title: The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample.
abstract: 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.
  
  
  
  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.
  
  
  
  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%.
  
  
  
  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.
authors.affiliation: The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States. Electronic address: philip_may@unc.edu.
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Anna-Susan
authors.initials: AS
authors.lastname: Marais
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Marlene M
authors.initials: MM
authors.lastname: de Vries
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
authors.forename: David
authors.initials: D
authors.lastname: Buckley
authors.affiliation: The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Hasken
authors.affiliation: University of Cape Town, Department of Psychiatry and Mental Health, South Africa.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Adnams
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Ronel
authors.initials: R
authors.lastname: Barnard
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Belinda
authors.initials: B
authors.lastname: Joubert
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Marise
authors.initials: M
authors.lastname: Cloete
authors.affiliation: California State University, Northridge, United States.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tabachnick
authors.affiliation: State University of New York, Buffalo, Department of Pediatrics, United States.
authors.forename: Luther K
authors.initials: LK
authors.lastname: Robinson
authors.affiliation: Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Manning
authors.affiliation: University of California San Diego School of Medicine, Department of Pediatrics, United States.
authors.forename: Kenneth Lyons
authors.initials: KL
authors.lastname: Jones
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Heidre
authors.initials: H
authors.lastname: Bezuidenhout
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, South Africa.
authors.forename: Charles D H
authors.initials: CDH
authors.lastname: Parry
authors.affiliation: Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States; The University of Arizona College of Medicine, Department of Pediatrics and the Center for Applied Genetics and Genomic Medicine, United States.
authors.forename: H Eugene
authors.initials: HE
authors.lastname: Hoyme
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D002657:Child Development; D004522:Educational Status; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D008423:Maternal Age; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: Alcohol abuse; Binge drinking; Children with FASD; Fetal alcohol spectrum disorders (FASD); Maternal risk for FASD; Microcephaly; Prenatal alcohol use; Prevalence; South Africa