Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA.
Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
Alcohol Clin Exp Res. 2022 Oct;46(10):1819-1836. doi: 10.1111/acer.14922. Epub 2022 Sep 1.
This study is the ninth cross-sectional community study of fetal alcohol spectrum disorders (FASD) conducted by the multidisciplinary Fetal Alcohol Syndrome Epidemiology Research team in the Western Cape Province of South Africa. It is the third comprehensive study of FASD in a rural, agricultural region of South Africa.
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 were conducted to identify all children with FASD to determine its 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 1000. The final weighted, estimated prevalence of FAS was 104.5 per 1000, PFAS was 77.7 per 1000, ARND was 125.2 per 1000, and total FASD prevalence was 310 per 1000 (95% CI = 283.4-336.7). Expressed as a percentage, 31% had FASD. Although the rate of total FASD remained steady over 9 years, the proportion of children within the FASD group has changed significantly: FAS trended down and ARND trended up. 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 the following: 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.
这是由南非西开普省多学科胎儿酒精谱系障碍（FASD）流行病学研究小组进行的第九次 FASD 横断面社区研究，也是第三次对南非农村农业区 FASD 的全面研究。
采用基于人群的主动病例确定方法，对以学校为基础的队列中的儿童进行身体和神经行为特征评估，并进行母体风险因素访谈，以确定所有患有 FASD 的儿童，从而确定其患病率。
该地区公立学校一年级共有 1158 名儿童，其中 76.7%的儿童同意参加。本文介绍了 95 例胎儿酒精综合征（FAS）、64 例部分胎儿酒精综合征（PFAS）、77 例酒精相关神经发育障碍（ARND）、2 例酒精相关出生缺陷（ARBD）和 213 名随机选择的对照儿童的病例对照结果。从个人检查和测试中使用四种技术估计 FASD 的患病率，得出的总 FASD 患病率范围为每 1000 人中有 206-366 人。最终加权估计的 FAS 患病率为 104.5/1000，PFAS 为 77.7/1000，ARND 为 125.2/1000，总 FASD 患病率为 310/1000（95%CI=283.4-336.7）。以百分比表示，有 31%的儿童患有 FASD。尽管 FASD 的总患病率在 9 年内保持稳定，但 FASD 组内儿童的比例发生了显著变化：FAS 呈下降趋势，而 ARND 呈上升趋势。本文详细评估了评估 FASD 全谱的特定儿童身体和神经行为特征。患有 FASD 的儿童的诊断与母体近端风险因素显著相关，例如：合并使用酒精和烟草进行产前（OR=19.1）；母亲每周饮用两杯（OR=5.9）、三杯（OR=5.9）、四杯（OR=38.3）或更多酒；以及在第一个三个月（OR=8.4）、第一个和第二个三个月（OR=17.7）或整个怀孕期间（OR=18.6）饮酒。母体远端风险因素包括以下因素：轻微或小的身体状况（身高、体重和头围）、较低的 BMI、较少的正规教育、妊娠后期认识、更高的孕次、产次和孕妇年龄。
该地区 FASD 的患病率仍然是一个严重的问题，但 FASD 连续谱中身体特征和异常的严重程度呈下降趋势。
