May, P.A., de Vries, M.M., Marais, A.-S., Kalberg, W.O., Buckley, D., Hasken, J.M., Abdul-Rahman, O., Robinson, L.K., Manning, M.A., Seedat, S., Parry, C.D.H. and Hoyme, H.E. (2022), The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors. Alcohol Clin Exp Res. Accepted Author Manuscript. https://doi.org/10.1111/acer.14922
A third comprehensive study of fetal alcohol spectrum disorders (FASD) in a rural, agricultural region of South Africa is described.
Population-based, active case ascertainment methods were employed among a school-based cohort to assess child physical and neurobehavioral traits, and maternal risk factor interviews conducted to identify all children with FASD to determine FASD prevalence.
Consent was obtained for 76.7% of 1158 children attending first grade in the region’s public schools. Case control results are presented for 95 with fetal alcohol syndrome (FAS), 64 with partial fetal alcohol syndrome (PFAS), 77 with alcohol-related neurodevelopmental disorder (ARND), 2 with alcohol-related birth defects (ARBD), and 213 randomly-selected controls. Four techniques estimating FASD prevalence from in-person examinations and testing yielded a range of total FASD prevalence of 206-366 per 1,000. Final weighted, estimated prevalence of FAS was 104.5 per 1,000, PFAS was 77.7 per 1,000, ARND was 125.2 per 1,000, and total FASD prevalence was 310 per 1,000 (95% CI = 283.4 – 336.7). Expressed as a percentage, 31% had FASD. Although the rate of total FASD remained steady over nine years, the proportion of children within the FASD group has changed significantly: FAS trended downward, and ARND trended upward. A detailed evaluation is presented of the specific child physical and neurobehavioral traits integral to assessing the full continuum of FASD. The diagnosis of a child with FASD was significantly associated with maternal proximal risk factors such as: co-morbid prenatal use of alcohol and tobacco (OR=19.1); maternal drinking of two (OR=5.9), three (OR=5.9), four (OR=38.3), or more alcoholic drinks per drinking day; and drinking in the first trimester (OR=8.4), first and second trimesters (OR=17.7), or throughout pregnancy (OR=18.6). Distal maternal risk factors included: slight or small physical status (height, weight, and head circumference), lower BMI, less formal education, late recognition of pregnancy, and higher gravidity, parity, and older age during the index pregnancy.
The prevalence of FASD remained a significant problem in this region, but the severity of physical traits and anomalies within the continuum of FASD is trending downwards.