Prevalence of fetal alcohol spectrum disorders in 4 US communities

Philip A. May, Christina D. Chambers, Wendy O. Kalberg, Jennifer Zellner, Haruna Feldman, David Buckley, David Kopald, Julie M. Hasken, Ronghui Xu, Gordon Honerkamp-Smith, Howard Taras, Melanie A. Manning, Luther K. Robinson, Margaret P. Adam, Omar Abdul-Rahman, Keith Vaux, Tamison Jewett, Amy J. Elliott, Julie A. Kable, Natacha AkshoomoffFalk Daniel, Judith A. Arroyo, Dale Hereld, Edward P. Riley, Michael E. Charness, Claire D. Coles, Kenneth R. Warren, Kenneth Lyons Jones, H. Eugene Hoyme

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

IMPORTANCE Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. OBJECTIVE To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. DESIGN, SETTING, AND PARTICIPANTS Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: Dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. EXPOSURES Alcohol consumption during pregnancy. MAIN OUTCOMES AND MEASURES Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95%CIs were calculated using the eligible first-grade population as the denominator.Weighted prevalences and 95%CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. RESULTS A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95%CI, 7.8-15.8) to 50.0 (95%CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95%CI, 16.1-54.0) to 98.5 (95%CI, 57.5-139.5) per 1000 children. CONCLUSIONS AND RELEVANCE Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.

Original languageEnglish (US)
Pages (from-to)474-482
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume319
Issue number5
DOIs
StatePublished - Feb 2018

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Fetal Alcohol Spectrum Disorders
Southwestern United States
Population
Growth and Development
Alcohol Drinking

ASJC Scopus subject areas

  • Medicine(all)

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May, P. A., Chambers, C. D., Kalberg, W. O., Zellner, J., Feldman, H., Buckley, D., ... Hoyme, H. E. (2018). Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA - Journal of the American Medical Association, 319(5), 474-482. https://doi.org/10.1001/jama.2017.21896

Prevalence of fetal alcohol spectrum disorders in 4 US communities. / May, Philip A.; Chambers, Christina D.; Kalberg, Wendy O.; Zellner, Jennifer; Feldman, Haruna; Buckley, David; Kopald, David; Hasken, Julie M.; Xu, Ronghui; Honerkamp-Smith, Gordon; Taras, Howard; Manning, Melanie A.; Robinson, Luther K.; Adam, Margaret P.; Abdul-Rahman, Omar; Vaux, Keith; Jewett, Tamison; Elliott, Amy J.; Kable, Julie A.; Akshoomoff, Natacha; Daniel, Falk; Arroyo, Judith A.; Hereld, Dale; Riley, Edward P.; Charness, Michael E.; Coles, Claire D.; Warren, Kenneth R.; Jones, Kenneth Lyons; Hoyme, H. Eugene.

In: JAMA - Journal of the American Medical Association, Vol. 319, No. 5, 02.2018, p. 474-482.

