Wendy O Kalberg1, Philip A May1,2,3, David Buckley1, Julie M Hasken2, Anna-Susan Marais3, Marlene M De Vries3, Heidre Bezuidenhout4, Melanie A Manning5, Luther K Robinson6, Margaret P Adam7, Derek B Hoyme8, Charles D H Parry3,9, Soraya Seedat3, Amy J Elliott10,11, H Eugene Hoyme12,11,13,14. 1. Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico. 2. Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. 4. Division of Molecular Biology and Human Genetics, Departments of Biomedical Sciences and. 5. Departments of Pathology and Pediatrics, School of Medicine, Stanford University, Stanford, California. 6. Department of Pediatrics, School of Medicine, State University of New York at Buffalo, Buffalo, New York. 7. Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington. 8. Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin; gene.hoyme@sanfordhealth.org. 9. Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. 10. Avera Research Institute Center for Pediatric and Community Research, Sioux Falls, South Dakota. 11. Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota. 12. Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; gene.hoyme@sanfordhealth.org. 13. Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota; and. 14. Departments of Pediatrics and Medicine, College of Medicine, University of Arizona, Tucson, Arizona.
Abstract
BACKGROUND AND OBJECTIVES: Fetal alcohol spectrum disorders (FASD) comprise the continuum of disabilities associated with prenatal alcohol exposure. Although infancy remains the most effective time for initiation of intervention services, current diagnostic schemes demonstrate the greatest confidence, accuracy, and reliability in school-aged children. Our aims for the current study were to identify growth, dysmorphology, and neurodevelopmental features in infants that were most predictive of FASD at age 5, thereby improving the timeliness of diagnoses. METHODS: A cohort of pregnant South African women attending primary health care clinics or giving birth in provincial hospitals was enrolled in the project. Children were followed longitudinally from birth to 60 months to determine their physical and developmental trajectories (N = 155). Standardized protocols were used to assess growth, dysmorphology, and development at 6 weeks and at 9, 18, 42, and 60 months. A structured maternal interview, including estimation of prenatal alcohol intake, was administered at 42 or 60 months. RESULTS: Growth restriction and total dysmorphology scores differentiated among children with and without FASD as early as 9 months (area under the receiver operating characteristic curve = 0.777; P < .001; 95% confidence interval: 0.705-0.849), although children who were severely affected could be identified earlier. Assessment of developmental milestones revealed significant developmental differences emerging among children with and without FASD between 18 and 42 months. Mothers of children with FASD were significantly smaller, with lower BMIs and higher alcohol intake during pregnancy, than mothers of children without FASD. CONCLUSIONS: Assessment of a combination of growth, dysmorphology, and neurobehavioral characteristics allows for accurate identification of most children with FASD as early as 9 to 18 months.
BACKGROUND AND OBJECTIVES:Fetal alcohol spectrum disorders (FASD) comprise the continuum of disabilities associated with prenatal alcohol exposure. Although infancy remains the most effective time for initiation of intervention services, current diagnostic schemes demonstrate the greatest confidence, accuracy, and reliability in school-aged children. Our aims for the current study were to identify growth, dysmorphology, and neurodevelopmental features in infants that were most predictive of FASD at age 5, thereby improving the timeliness of diagnoses. METHODS: A cohort of pregnant South African women attending primary health care clinics or giving birth in provincial hospitals was enrolled in the project. Children were followed longitudinally from birth to 60 months to determine their physical and developmental trajectories (N = 155). Standardized protocols were used to assess growth, dysmorphology, and development at 6 weeks and at 9, 18, 42, and 60 months. A structured maternal interview, including estimation of prenatal alcohol intake, was administered at 42 or 60 months. RESULTS: Growth restriction and total dysmorphology scores differentiated among children with and without FASD as early as 9 months (area under the receiver operating characteristic curve = 0.777; P < .001; 95% confidence interval: 0.705-0.849), although children who were severely affected could be identified earlier. Assessment of developmental milestones revealed significant developmental differences emerging among children with and without FASD between 18 and 42 months. Mothers of children with FASD were significantly smaller, with lower BMIs and higher alcohol intake during pregnancy, than mothers of children without FASD. CONCLUSIONS: Assessment of a combination of growth, dysmorphology, and neurobehavioral characteristics allows for accurate identification of most children with FASD as early as 9 to 18 months.
Authors: Julie M Hasken; Linda S Adair; Stephanie L Martin; Amanda L Thompson; Anna-Susan Marais; Marlene M de Vries; Wendy O Kalberg; David Buckley; H Eugene Hoyme; Soraya Seedat; Charles D H Parry; Philip A May Journal: Curr Res Toxicol Date: 2022-05-20
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