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pediatrics at the University of California, San Diego. “If it truly is affecting a substantial proportion of the population, then we can do something about it. We can provide better services for those kids, and we can do a better job of preventing the disorders to begin with.”
The range of fetal alcohol spectrum disorders (also called FASDS) can cause cognitive, behavioral and physical difficulties. The most severe is fetal alcohol syndrome, in which children have smaller-than-typical heads and bodies, as well as eyes unusually short in width, thin upper lips, and smoother-than-usual skin between the nose and mouth, Chambers said. A moderate form is partial fetal alcohol syndrome. Less severe is alcohol-related neurodevelopmental disorder, in which children have neurological but not physical characteristics and it is known that their mothers drank during pregnancy.
Chambers said the researchers were in the process of analyzing the mothers’ answers to questions to see if they could identify relationships between the timing and amount of drinking during pregnancy and the type and severity of children’s impairment.
It has been unclear how common these disorders are because the facial features are subtle, and some effects, like problems paying attention or recognizing the consequences of behavior, can apply to other diagnoses. Also, the degree and area of a child’s brain damage appears to vary depending on when and how much during pregnancy the mother drank, as well as genetics, so symptoms can vary, too.
Then there is the stigma that often makes mothers reluctant to acknowledge alcohol consumption.
“When you identify a kid with FASD, you’ve just identified a mom who drank during pregnancy and harmed her child,” said Susan Astley, director of the Fetal Alcohol Syndrome Diagnostic and Prevention Network at the University of Washington, who was not involved in the study.
While Astley, a longtime expert in the field, said she admired the researchers’ hard work, she said the reliability of the study’s numbers was hampered by several factors. For example, only 60 percent of eligible families in the schools allowed their children to be evaluated and more than a third of those children’s mothers declined to answer questions about drinking during pregnancy.
“If we could generate accurate estimates of FASD, we’d all benefit,” Astley said. “But the major limitations in the study design render the results, for the most part, uninterpretable.”
The authors of the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, acknowledged the study’s limitations and tried to partly compensate by providing a conservative estimate (of 1.1 percent to 5 percent) that is likely low and another estimate (of 3.1 percent to 9.9 percent) that is likely high. Chambers also said the results might not generalize across the country because although the four communities were diverse, they did not include a large, high-poverty urban area or certain rural or indigenous communities that struggle with high rates of alcoholism.
The locations, which are not named in the publication, include small-to-midsize cities in the Midwest and Rocky Mountains, a Southeast county and a Pacific Coast city the authors identified in interviews as San Diego. Participating first-graders were given neurodevelopmental evaluations, and most also had their facial features evaluated by dysmorphologists. About 62 percent of the first-graders’ mothers were interviewed.
Of 2,962 children evaluated, the researchers identified 222 with a fetal alcohol spectrum disorder, Chambers said. All but two of them had not been previously diagnosed, although the authors said many parents had been aware their children had learning and behavioral difficulties.
“It’s kind of like the hidden problem,” said Dr. Howard Taras, a study author and professor at the University of California, San Diego, who is the physician for the San Diego Unified School District, which participated in the study. “If not in one classroom, certainly in another, there’s going to be one or two kids with these problems, but they’re not identified as such.”