Research output: Contribution to journalArticle

May, PA, Chambers, CD, Kalberg, WO, Zellner, J, Feldman, H, Buckley, D, Kopald, D, Hasken, JM, Xu, R, Honerkamp-Smith, G, Taras, H, Manning, MA, Robinson, LK, Adam, MP, Abdul-Rahman, O, Vaux, K, Jewett, T, Elliott, AJ, Kable, JA, Akshoomoff, N, Daniel, F, Arroyo, JA, Hereld, D, Riley, EP, Charness, ME, Coles, CD, Warren, KR, Jones, KL & Hoyme, HE 2018, 'Prevalence of fetal alcohol spectrum disorders in 4 US communities', JAMA - Journal of the American Medical Association, vol. 319, no. 5, pp. 474-482. https://doi.org/10.1001/jama.2017.21896
May, Philip A. ; Chambers, Christina D. ; Kalberg, Wendy O. ; Zellner, Jennifer ; Feldman, Haruna ; Buckley, David ; Kopald, David ; Hasken, Julie M. ; Xu, Ronghui ; Honerkamp-Smith, Gordon ; Taras, Howard ; Manning, Melanie A. ; Robinson, Luther K. ; Adam, Margaret P. ; Abdul-Rahman, Omar ; Vaux, Keith ; Jewett, Tamison ; Elliott, Amy J. ; Kable, Julie A. ; Akshoomoff, Natacha ; Daniel, Falk ; Arroyo, Judith A. ; Hereld, Dale ; Riley, Edward P. ; Charness, Michael E. ; Coles, Claire D. ; Warren, Kenneth R. ; Jones, Kenneth Lyons ; Hoyme, H. Eugene. / Prevalence of fetal alcohol spectrum disorders in 4 US communities. In: JAMA - Journal of the American Medical Association. 2018 ; Vol. 319, No. 5. pp. 474-482.
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abstract = "IMPORTANCE Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. OBJECTIVE To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. DESIGN, SETTING, AND PARTICIPANTS Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: Dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. EXPOSURES Alcohol consumption during pregnancy. MAIN OUTCOMES AND MEASURES Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95{\%}CIs were calculated using the eligible first-grade population as the denominator.Weighted prevalences and 95{\%}CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. RESULTS A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9{\%}; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3{\%}). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95{\%}CI, 7.8-15.8) to 50.0 (95{\%}CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95{\%}CI, 16.1-54.0) to 98.5 (95{\%}CI, 57.5-139.5) per 1000 children. CONCLUSIONS AND RELEVANCE Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1{\%} to 5.0{\%} using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.",
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T1 - Prevalence of fetal alcohol spectrum disorders in 4 US communities

AU - May, Philip A.

AU - Chambers, Christina D.

AU - Kalberg, Wendy O.

AU - Zellner, Jennifer

AU - Feldman, Haruna

AU - Buckley, David

AU - Kopald, David

AU - Hasken, Julie M.

AU - Xu, Ronghui

AU - Honerkamp-Smith, Gordon

AU - Taras, Howard

AU - Manning, Melanie A.

AU - Robinson, Luther K.

AU - Adam, Margaret P.

AU - Abdul-Rahman, Omar

AU - Vaux, Keith

AU - Jewett, Tamison

AU - Elliott, Amy J.

AU - Kable, Julie A.

AU - Akshoomoff, Natacha

AU - Daniel, Falk

AU - Arroyo, Judith A.

AU - Hereld, Dale

AU - Riley, Edward P.

AU - Charness, Michael E.

AU - Coles, Claire D.

AU - Warren, Kenneth R.

AU - Jones, Kenneth Lyons

AU - Hoyme, H. Eugene

PY - 2018/2

Y1 - 2018/2

N2 - IMPORTANCE Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. OBJECTIVE To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. DESIGN, SETTING, AND PARTICIPANTS Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: Dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. EXPOSURES Alcohol consumption during pregnancy. MAIN OUTCOMES AND MEASURES Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95%CIs were calculated using the eligible first-grade population as the denominator.Weighted prevalences and 95%CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. RESULTS A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95%CI, 7.8-15.8) to 50.0 (95%CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95%CI, 16.1-54.0) to 98.5 (95%CI, 57.5-139.5) per 1000 children. CONCLUSIONS AND RELEVANCE Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.

AB - IMPORTANCE Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. OBJECTIVE To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. DESIGN, SETTING, AND PARTICIPANTS Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: Dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. EXPOSURES Alcohol consumption during pregnancy. MAIN OUTCOMES AND MEASURES Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95%CIs were calculated using the eligible first-grade population as the denominator.Weighted prevalences and 95%CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. RESULTS A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95%CI, 7.8-15.8) to 50.0 (95%CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95%CI, 16.1-54.0) to 98.5 (95%CI, 57.5-139.5) per 1000 children. CONCLUSIONS AND RELEVANCE Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.

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