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2016 ; 168
(ä): 274-286
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The continuum of fetal alcohol spectrum disorders in a community in South Africa:
Prevalence and characteristics in a fifth sample
#MMPMID27736681
May PA
; Marais AS
; de Vries MM
; Kalberg WO
; Buckley D
; Hasken JM
; Adnams CM
; Barnard R
; Joubert B
; Cloete M
; Tabachnick B
; Robinson LK
; Manning MA
; Jones KL
; Bezuidenhout H
; Seedat S
; Parry CDH
; Hoyme HE
Drug Alcohol Depend
2016[Nov]; 168
(ä): 274-286
PMID27736681
show ga
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.