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Drug Alcohol Depend. 2016 Nov 1;168:274-286. doi: 10.1016/j.drugalcdep.2016.09.025. Epub 2016 Oct 6.

The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample.

Author information

1
The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States. Electronic address: philip_may@unc.edu.
2
Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
3
The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
4
The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States.
5
University of Cape Town, Department of Psychiatry and Mental Health, South Africa.
6
California State University, Northridge, United States.
7
State University of New York, Buffalo, Department of Pediatrics, United States.
8
Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States.
9
University of California San Diego School of Medicine, Department of Pediatrics, United States.
10
Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, South Africa.
11
Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States; The University of Arizona College of Medicine, Department of Pediatrics and the Center for Applied Genetics and Genomic Medicine, United States.

Abstract

BACKGROUND:

The prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in a fifth sample in a South African community.

METHODS:

An active case ascertainment approach was employed among all first grade learners in this community (n=862). Following individual examination by clinical geneticists/dysmorphologists, cognitive/behavioral testing, and maternal interviews, final diagnoses were made in multidisciplinary case conferences.

RESULTS:

Physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories in a consistent, linear fashion, from severe to mild. Neurodevelopmental delays and behavioral problems were significantly worse for each of the FASD diagnostic categories, although not as consistently linear across diagnostic groups. Alcohol use was documented by direct report from the mother in 71% to 100% of cases in specific diagnostic groups. Significant distal maternal risk factors in this population are: advanced maternal age at pregnancy; low height, weight, and body mass index (BMI); small head circumference; low education; low income; and rural residence. Even when controlling for socioeconomic status, prenatal drinking correlates significantly with total dysmorphology score, head circumference, and five cognitive and behavioral measures. In this community, FAS occurs in 59-79 per 1,000 children, and total FASD in 170-233 per 1,000 children, or 17% to 23%.

CONCLUSIONS:

Very high rates of FASD continue in this community where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development in a significant portion of the population.

KEYWORDS:

Alcohol abuse; Binge drinking; Children with FASD; Fetal alcohol spectrum disorders (FASD); Maternal risk for FASD; Microcephaly; Prenatal alcohol use; Prevalence; South Africa

PMID:
27736681
PMCID:
PMC5086258
[Available on 2017-11-01]
DOI:
10.1016/j.drugalcdep.2016.09.025
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