Objective
To detail the characteristic traits of children with fetal alcohol spectrum disorders (FASDs) and maternal risk factors in a southeastern U.S. County.
Methods
Independent samples were drawn ...from 2 different cohorts of first‐grade students. All consented children (49.8%) were measured for height, weight, and head circumference, and those ≤ 25th centile entered the study along with a random sample drawn from all enrolled students. Study children were examined for physical growth, dysmorphology, and neurobehavior, and their mothers were interviewed.
Results
Total dysmorphology scores discriminated well the physical traits of children across the FASD continuum: fetal alcohol syndrome (FAS) = 15.8, partial FAS (PFAS) = 10.8, alcohol‐related neurobehavioral disorder (ARND) = 5.2, and typically developing controls = 4.4. Additionally, a neurobehavioral battery distinguished children with each FASD diagnosis from controls. Behavioral problems qualified more children for FASD diagnoses than cognitive traits. Significant proximal maternal risk variables were as follows: reports of prepregnancy drinking, drinking in any trimester, and comorbid use of other drugs in lifetime and during pregnancy, especially alcohol and marijuana (14.9% among mothers of children with FASD vs. 0.4% for controls). Distal maternal risks included reports of other health problems (e.g., depression), living unmarried with a partner during pregnancy, and a lower level of spirituality. Controlling for other drug use during pregnancy, having a child diagnosed with a FASD was 17.5 times greater for women who reported usual consumption of 3 drinks per drinking day prior to pregnancy than for nondrinking mothers (p < 0.001, 95% CI = 5.1 to 59.9). There was no significant difference in the prevalence of FASD by race, Hispanic ethnicity, or socioeconomic status. The prevalence of FASD was not lower than 17.3 per 1,000, and weighted estimated prevalence was 49.0 per 1,000 or 4.9%.
Conclusion
This site had the second lowest rate in the CoFASP study, yet children with FASD are prevalent.
In the Southeastern US site, mothers of children with fetal alcohol spectrum disorders (FASD) were significantly later than mothers of typically developing controls in recognizing their pregnancy. Self‐rated spirituality was significantly lower among mothers of children with FASD, and self‐reported drinking prior to pregnancy was significantly associated with increased odds (7.8‐17.6 times) of bearing a child with FASD than that of women reporting no drinking. This site had the second lowest weighted prevalence of FASD of the four Collaboration on Fetal Alcohol Spectrum Disorders Prevalence (CoFASP) sites of 4.9%.
Objective
To document prevalence and traits of children with fetal alcohol spectrum disorders (FASD) and maternal risk factors in a Rocky Mountain city.
Methods
Variations on active case ...ascertainment methods were used in 2 first‐grade cohorts in all city schools. The consent rate was 59.2%. Children were assessed for physical growth, dysmorphology, and neurobehavior and their mothers interviewed.
Results
Thirty‐eight children were diagnosed with FASD and compared with 278 typically developing controls. Total dysmorphology scores summarized well the key physical indicators of FASD and defined specific diagnostic groups. On average, children with FASD performed significantly poorer than controls on intellectual, adaptive, learning, attention, and behavioral tasks. More mothers of children with FASD reported drinking prior to pregnancy and in the first and second trimesters, and had partners with drinking problems than mothers of controls; however, reports of comorbid alcohol use and 6 other drugs were similar for mothers of children with FASD and mothers of controls. Mothers of children with FASD were significantly younger at pregnancy, had lower average weight before pregnancy and less education, initiated prenatal clinic visits later, and reported more health problems (e.g., stomach ulcers and accidents). Children with FASD had significantly lower birth weight and more problems at birth, and were less likely to be living with biological mother and father. Controlling for other drug and tobacco use, a FASD diagnosis is 6.7 times (OR = 6.720, 95% CI = 1.6 to 28.0) more likely among children of women reporting prepregnancy drinking of 3 drinks per drinking day (DDD) and 7.6 times (OR = 7.590, 95% CI = 2.0 to 31.5) more likely at 5 DDD. Prevalence of FAS was 2.9–5.8 per 1,000 children, and total FASD was 34.9 to 82.5 per 1,000 children or 3.5 to 8.3% at this site.
Conclusion
This site had the second highest prevalence of FASD of the 4 Collaboration on FASD Prevalence sites and clearly identifiable child and maternal risk traits.
The general cognitive abilities scores of children in the Rocky Mountain site were poorer among children with fetal alcohol spectrum disorders (FASD) than controls and poorest among children with alcohol‐related neurodevelopmental disorder (ARND). Mothers of children with FASD weighed less and sought prenatal care later during pregnancy than mothers of typically‐developing controls. High levels of self‐reported pre‐pregnancy drinking was strongly associated with children with FASD. This site had the third highest prevalence of FASD of the four Collaboration on Fetal Alcohol Spectrum Disorders Prevalence (CoFASP) sites, 3.5% to 8.3%.
