Surprising impact of drinking during pregnancy

The number of children affected by fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) is substantially higher than previous estimates indicate, a new study suggests.

Researchers studied 70.5% (children whose parents consented) of more than 2000 first-graders enrolled in 32 public and private schools in a nationally representative Midwestern city. They gave memory, cognitive, and behavioral tests to children with developmental disabilities or who were at or below the 25th percentile for height, weight, or head circumference, and to a control group of normally developing children. They also examined the children for physical signs of fetal alcohol syndrome and interviewed the mothers for risk factors.   

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The study estimated a total rate of FASD of 24 to 48 per 1000 children, or 2.4% to 4.8%, significantly higher than the previously estimated rate of 1% for the overall United States population. The FAS rate, at 6 to 9 per 1000 children, was well above previous estimates of 0.2 to 3 per 1000.

Earlier estimates were based on less representative samples, which, unlike the current study, used passive methods such as surveillance or clinic studies rather than active case ascertainment, the researchers note. They point out that recent estimates of FAS rates using active case ascertainment in the United States and Europe (2 to 7 per 1000) more closely resemble their findings.

The researchers conclude that the rates of FASD, FAS, and partial fetal alcohol syndrome (11 to 17 per 1000) in their study indicate that the conditions occur far more frequently than older estimates suggest. The most predictive maternal risk variables were late recognition of pregnancy, amount of alcohol consumed by the mother in the 3 months before pregnancy, and reported alcohol consumption by the index child’s father.

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