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Fetal alcohol spectrum disorders in children residing in Russian orphanages: a phenotypic survey
Laurie C Miller1, Wilma Chan, Aina Litvinova
1International Adoption Clinic, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. lmiller1@tufts-nemc.org
Insights
High rates of prenatal alcohol exposure are evident in Russian institutionalized children. Over half of baby home residents showed phenotypic signs of fetal alcohol spectrum disorders (FASD), correlating with developmental delays.
Area of Science:
- Pediatrics
- Public Health
- Neuroscience
Background:
- Alcohol consumption in Russia is exceptionally high.
- Over 600,000 children are in Russian institutional care, primarily in baby homes and orphanages.
- The prevalence of fetal alcohol spectrum disorders (FASD) in these children is largely unknown.
Purpose of the Study:
- To systematically survey phenotypic features linked to prenatal alcohol exposure in institutionalized Russian children.
- To correlate these phenotypic findings with growth, development, and medical/social histories.
Main Methods:
- Phenotypic screening of 234 baby home residents in Russia's Murmansk region.
- Development of phenotypic expression scores based on facial dysmorphology and physical findings.
- Analysis of growth measurements and retrospective chart review of maternal, medical, developmental, and social histories.
Main Results:
- 13% of children had high and 45% had intermediate facial phenotype scores suggestive of prenatal alcohol exposure.
- Phenotypic scores correlated with maternal gravidity and age; at least 40% of mothers reported alcohol use during pregnancy.
- Significant growth and developmental delays were observed, particularly in children with higher phenotypic scores.
Conclusions:
- Over half of baby home residents in Murmansk exhibit phenotypic scores indicating prenatal alcohol exposure.
- Despite adequate institutional care, these children experience significant growth and developmental delays.
- Findings highlight the critical need for addressing prenatal alcohol exposure in vulnerable institutionalized populations.
Background:
Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories.
Methods:
Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories.
Results:
Thirteen percent of children had facial phenotype scores highly compatible with prenatal alcohol exposure and 45% had intermediate facial phenotype scores. These scores correlated with maternal gravidity and age. At least 40% of mothers in whom history was available ingested alcohol during pregnancy; some also used illicit drugs and tobacco. Z scores for growth measurements corresponded to phenotypic score, as did the degree of developmental delay. Children with no or mild delay had significantly lower phenotypic scores than those with moderate or severe delay (p = 0.04); more than 70% of children with high phenotypic scores were moderately or severely delayed.
Conclusions:
More than half of residents of the baby homes in Murmansk, Russia, have intermediate (45%) or high (13%) phenotypic expression scores suggesting prenatal exposure to alcohol. Despite good physical care, stable daily routine, availability of well-trained specialists, and access to medical care, these vulnerable children show significant growth and developmental delays compared with their institutionalized peers.
