The prevalence, child characteristics, and maternal risk factors for the continuum of fetal alcohol spectrum disorders: A sixth population-based study in the same South African community

Drug Alcohol Depend. 2021 Jan 1:218:108408. doi: 10.1016/j.drugalcdep.2020.108408. Epub 2020 Nov 13.

Abstract

Background: Prevalence and characteristics of fetal alcohol spectrum disorders (FASD) have been described previously in this community.

Methods: Active case ascertainment methods were employed in a new cross-sectional study with Revised Institute of Medicine criteria among first grade students (n = 735) via dysmorphology examinations and neurobehavioral assessments. Their mothers were interviewed regarding risk factors. Final diagnoses were assigned via structured case conferences.

Results: Children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and alcohol related-neurodevelopmental disorder (ARND) were significantly different from controls on all cardinal variables, multiple dysmorphology traits and neurobehavioral performance. Mothers of children with FASD reported significantly more drinking before and during pregnancy (mothers of children with FAS reported 7.8 (±6.1) drinks per drinking day (DDD) prior to pregnancy and 5.1 (±5.9) after pregnancy recognition). Distal risk variables for a diagnosis on the continuum of FASD were: lower maternal height, weight, and body mass index; higher gravidity; lower education and household income; and later pregnancy recognition. Alcohol and tobacco remain the only commonly used drugs. Women reporting first trimester drinking of two DDD were 13 times more likely (95 % CI:1.3-133.4) to have a child with FASD than non-drinkers; and those who reported drinking throughout pregnancy were 19.4 times more likely (95 % CI:8.2-46.0) to have a child with FASD.

Conclusion: Seventeen years after the first study in this community, FASD prevalence remains high at 16 %-31 %. The FAS rate may have declined somewhat, but rates of PFAS and ARND seemed to plateau, at a high rate.

Keywords: Binge drinking; Dysmorphology; Maternal risk for FASD; Prenatal alcohol use; Prevalence; South Africa; Traits of fetal alcohol spectrum disorders (FASD).

MeSH terms

  • Adult
  • Alcohol Drinking / epidemiology
  • Alcoholism / complications
  • Black People
  • Body Mass Index
  • Child
  • Child Development
  • Cross-Sectional Studies
  • Educational Status
  • Female
  • Fetal Alcohol Spectrum Disorders / epidemiology*
  • Humans
  • Male
  • Mothers
  • Pregnancy
  • Prevalence
  • Research
  • Risk Factors
  • South Africa / epidemiology
  • Tobacco Use