title: Approaching the prevalence of the full spectrum of fetal alcohol spectrum disorders in a South African population-based study.
abstract: BACKGROUND
  The prevalence and characteristics of fetal alcohol spectrum disorders (FASD) were determined in this fourth study of first-grade children in a South African community.
  
  
  METHODS
  Active case ascertainment methods were employed among 747 first-grade pupils. The detailed characteristics of children within the continuum of FASD are contrasted with randomly selected, normal controls on (i) physical growth and dysmorphology; (ii) cognitive/behavioral characteristics; and (iii) maternal risk factors.
  
  
  RESULTS
  The rates of specific diagnoses within the FASD spectrum continue to be among the highest reported in any community in the world. The prevalence (per 1,000) is as follows: fetal alcohol syndrome (FAS)-59.3 to 91.0; partial fetal alcohol syndrome (PFAS)-45.3 to 69.6; and alcohol-related neurodevelopmental disorder (ARND)-30.5 to 46.8. The overall rate of FASD is therefore 135.1 to 207.5 per 1,000 (or 13.6 to 20.9%). Clinical profiles of the physical and cognitive/behavioral traits of children with a specific FASD diagnosis and controls are provided for understanding the full spectrum of FASD in a community. The spectral effect is evident in the characteristics of the diagnostic groups and summarized by the total (mean) dysmorphology scores of the children: FAS = 18.9; PFAS = 14.3; ARND = 12.2; and normal controls, alcohol exposed = 8.2 and unexposed = 7.1. Documented drinking during pregnancy is significantly correlated with verbal (r = -0.253) and nonverbal ability (r = -0.265), negative behaviors (r = 0.203), and total dysmorphology score (r = 0.431). Other measures of drinking during pregnancy are significantly associated with FASD, including binge drinking as low as 3 drinks per episode on 2 days of the week.
  
  
  CONCLUSIONS
  High rates of specific diagnoses within FASD were well documented in this new cohort of children. FASD persists in this community. The data reflect an increased ability to provide accurate and discriminating diagnoses throughout the continuum of FASD.
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA. philip_may@unc.edu
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
authors.forename: Jason
authors.initials: J
authors.lastname: Blankenship
authors.forename: Anna-Susan
authors.initials: AS
authors.lastname: Marais
authors.forename: J Phillip
authors.initials: JP
authors.lastname: Gossage
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.forename: Ronel
authors.initials: R
authors.lastname: Barnard
authors.forename: Marlene
authors.initials: M
authors.lastname: De Vries
authors.forename: Luther K
authors.initials: LK
authors.lastname: Robinson
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Adnams
authors.forename: David
authors.initials: D
authors.lastname: Buckley
authors.forename: Melanie
authors.initials: M
authors.lastname: Manning
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Jones
authors.forename: Charles
authors.initials: C
authors.lastname: Parry
authors.forename: H Eugene
authors.initials: HE
authors.lastname: Hoyme
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology