An update on incidence of FAS: FAS is not an equal opportunity birth defect

doi:10.1016/0892-0362(95)00005-C

Neurotoxicology and Teratology

Volume 17, Issue 4, July–August 1995, Pages 437-443

https://doi.org/10.1016/0892-0362(95)00005-C Get rights and content

Abstract

The incidence of Fetal Alcohol Syndrome is now estimated at 0.97 cases per 1,000 live births in the general obstetric population and 4.3% among “heavy” drinkers. The general incidence is more than 20 times higher in the United States (1.95 per 1,000) compared to Europe and other countries (0.08 per 1,000). Within the United States, the incidence at sites characterized by low socioeconomic status, and African American or Native American background are about 10 times higher (2.29 cases per 1,000) compared to sites with a predominant middle/upper SES and Caucasian background (0.26 per 1,000). Based on racial background, the number of pregnant women in the U.S. giving birth to FAS children is 2,043 per year; if based on socioeconomic status, the number is slightly higher 2,366. Although race and SES are confounded in the U.S. studies, an examination of U.S. and European studies suggests that the major factor associated with FAS is low SES rather than racial background.

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Substance use disorders affect people of childbearing age, with the highest prevalence in people 18 to 25 years of age. Intrauterine exposure to drugs, both licit and illicit, is therefore common, and substance use disorders are associated with increased risks of stillbirth and fetal growth restriction. Fetal alcohol exposure is associated with a spectrum of conditions which may be underrecognized. Use of tobacco and e-cigarettes during pregnancy is associated with low birth weight and preterm birth as well as sudden infant death syndrome (SIDS). Cannabis use has risen markedly since it has been legalized in numerous US states, increasing concerns about its impact on the developing brain. Chronic fetal opioid exposure may be associated with neonatal abstinence syndrome, which requires monitoring in the neonatal period to guide treatment. Pharmacologic and behavioral treatment of opioid use disorder during pregnancy is associated with improved maternal and neonatal outcomes. Stimulant use during pregnancy is associated with cardiovascular abnormalities and adverse pregnancy outcomes. Short-term sequelae of other intrauterine psychotropic drug exposures have been increasingly recognized and characterized in the medical literature. Screening for substance use during pregnancy and referral for sensitive, informed, and comprehensive prenatal care benefit the mother-infant dyad. Neonatal and childhood outcome assessments can be confounded by polypharmacy, concurrent maternal psychiatric and/or medical conditions, disparities in health care delivery, and socioeconomic disadvantages. Well-designed, supportive postnatal follow-up care can improve outcomes for the infant and family.
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Prevalence and characteristics of fetal alcohol spectrum disorders (FASD) have been described previously in this community.
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Children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and alcohol related-neurodevelopmental disorder (ARND) were significantly different from controls on all cardinal variables, multiple dysmorphology traits and neurobehavioral performance. Mothers of children with FASD reported significantly more drinking before and during pregnancy (mothers of children with FAS reported 7.8 (±6.1) drinks per drinking day (DDD) prior to pregnancy and 5.1 (±5.9) after pregnancy recognition). Distal risk variables for a diagnosis on the continuum of FASD were: lower maternal height, weight, and body mass index; higher gravidity; lower education and household income; and later pregnancy recognition. Alcohol and tobacco remain the only commonly used drugs. Women reporting first trimester drinking of two DDD were 13 times more likely (95 % CI:1.3-133.4) to have a child with FASD than non-drinkers; and those who reported drinking throughout pregnancy were 19.4 times more likely (95 % CI:8.2–46.0) to have a child with FASD.
Seventeen years after the first study in this community, FASD prevalence remains high at 16 %–31 %. The FAS rate may have declined somewhat, but rates of PFAS and ARND seemed to plateau, at a high rate.
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Citation Excerpt :
Thus, the final adult expression of developmental ethanol effects reflects an interaction between ethanol exposure, genetics (Eberhart and Parnell, 2016), and later life environment in both animal models (Caldwell et al., 2015; Chokroborty-Hoque et al., 2014; Hamilton et al., 2014, 2017; Hannigan et al., 1993; Hellemans et al., 2010; Lam et al., 2018) and humans (Fagerlund et al., 2011; Streissguth et al., 2004). Given that individuals with FASD are exposed to high rates of poverty and adverse childhood events (Abel, 1995; Kambeitz et al., 2019), understanding how post-exposure environment can improve or impair long-term outcomes has high clinical relevance. Developmental ethanol has its effects on cognition and behavior, in part through disruption of neural circuit plasticity and excitation/inhibition balance (Puglia and Valenzuela, 2010a, 2010b; Sadrian et al., 2012, 2013; Subbanna et al., 2013).
Developmental exposure to ethanol has a wide range of anatomical, cellular, physiological and behavioral impacts that can last throughout life. In humans, this cluster of effects is termed fetal alcohol spectrum disorder and is highly prevalent in western cultures. The ultimate expression of the effects of developmental ethanol exposure however can be influenced by post-exposure experience. Here we examined the effects of developmental binge exposure to ethanol (postnatal day 7) in C57BL/6By mice on a specific cohort of inter-related long-term outcomes including contextual memory, hippocampal parvalbumin-expressing neuron density, frontal cortex oscillations related to sleep-wake cycling including delta oscillation amplitude and sleep spindle density, and home-cage behavioral activity. When assessed in adults that were raised in standard housing, all of these factors were altered by early ethanol exposure compared to saline controls except home-cage activity. However, exposure to an enriched environment and exercise from weaning to postnatal day 90 reversed most of these ethanol-induced impairments including memory, CA1 but not dentate gyrus PV+ cell density, delta oscillations and sleep spindles, and enhanced home-cage behavioral activity in Saline- but not EtOH-treated mice. The results are discussed in terms of the inter-dependence of diverse developmental ethanol outcomes and potential mechanisms of post-exposure experiences to regulate those outcomes.
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2019, British Journal of Oral and Maxillofacial Surgery
Our aim was to evaluate the possible correlation between maternal alcohol consumption during the first trimester and the risk of having an offspring with non-syndromic oral cleft. We electronically searched all published papers from 1950 to 2019 about maternal alcohol consumption and oral clefts in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Institute for Scientific Information (ISI) databases. Descriptive and quantitative data were extracted from eligible studies for systemic evaluation and meta-analysis. A total of 12 publications met our inclusion criteria, and nine of them presented sufficient data for quantitative analyses. The overall odds ratio of the nine reports was 1.00 (95% CI 0.87 to 1.15) for cleft lip with or without cleft palate (CL/P) and 1.02 (95% CI 0.92 to 1.14) for cleft palate only, indicating no significant difference between drinking and non-drinking mothers in the risk of having a child with a non-syndromic oral cleft. We found no confirmatory evidence for the presence of a dose-response relation between alcohol consumption and increase in the risk of oral cleft. Nevertheless, four of the studies enrolled found significantly increased risk of CL/P among mothers in the groups that consumed the most alcohol. All but one of the four studies suggested a positive correlation between binge drinking and the occurrence of non-syndromic oral cleft. Although we found no concrete correlation between mild alcohol consumption during pregnancy and the occurrence of non-syndromic oral cleft, precautions should still be taken to avoid binge drinking during the first trimester.
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ArticleAn update on incidence of FAS: FAS is not an equal opportunity birth defect

Abstract

Drug Alc. Depend.

Commununity Health Stud.

J. Pediatr.

Neurotoxicol. Teratol.

J. Pediatr.

Neurotoxicol. Teratol.

Lancet

Lancet

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

Early Hum. Develop.

Lancet

J. Nutr.

Fetal Alcohol Syndrome and fetal alcohol effects

Behavioral teratogenesis and behavioral mutagenesis

Maternal risk factors in fetal alcohol syndrome: Provocative and permissive influences

Neurotoxicol. Teratol.

Ratings of fetal alcohol syndrome facial features by medical providers and biomedical scientists

Alc. Clin. Exp. Res.

A revised conservative estimate of the incidence of FAS and its economic impact

Alc. Clin. Exp. Res.

Alcohol use during pregnancy: What is the risk?

Pediatr. Rev.

Children of alcoholic mothers

Analysis of facial shape in children gestationally exposed to marijuana, alcohol, and/or cocaine

Pediatrics

Limitations in the application of case-control methodology

Epidemiol. Rev.

Dysmorphic features in offspring of alcoholic mothers

Arch. Dis. Child.

The influence of socioeconomic factors on the occurrence of fetal alcohol syndrome

Adv. Alcohol. Subst. Abuse

Smoking and drinking habits before and during pregnancy in Spanish Women

J. Epid. Commun. Hlth.

Risk of febrile seizure in childhood in relation to prenatal cigarette smoking and alcohol intake

Am. J. Epidemiol.

Facial effects of fetal alcohol exposure: Assessment by photographs and morphometric analysis

Am. J. Med. Genet.

A comparison of prenatal drinking in two recent samples of adolescents and adults

J. Stud. Alcohol.

Prenatal exposure to alcohol: Effect on infant growth and morphologic characteristics

Pediatr.

Methodological issues in the measurement of substance abuse

NY Acad. Sci.

Aspects epidemiologiques du syndrome d'alcoolisme foetal: 45 observations en 3 ans

Nouv. Press Med.

Underreporting of alcohol use in pregnancy

Alc. Clin. Exp. Res.

Schwangerschaftsverlauf in einem repräsentativen Schweizer Kollektiv (Aarauer Schwangerschafts- und Neugeborenenstudie). II. Genussmittel in der Schwangerschaft

Schweiz. Med. Wschr.

Moderate alcohol intake increased levels of high-density lipoprotein and its subreactions and decreased risk of myocardial infarction

N. Engl. J. Med.

Maternal alcohol, tobacco and cannabis consumption and the outcome of pregnancy

Aust. N.Z.J. Obstet. Gynaecol.

Alcohol counselling of 85 pregnant problem drinkers: Effect on drinking and fetal outcome

Br. J. Obstet. Gynaecol.

Maternal serum gamma-glutamyltransferase in theprenatal screening of fetal alcohol effects

Pediatr. Res.

Effects of maternal drinking and marijuana use on fetal growth and development

Pediatrics

Long-term follow-up of three siblings with fetal alcohol syndrome

Alc. Clin. Exp. Res.

Article
An update on incidence of FAS: FAS is not an equal opportunity birth defect