in Table 2, are reflected in the total dysmorphology score, which differentiates well the FASD diagnostic groups. Minor anomalies play an important role in identifying affected children.…”

“…[56][57][58][59][60][61] Recruitment of mothers to obtain maternal risk data posed significant challenges for the interviewers. Therefore, variables that differentiate maternal risk in this population were not as evident or readily obtained in this US population or in our Italian studies 15,16 as elsewhere. [23][24][25] Individualized risk for FASD via genetic and epigenetic factors may be more important to explore in this and similar middle and upper SES populations than the more generalized lower SES and childbearing risk factors of higher prevalence populations.…”

“…8 More current estimates of the prevalence of FAS in the US general population range from 0.2 to 7 per 1000 children, 5 and 2% to 5% for the entire continuum of FASD. 5,9 One approach used successfully to determine the minimal prevalence of FASD in communities in South Africa, [10][11][12][13][14] Italy, 15,16 and Croatia 17,18 uses active case ascertainment in schools. Providing targeted physical examinations and cognitive/ behavioral testing to primary school children [19][20][21][22] and interviewing their mothers [23][24][25] can be effective for studying FASD prevalence and characteristics.…”

Urgent global opportunities to prevent birth defects

“…In the USA, the estimated prevalence is 2e7 cases per 1000 live births [23]. Studies from Europe [24], Africa [25e27], Israel [28], Australia [29,30], and Russia [31] show a much higher prevalence. The highest prevalence to date has been reported from high-alcohol-consuming regions of South Africa (90 per 1000 births) [32].…”

Letter to the Editor: Why do pregnant South African women drink alcohol? A call to action for more qualitative investigations

“…However, in parts of France FAS and FASD prevalence rates are 1.2 and 4.8 per 1,000, respectively (Dehaene et al, 1991). FASD in Italy is estimated at 2.3% to 6.3% (May et al, 2011). Prevalence rates for FAS and PFAS in regions of Italy are even higher, ranging from 4.0 to 12.0, and 18.1 to 46.3 per 1,000 children, respectively (May et al, 2011).…”