The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors

Abstract

Background: This study is the ninth cross-sectional community study of fetal alcohol spectrum disorders (FASD) conducted by the multidisciplinary Fetal Alcohol Syndrome Epidemiology Research team in the Western Cape Province of South Africa. It is the third comprehensive study of FASD in a rural, agricultural region of South Africa.Methods: Population-based, active case ascertainment methods were employed among a school-based cohort to assess child physical and neurobehavioral traits, and maternal risk factor interviews were conducted to identify all children with FASD to determine its prevalence.Results: Consent was obtained for 76.7% of 1158 children attending first grade in the region's public schools. Case-control results are presented for 95 with fetal alcohol syndrome (FAS), 64 with partial fetal alcohol syndrome (PFAS), 77 with alcohol-related neurodevelopmental disorder (ARND), 2 with alcohol-related birth defects (ARBD),

Multifaceted case management during pregnancy is associated with better child outcomes and less fetal alcohol syndrome

“…The social, cultural, and economic conditions are similar in the two sub-regions, and drinking frequently continues through much of the first trimester for a majority of the women who are drinkers. Many women drink throughout the second trimester, and some throughout the entire pregnancy [ 4 , 6 ]. There are few outlets for recreation for the workers on the farms, orchards, vineyards and small industries, and group drinking on Friday and Saturday night is a major and commonly accepted mode of relaxation and recreation.…”

“…There are few outlets for recreation for the workers on the farms, orchards, vineyards and small industries, and group drinking on Friday and Saturday night is a major and commonly accepted mode of relaxation and recreation. The result is many alcohol-exposed pregnancies and the highest known rates of FASD recorded in the world to date, rates of 28–31% among active case ascertainment, first grade students in population-bases studies [ 4 , 6 , 27 , 73 ].…”

“…Therefore, statistical controls for exposures other than tobacco were not needed. Tobacco has been shown to exert a relatively minor influence on the diagnosis of FASD in this population when compared to the influence of alcohol [ 4 , 6 ], and it is also controlled and assessed separately in the regression analysis.…”

“…The adverse effects of prenatal alcohol exposure are persistent across the lifespan [ 2 , 3 ]. In the WCP, FASD affected 17–31% of first grade students in the general populations of five communities [ 4–7 ]. The prevalence of FASD in general populations has been conservatively estimated to be 1–5% in the United States, 2–3% in Ontario, Canada, 2–4% in Italy, 1.8% in Manchester, United Kingdom, and 4–6% in Croatia [ 8–14 ].…”

Commentary on Luukkonen et al.: Policy possibilities for reducing public health harms related to pregnant people’s alcohol consumption

“…Despite decades of efforts by public health authorities, rates of alcohol use during pregnancy and public health harms from pregnant people's alcohol consumption remain persistent public health challenges [1][2][3]. However, recently researched and recently promoted policy and programmatic solutions-for example, pregnancy-specific warning signs or labels; screening and brief interventions; preventing pregnancy among women of reproductive age who drink more heavily [4][5][6]-are the same public health approaches that have been around for decades.…”