Epidemiology of FASD in a province in Italy: Prevalence and characteristics of children in a random sample of schools.
BACKGROUND
Accurate estimates of the prevalence and characteristics of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) in a Western European population are lacking and are of particular interest in settings where the usual pattern of alcohol consumption is thought to be daily drinking with meals. To address these issues, an epidemiology study of FAS and other FASD was undertaken in Italian schools.


METHODS
Primary schools (n = 25) in 2 health districts of the Lazio region were randomly selected and recruited for the study. Five hundred forty-three children, 50% of those enrolled in first-grade classes, received parental permission to participate in a 2-tiered, active case ascertainment screening process. Detailed evaluation of children selected in a preliminary screening phase was carried out on those who were small for height, weight, and head circumference and/or referred by teachers for suspected learning and behavioral problems. Detailed evaluation was carried out on each child's: (1) physical growth and dysmorphology, (2) psychological development and behavior, and (3) prenatal exposure to alcohol and other risk factors for FASD via maternal interviews. A group of 67 randomly selected children without FASD from the same classes was utilized as a comparison group.


RESULTS
Using 2 denominators for prevalence estimation, a conservative one and a strict sample-based estimate, the prevalence of FAS in this province of Italy was 3.7 to 7.4 per 1,000 children. When cases of partial FAS (PFAS) and a case of alcohol-related neurodevelopmental deficits (ARND) were added to FAS cases, the rate of FASD was 20.3 to 40.5 per 1,000 and estimated at 35 per 1,000 overall or between 2.3 and 4.1% of all children. This exceeds previously published estimates of both FAS and FASD for the western world. Detailed data are presented that demonstrate the utility of the guidelines of the revised Institute of Medicine diagnostic criteria for FASD. Children with FASD are significantly more impaired/affected (p < 0.05) than randomly selected comparison children on all measures of growth deficiency, key facial features of FASD, overall dysmorphology scores, language comprehension, nonverbal IQ, and behavior. Maternal reports of current drinking were significantly higher for mothers of FASD children than comparison mothers, but reported rates of overall drinking during pregnancy were not significantly different. In contrast to expectations, daily drinking among mothers of the comparison group was not common. However, dysmorphology scores of the children were significantly correlated with drinking in the second and third trimesters, drinks per current drinking day, and current drinks per month. Finally, children with the physical features of FASD had lower IQs; nonverbal IQ was significantly correlated with head circumference and negatively correlated with overall dysmorphology score, smooth philtrum, and several other facial and physical anomalies characteristic of FAS.


CONCLUSIONS
Using careful measures of ascertainment in a primary school setting, these results provide relatively high estimates of the prevalence of FASD and raise the question of whether FASD is more common in the western world than previously estimated.
May
Philip A
PA
Center on Alcholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico 87106, USA. pmay@unm.edu
Fiorentino
Daniela
D
Phillip Gossage
J
J
Kalberg
Wendy O
WO
Eugene Hoyme
H
H
Robinson
Luther K
LK
Coriale
Giovanna
G
Jones
Kenneth Lyons
KL
del Campo
Miguel
M
Tarani
Luigi
L
Romeo
Marina
M
Kodituwakku
Piyadasa W
PW
Deiana
Luca
L
Buckley
David
D
Ceccanti
Mauro
M
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000428:Alcohol Drinking / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002657:Child Development; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology* / Q000473:pathology; D006128:Growth / Q000502:physiology; D006801:Humans; D007361:Intelligence Tests; D007558:Italy / Q000453:epidemiology; D008297:Male; D009035:Mothers; D009483:Neuropsychological Tests; D011247:Pregnancy; D011581:Psychological Tests; D012189:Retrospective Studies; D012574:Schools; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors