Fetal Alcohol Spectrum Disorders in a Pacific Southwest City: Maternal and Child Characteristics

Background There are limited data on the characteristics of children with fetal alcohol spectrum disorders (FASD) and their mothers from the general population in the United States. Methods During the 2012 and 2013 academic years, first‐grade children in a large urban Pacific Southwest city were invited to participate in a study to estimate the prevalence of FASD. Children who screened positive on weight, height, or head circumference ≤25th centile or on parental report of developmental concerns were selected for evaluation, along with a random sample of those who screened negative. These children were examined for dysmorphology and neurobehavior and their mothers or collateral sources were interviewed. Children were classified as fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol‐related neurodevelopmental disorder (ARND), or No FASD. Results A total of 854 children were evaluated; 5 FAS, 44 pFAS, 44 ARND, and 761 No FASD. Children with FAS or pFAS were more likely to have dysmorphic features, and 32/49 (65.3%) of those met criteria for neurobehavioral impairment on cognitive measures with or without behavioral deficits. In contrast, 28/44 (63.6%) of children with ARND met criteria on behavioral measures alone. Mothers of FASD children were more likely to recognize pregnancy later, be unmarried, and report other substance use or psychiatric disorders, but did not differ on age, socioeconomic status, education, or parity. Mothers of FASD children reported more drinks/drinking day each trimester. The risk of FASD was elevated with increasing number of drinks/drinking day prior to pregnancy recognition, even at the level of 1 drink per day (adjusted odds ratio 3.802, 95% confidence interval 1.634, 8.374). Conclusions Data from this general population sample in a large urban region in the United States demonstrate the variability of expression of FASD and point to risk and protective factors for mothers in this setting. Among 854 first grade children evaluated for Fetal Alcohol Spectrum Disorders (FASD) in a Pacific Southwest city from 2012 to 2013, 93 met criteria for a minimum prevalence of 18.8–22.6 per 1,000 children. Maternal age, SES and education were not associated with FASD, but later pregnancy recognition, being unmarried, other substance use, and history of psychiatric diagnoses were, suggesting strategies for prevention. Increasing number of drinks per drinking day before pregnancy recognition was associated with having a