•The rate of total FASD in this community was high in 2014, 16–30 %.•The rate of fetal alcohol syndrome was 4.3–6.6 %, similar to that in 1999.•As few as 2 drinks per drinking day was significantly ...associated with FASD diagnoses.•Two days per week was the modal drinking frequency reported for FASD diagnoses.•Drinking in all trimesters increased the odds of FASD to 19 times that of abstinence.
Prevalence and characteristics of fetal alcohol spectrum disorders (FASD) have been described previously in this community.
Active case ascertainment methods were employed in a new cross-sectional study with Revised Institute of Medicine criteria among first grade students (n = 735) via dysmorphology examinations and neurobehavioral assessments. Their mothers were interviewed regarding risk factors. Final diagnoses were assigned via structured case conferences.
Children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and alcohol related-neurodevelopmental disorder (ARND) were significantly different from controls on all cardinal variables, multiple dysmorphology traits and neurobehavioral performance. Mothers of children with FASD reported significantly more drinking before and during pregnancy (mothers of children with FAS reported 7.8 (±6.1) drinks per drinking day (DDD) prior to pregnancy and 5.1 (±5.9) after pregnancy recognition). Distal risk variables for a diagnosis on the continuum of FASD were: lower maternal height, weight, and body mass index; higher gravidity; lower education and household income; and later pregnancy recognition. Alcohol and tobacco remain the only commonly used drugs. Women reporting first trimester drinking of two DDD were 13 times more likely (95 % CI:1.3-133.4) to have a child with FASD than non-drinkers; and those who reported drinking throughout pregnancy were 19.4 times more likely (95 % CI:8.2–46.0) to have a child with FASD.
Seventeen years after the first study in this community, FASD prevalence remains high at 16 %–31 %. The FAS rate may have declined somewhat, but rates of PFAS and ARND seemed to plateau, at a high rate.
A Practical Approach to using Multivariate Analyses Using Multivariate Statistics, 6th edition provides advanced undergraduate as well as graduate students with a timely and comprehensive ...introduction to today's most commonly encountered statistical and multivariate techniques, while assuming only a limited knowledge of higher-level mathematics. This text's practical approach focuses on the benefits and limitations of applications of a technique to a data set - when, why, and how to do it. Learning Goals Upon completing this book, readers should be able to: Learn to conduct numerous types of multivariate statistical analyses Find the best technique to use Understand Limitations to applications Learn how to use SPSS and SAS syntax and output.
This early intervention study investigated the effectiveness of a relationship-based, developmental enhancement process for children who were prenatally exposed to alcohol in the South African ...context. Methods: Groups were created according to the child’s level of risk for alcohol-related developmental issues based on each mother’s alcohol use during pregnancy as assessed using the Alcohol Use Disorders Identification Test (AUDIT). Primary caregiver/child dyads were the focus of the intervention and child development was monitored by the Ages and Stages Questionnaire (ASQ). Eighteen caregiver/child dyads were in the heavily alcohol-exposed group, and 20 caregiver/child dyads were in the no or light alcohol-exposure group. The Home Observation Measurement of the Environment (HOME) was measured pre and post intervention. Results: The results indicated significant improvements in the home environment (p < .001) post-intervention for the entire cohort. For the total HOME score, there was a statistically significant main effect for time (pre- vs post-test), F(1, 36)= 65.205, p < .001, partial η2 = .64. with 99% confidence limits from .35 to .78. The offspring and parents from both the heavy alcohol exposure group and the no/low alcohol exposure group benefitted from the intervention over the duration of the intervention. Of the HOME domains affected, responsivity was the most improved in the households. The children’s scores on the ASQ varied substantially over the months of the intervention, and the offspring of the heavy exposure group often performed significantly worse than the no/low exposure group. Nevertheless, further analysis revealed that children with the lowest performance at baseline improved their performance on most ASQ domains throughout the intervention and performed significantly better on all ASQ domains over time and at completion of the intervention. Conclusions: This relationship-based, early intervention program for children resulted in benefits to all of the children over time.
•Heart Start Model improves development in young children with PAE and FASD.•Early intervention in an impoverished group improves development of most children.•Reciprocal relationships is the domain most improved in this Heart Start trial.
