The Wisconsin Fetal Alcohol Syndrome Screening Project.

PROBLEM: Fetal Alcohol Syndrome (FAS) is preventable, under-diagnosed, and under-reported. Wisconsin rates for alcohol use and binge drinking in childbearing-age women exceed the national average. FAS prevalence in Wisconsin has not previously been systematically evaluated.
METHODS: The Wisconsin Fetal Alcohol Syndrome Screening Project (WFASSP) used a multi-stage, multisource prospective population-based screening methodology to identify children born in 1998-1999 in Southeast Wisconsin who met a surveillance case definition for FAS. The 4-stage methodology used screening of electronic birth files, abstraction of neonatal medical records, and direct assessment of facial features, growth, and development at age 2 to 3 years.
RESULTS: The FAS prevalence rate was 0.23 per 1000 births. Children directly evaluated had fewer demographic, pregnancy, and maternal substance use risk factors than lost-to-follow-up children. Thirty-two percent of children with weight and head circumference below the 10th percentile at birth were developmentally delayed and 47% had at least one physical growth delay.
CONCLUSIONS: The WFASSP methodology identified children who had not previously been diagnosed with FAS. Using the combination of weight and head circumference below the 10th percentile at birth is a useful methodology for identifying children at substantial risk for growth and developmental delays from FAS or other unspecified etiologies.