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The prevalence of fetal alcohol syndrome in the United States may be much higher than previous estimates have assumed, with conservative estimates suggesting as many as 1.1% to 5% of first-grade children in four communities are affected, according to a report published today in JAMA.
The results suggest that physicians should be alert to identifying women of child-bearing age who may be at risk for alcohol abuse.
“These prevalence estimates are consistent with mounting evidence that harmful fetal alcohol exposure is common in the United States today,” Philip A. May, Ph.D., of the University of North Carolina at Chapel Hill and colleagues wrote. They “may represent more accurate U.S. prevalence estimates than previous studies but may not be generalizable to all communities.”
Using “active case ascertainment”—an especially rigorous study method for case identification—May and colleagues sampled more than 6,000 first graders in four communities: the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions. The researchers systematically assessed the children in the four domains relevant to fetal alcohol spectrum disorders: physical growth, dysmorphic features, neurodevelopment, and prenatal exposure. Prenatal exposure was assessed through maternal interviews conducted by trained study staff in person or over the telephone.
Of 6,639 children selected for participation (out of a first-grade population in the four regions of more than 13,000), a total of 222 cases of fetal alcohol spectrum disorders were identified. “Only 2 of the 222 children classified with a fetal alcohol spectrum disorder had been diagnosed previously with the disorder, although many parents and guardians were aware of the learning and behavioral challenges facing their children,” the authors noted.
The researchers derived a conservative estimate (which assumed that those children not included in the final sample did not have fetal alcohol syndrome) of 11.3 per 1,000 children (1.1 percent) in one Midwestern sample to a high of 50 per 1,000 (5 percent) in one Rocky Mountain sample. A second estimate (in which those children not sampled were assumed to have the same rate of fetal alcohol syndrome as the sampled population) ranged from 31 children per 1,000 to 98.5 per 1,000.
“Although the different approaches reflect the uncertainty about the actual prevalence, these new estimates are up to 10 times higher than those previously reported using similar methods from two single-site studies and up to five times higher than a recent meta-analysis of studies from the United States with a pooled prevalence of 2%,” Shannon Lange, M.P.H., Jürgen Rehm, Ph.D., and Svetlana Popova, Ph.D., wrote in an accompanying editorial. The finding that “fetal alcohol spectrum disorders is not a rare condition among the general U.S. population has substantial implications for clinicians and researchers, including that many cases are either missed or misdiagnosed…”
They added, “As the first point-of-contact, physicians and other health care professionals have an important role in prevention and identification. Special attention should be paid to young women who may engage in binge drinking because it can lead to unprotected sex and unplanned pregnancy.”
For related information, see the Psychiatric News article “Strategy Emerges to Combat Effects of Prenatal Alcohol Exposure.”
(Image: iStock/toddtaulman)
