Fetal Alcohol Spectrum Disorders – CDC Summary and Updates
WHAT IS IT?
The current understanding of Fetal Alcohol Spectrum Disorder (FASD) is that there is no known safe amount of alcohol during pregnancy or when trying to get pregnant. All types of alcohol are equally harmful, including all wines and beer. Professional colleges recommend screening women in pregnancy. Fetal Alcohol Syndrome (FAS) is on the most severe end of the spectrum.
Smooth philtrum (ridge between nose and upper lip)
Thin vermillion (upper lip)
Small palpebral fissures (distance between inner and outer corners of the eyes) giving the eyes a wide-spaced appearance
Growth problems (prenatal or postnatal)
Height and/or weight ≤10th percentile
Head circumference ≤10th percentile
Clinically significant brain abnormalities observable through imaging
Neurological deficits unrelated to a postnatal insult or fever
Functional Performance below expectations
Global cognitive or intellectual deficits (Low IQ or developmental delay in younger children) or
Problems in at least 3 of the following areas
Cognitive or developmental deficits or discrepancies | Executive functioning deficits | Motor functioning delays | Attention deficit or hyperactivity | Social skills | Other problems such as sensory / language / memory
Maternal Alcohol Exposure
Helpful if maternal alcohol use can be confirmed during pregnancy
Confirmation of maternal alcohol use is not needed if child meets the other, above criteria
How Prevalent is Fetal Alcohol Spectrum Disorder in the US?
BACKGROUND AND PURPOSE:
Fetal alcohol spectrum disorders include
Fetal alcohol syndrome (FAS)
Partial fetal alcohol syndrome
Alcohol-related neurodevelopmental disorder
Leading cause of developmental disabilities worldwide
Accepted US estimate: 10/1000 children affected
However, likely that prevalence underestimated due to ‘not diagnosed’ or ‘misdiagnosis’
Other countries use ‘active case ascertainment’ where “surveillance personnel are hired and trained to abstract data from all data sources. Abstractors regularly visit or have electronic access to participating institutions, such as hospitals and clinics” (CDC)
Philip et al. (JAMA, 2018) used active case ascertainment to estimate the overall prevalence of fetal alcohol spectrum disorder in the United States
Active case ascertainment methods using a cross-sectional design
Two research teams, both funded by the National Institute on Alcohol Abuse and Alcoholism
Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum:
Prenatal alcohol exposure
The settings were 4 communities in the US
The Rocky Mountains
Pacific Southwestern US
First-grade children and their parents or guardians were enrolled
The primary outcome was Prevalence of fetal alcohol spectrum disorder in the 4 communities
6,639 children were included in the study population
Boys, 51.9% | Mean age, 6.7 years [SD, 0.41] | White maternal race, 79.3%
A total of 222 cases of fetal alcohol spectrum disorders were identified
The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children
Calculated as total number of children with alcohol spectrum disorder divided by number of children participating in first grade or selected randomly
The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children
Denominator restricted to children with sufficient information to be properly classified with the condition
Using a conservative estimate, fetal alcohol spectrum disorder has a prevalence between 1.1% to 5.0% of the population with much higher prevalence using weighted approach
Supporting evidence “that harmful fetal alcohol exposure is common in the United States today”
For perspective, CDC autism spectrum disorder estimates are 14.6/1000 children (approximately 1/2 the lowest conservative estimate for fetal alcohol spectrum disorders)
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