Philip A May1, Anna-Susan Marais2, Marlene M de Vries2, Wendy O Kalberg3, David Buckley3, Julie M Hasken4, Colleen M Adnams5, Ronel Barnard2, Belinda Joubert2, Marise Cloete2, Barbara Tabachnick6, Luther K Robinson7, Melanie A Manning8, Kenneth Lyons Jones9, Heidre Bezuidenhout2, Soraya Seedat2, Charles D H Parry10, H Eugene Hoyme11. 1. 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. 2. Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa. 3. The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States. 4. The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States. 5. University of Cape Town, Department of Psychiatry and Mental Health, South Africa. 6. California State University, Northridge, United States. 7. State University of New York, Buffalo, Department of Pediatrics, United States. 8. Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States. 9. University of California San Diego School of Medicine, Department of Pediatrics, United States. 10. Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, South Africa. 11. 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.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
Keywords:
Alcohol abuse; Binge drinking; Children with FASD; Fetal alcohol spectrum disorders (FASD); Maternal risk for FASD; Microcephaly; Prenatal alcohol use; Prevalence; South Africa
Authors: Philip A May; Barbara G Tabachnick; J Phillip Gossage; Wendy O Kalberg; Anna-Susan Marais; Luther K Robinson; Melanie Manning; David Buckley; H Eugene Hoyme Journal: Drug Alcohol Depend Date: 2011-06-11 Impact factor: 4.492
Authors: Philip A May; Amy Baete; Jaymi Russo; Amy J Elliott; Jason Blankenship; Wendy O Kalberg; David Buckley; Marita Brooks; Julie Hasken; Omar Abdul-Rahman; Margaret P Adam; Luther K Robinson; Melanie Manning; H Eugene Hoyme Journal: Pediatrics Date: 2014-11 Impact factor: 7.124
Authors: Philip A May; Carol Keaster; Rosemary Bozeman; Joelene Goodover; Jason Blankenship; Wendy O Kalberg; David Buckley; Marita Brooks; Julie Hasken; J Phillip Gossage; Luther K Robinson; Melanie Manning; H Eugene Hoyme Journal: Drug Alcohol Depend Date: 2015-08-14 Impact factor: 4.492
Authors: Philip A May; Marlene M de Vries; Anna-Susan Marais; Wendy O Kalberg; Colleen M Adnams; Julie M Hasken; Barbara Tabachnick; Luther K Robinson; Melanie A Manning; Kenneth Lyons Jones; Derek Hoyme; Soraya Seedat; Charles D H Parry; H Eugene Hoyme Journal: Drug Alcohol Depend Date: 2015-12-31 Impact factor: 4.492
Authors: Philip A May; Daniela Fiorentino; Giovanna Coriale; Wendy O Kalberg; H Eugene Hoyme; Alfredo S Aragón; David Buckley; Chandra Stellavato; J Phillip Gossage; Luther K Robinson; Kenneth Lyons Jones; Melanie Manning; Mauro Ceccanti Journal: Int J Environ Res Public Health Date: 2011-06-22 Impact factor: 3.390
Authors: Philip A May; Julie M Hasken; Marlene M De Vries; Anna-Susan Marais; Julie M Stegall; Daniel Marsden; Charles D H Parry; Soraya Seedat; Barbara Tabachnick Journal: Reprod Toxicol Date: 2018-02-06 Impact factor: 3.143
Authors: Evelyne Muggli; Harold Matthews; Anthony Penington; Peter Claes; Colleen O'Leary; Della Forster; Susan Donath; Peter J Anderson; Sharon Lewis; Cate Nagle; Jeffrey M Craig; Susan M White; Elizabeth J Elliott; Jane Halliday Journal: JAMA Pediatr Date: 2017-08-01 Impact factor: 16.193
Authors: Michael Suttie; Leah Wetherill; Sandra W Jacobson; Joseph L Jacobson; H Eugene Hoyme; Elizabeth R Sowell; Claire Coles; Jeffrey R Wozniak; Edward P Riley; Kenneth L Jones; Tatiana Foroud; Peter Hammond Journal: Alcohol Clin Exp Res Date: 2017-07-10 Impact factor: 3.455
Authors: Philip A May; Julie M Hasken; Stephen R Hooper; Dixie M Hedrick; Julia Jackson-Newsom; Chalise E Mullis; Elizabeth Dobyns; Wendy O Kalberg; David Buckley; Luther K Robinson; Omar Abdul-Rahman; Margaret P Adam; Melanie A Manning; Tamison Jewett; H Eugene Hoyme Journal: Drug Alcohol Depend Date: 2021-08-02 Impact factor: 4.852
Authors: Philip A May; Julie M Hasken; Amy Baete; Jaymi Russo; Amy J Elliott; Wendy O Kalberg; David Buckley; Marita Brooks; Marian A Ortega; Dixie M Hedrick; Barbara G Tabachnick; Omar Abdul-Rahman; Margaret P Adam; Tamison Jewett; Luther K Robinson; Melanie A Manning; H Eugene Hoyme Journal: Alcohol Clin Exp Res Date: 2020-04-15 Impact factor: 3.455
Authors: Philip A May; Julie M Hasken; Rosemary Bozeman; Jo-Viviane Jones; Mary Kay Burns; Joelene Goodover; Wendy O Kalberg; David Buckley; Marita Brooks; Marian A Ortega; Amy J Elliott; Dixie M Hedrick; Barbara G Tabachnick; Omar Abdul-Rahman; Margaret P Adam; Tamison Jewett; Luther K Robinson; Melanie A Manning; H Eugene Hoyme Journal: Alcohol Clin Exp Res Date: 2020-04-15 Impact factor: 3.455
Authors: Philip A May; Julie M Hasken; Julie M Stegall; Heather A Mastro; Wendy O Kalberg; David Buckley; Marita Brooks; Dixie M Hedrick; Marian A Ortega; Amy J Elliott; Barbara G Tabachnick; Omar Abdul-Rahman; Margaret P Adam; Luther K Robinson; Melanie A Manning; Tamison Jewett; H Eugene Hoyme Journal: Alcohol Clin Exp Res Date: 2020-04-15 Impact factor: 3.455
Authors: Julie M Hasken; Anna-Susan Marais; Marlene de Vries; Belinda Joubert; Marise Cloete; Isobel Botha; Sumien Roux Symington; Wendy O Kalberg; David Buckley; Luther K Robinson; Melanie A Manning; Charles D H Parry; Soraya Seedat; H Eugene Hoyme; Philip A May Journal: Alcohol Clin Exp Res Date: 2021-08-02 Impact factor: 3.928