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Published on: August 5, 2017
Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities
Philip A May1,2, Christina D Chambers3,4, Wendy O Kalberg2
1University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill.
Insights
Fetal alcohol spectrum disorders (FASDs) affect 1.1% to 5.0% of first-graders in the US, based on a 2010-2016 study. These findings highlight the need for updated prevalence data on these lifelong disabilities.
Area of Science:
- Pediatrics
- Public Health
- Neuroscience
Background:
- Fetal alcohol spectrum disorders (FASDs) represent significant, lifelong disabilities with limited current prevalence data in diverse US populations.
- Previous estimates suggested a prevalence of 10 per 1000 children, but newer, larger-scale studies are needed.
Purpose of the Study:
- To estimate the prevalence of FASDs, including fetal alcohol syndrome, partial FASD, and alcohol-related neurodevelopmental disorder, across four distinct US regions.
- To provide updated prevalence figures for FASDs in a contemporary, diverse population sample.
Main Methods:
- A cross-sectional study employed active case ascertainment from 2010 to 2016, assessing first-grade children across four US communities.
- Systematic assessment covered four key domains: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure.
- Data were collected from 6,639 first-graders, with analyses focusing on conservative and weighted prevalence estimates.
Main Results:
- The study identified 222 cases of FASDs among 6,639 first-graders.
- Conservative prevalence estimates for FASDs ranged from 11.3 to 50.0 per 1000 children (1.1% to 5.0%).
- Weighted prevalence estimates indicated a range from 31.1 to 98.5 per 1000 children (3.1% to 9.9%).
Conclusions:
- Estimated FASD prevalence among first-graders in the studied US communities falls between 1.1% and 5.0% using a conservative estimation method.
- These findings offer more current and potentially accurate US prevalence estimates compared to older data.
- The generalizability of these estimates to all US communities may be limited.
Importance:
Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples.
Objective:
To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States.
Design, Setting, And Participants:
Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled.
Exposures:
Alcohol consumption during pregnancy.
Main Outcomes And Measures:
Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation.
Results:
A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and 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. 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.
Conclusions And Relevance:
Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.
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