A study (May, P.A., et al. Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities. JAMA. Online February 6, 2018.) of more than 6,000 first-graders across four U.S. communities
has found that a significant number of the children have fetal alcohol
spectrum disorders (FASD), with conservative rates ranging from 1 to 5
percent in community samples.
The new findings represent more accurate
prevalence estimates of FASD among general U.S. communities than prior
research. Previous FASD estimates were based on smaller study
populations and did not reflect the overall U.S. population. The study
was funded by the National Institute on Alcohol Abuse and Alcoholism
(NIAAA), part of the National Institutes of Health.
FASD is an umbrella term for a range of health effects caused by
prenatal alcohol exposure. Individuals with FASD may experience growth
deficiencies, facial abnormalities, and organ damage, including to the
brain. The effects of prenatal alcohol exposure on the brain can result
in a range of neurobiological deficits that contribute to physical,
cognitive, behavioral, and social challenges throughout life.
“Prenatal alcohol exposure is a leading preventable cause of
developmental disabilities worldwide,” said NIAAA Director George F.
Koob, Ph.D. “Estimating the prevalence of FASD in the United States has
been complex due to the challenges in identifying prenatally exposed
children. The findings of this study confirm that FASD is a significant
public health problem, and strategies to expand screening, diagnosis,
prevention, and treatment are needed to address it.”
The study was conducted by the Collaboration on Fetal Alcohol
Spectrum Disorders Prevalence (CoFASP) consortium, which studies the
prevalence of FASD among U.S. school children. Before the study began,
consortium members established standardized classification criteria for
FASD based on facial features, growth, and neurodevelopmental
performance. Co-led by Philip May, Ph.D., of the University of North
Carolina Nutrition Research Institute, Kannapolis, and Christina
Chambers, Ph.D., of the University of California San Diego School of
Medicine, the findings are reported online in the Journal of the
American Medical Association.
Researchers collected data between 2010 and 2016 on 6,639 children in
four communities in the Midwest, Rocky Mountain, Southeast and Pacific
Southwest, sites that were selected to be more reflective of U.S.
community populations than previous studies. At each site, first-graders
in public and private schools were recruited across two academic years
and evaluated based on the FASD criteria. Prenatal alcohol exposure was
assessed by interviewing mothers or other close relatives.
The researchers found that the prevalence estimates for FASD among
the selected sites ranged from 1.1 to 5 percent. This was the most
conservative estimate and assumed that no additional cases of FASD would
be found in first-graders who did not participate in the study.
Using a
“weighted prevalence” approach that assumed that the rate of FASD in
children who were evaluated would be the same in all eligible
first-grade children in each community, the estimated prevalence of FASD
was higher—ranging from 3.1 to 9.8 percent among the study sites. Of
the 222 children diagnosed with FASD in the study, only two had been
previously diagnosed with FASD, although many parents and guardians were
aware of the children’s learning and behavioral challenges. This
finding suggests that children with FASD often go undiagnosed or
misdiagnosed.
“We believe our study is the first to use school-based assessments, a
common methodology and classification system, and expert in-person
evaluations for the full range of FASD on many children from communities
across the United States,” said May.
“This comprehensive approach should reflect estimates that more
closely resemble the prevalence of FASD in the United States, and
further highlights the public health burden of FASD,” added Chambers.
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