A semiquantitative score system for epidemiologic studies of fetal alcohol syndrome.

A total of 464 children of 323 women registered for alcoholism treatment in Budapest, Hungary, were studied in 1977-1979. A complex epidemiologic investigation was carried out using medical, psychological and anthropological data. The data were evaluated on the basis of a semiquantitative diagnostic scoring system for fetal alcohol syndrome. The score distribution curve for 301 children whose mothers imbibed during pregnancy was statistically significantly different from the score distribution curve for 163 children born to alcoholic mothers who remained abstinent during pregnancy and from the curve for a matched control group of 464 children. A significant difference was also found between the score distribution curves for the latter two groups. Twenty-five children of 301 drinkers (8.3%) scored below -30 points and were said to show typical manifestations of the syndrome. All of the mothers in this group imbibed large amounts of alcohol during pregnancy. A further 205 children of 464 alcoholic mothers (44.2%) scored between -30 and -10 points and were diagnosed as having an atypical form of the syndrome. Among the 205 children, 168 were the offspring of 301 drinkers (55.8%) and 37 were the offspring of 163 alcoholic females who were abstinent during pregnancy (22.7%). A stepwise discriminant analysis showed the best discriminating variables--in order of entry into the discriminant functions--to be current weight, nose-upper lip distance, behavioral disturbance (irritability), root of the nose, intelligence quotient, and palpebral fissure. The most important cause of fetal alcohol syndrome is the direct toxic effect of alcohol on the fetus.