Valid, accessible, reusable methods for instructional video game design and embedded assessment can provide actionable information enhancing individual and collective achievement. Cyberlearning ...through game‐based, metaphor‐enhanced learning objects (CyGaMEs) design and embedded assessment quantify player behavior to study knowledge discovery and application. CyGaMEs is grounded by analogical reasoning theory, cognitive task analysis and knowledge representation. A construct representation argument for validity using evidence‐centered design warrants CyGaMEs, its web‐based learning environment, Selene: A Lunar Construction GaME, its embedded assessment, and a learning dynamics approach to student, measurement and statistical models. Two studies (US volunteers, Study 1: n = 267, mean (M)age = 15; Study 2: n = 90, Mage = 12) cross‐validate learning dynamics (learner progress, rate of progress and changes in that rate) for Selene's multidimensional goals while players learn and apply standard‐based science about fundamental geology and space science concepts. Gameplay data analyzed using regression, calculus and hierarchical linear modeling exhibit overall relatively high standardized rates of progress toward each goal statistically higher than zero. For example, adjusting for nesting within individual players, average rate of progress toward the goal of accreting lunar mass is a z‐score of 1.4 (99% confidence interval = 1.40lower, 1.48upper) or 1.4 standard deviations above zero.
Objectives: This is a third exploration of risk factors for the two most severe forms of fetal alcohol spectrum disorders (FASD), fetal alcohol syndrome (FAS) and Partial FAS (PFAS), in a South ...African community with the highest reported prevalence of FAS in the world.
Methods: In a case control design, interview and collateral data concerning mothers of 72 first grade children with FAS or PFAS are compared with 134 randomly selected maternal controls of children from the same schools.
Results: Significant differences were found between the mothers of FASD children and controls in socio‐economic status, educational attainment, and a higher prevalence of FASD among rural residents. The birth order of the index children, gravidity, and still birth were significantly higher among mothers of FASD children. Mothers of children with a FASD are less likely to be married and more likely to have a male partner who drank during the index pregnancy. Current and gestational alcohol use by mothers of FASD children is bingeing on weekends, with no reduction in drinking reported in any trimester in 75 to 90% of the pregnancies that resulted in an FAS child or during 50 to 87% of PFAS‐producing pregnancies. There was significantly less drinking among the controls in the second and third trimesters (11 to 14%). Estimated peak blood alcohol concentrations (BAC)s of the mothers of PFAS children range from 0.155 in the first trimester to 0.102 in the third, and for mothers of FAS children the range is from 0.197 to 0.200 to 0.191 in the first, second, and third. Smoking percentage during pregnancy was significantly higher for mothers of FASD children (82 to 84%) than controls (35%); but average quantity smoked is low in the 3 groups at 30 to 41 cigarettes per week. A relatively young average age of the mother at the time of FAS and PFAS births (28.8 and 24.8 years respectively) is not explained by early onset of regular drinking (mean = 20.3 to 20.5 years of age). But the mean years of alcohol consumption is different between groups, 16.3, 10.7, and 12.1 years respectively for mothers of FAS, FASD, and drinking controls. Mothers of FAS and PFAS children were significantly smaller in height and weight than controls at time of interview. The child’s total dysmorphology score correlates significantly with mother’s weight (−0.46) and BMI (−0.39). Bivariate correlations are significant between the child’s dysmorphology and known independent demographic and behavioral maternal risk factors for FASD: higher gravidity and parity; lower education and income; rural residence; drinks consumed daily, weekly, and bingeing during pregnancy; drinking in all trimesters; partner's alcohol consumption during pregnancy; and use of tobacco during pregnancy. Similar significant correlations were also found for most of the above independent maternal risk variables and the child’s verbal IQ, non‐verbal IQ and behavioral problems.
Conclusions: Maternal data in this population are generally consistent with a spectrum of effects exhibited in the children. Variation within the spectrum links greater alcohol doses with a greater severity of effects among children of older and smaller mothers of lower socio economic status in their later pregnancies. Prevention is needed to address known maternal risk factors for FASD in this population.
Ocular measurements in fetal alcohol spectrum disorders Gomez, Diego A.; May, Philip A.; Tabachnick, Barbara G. ...
American journal of medical genetics. Part A,
October 2020, 2020-10-00, 20201001, Letnik:
182, Številka:
10
Journal Article
Recenzirano
Fetal alcohol spectrum disorders (FASD) describe a range of physical, behavioral, and neurologic deficits in individuals exposed to alcohol prenatally. Reduced palpebral fissure length is one of the ...cardinal facial features of FASD. However, other ocular measurements have not been studied extensively in FASD. Using the Fetal Alcohol Syndrome Epidemiologic Research (FASER) database, we investigated how inner canthal distance (ICD), interpupillary distance (IPD), and outer canthal distance (OCD) centiles differed between FASD and non‐FASD individuals. We compared ocular measurement centiles in children with FASD to non‐FASD individuals and observed reductions in all three centiles for ICD, IPD, and OCD. However, when our non‐FASD children who had various forms of growth deficiency (microcephaly, short‐stature, or underweight) were compared to controls, we did not observe a similar reduction in ocular measurements. This suggests that reductions in ocular measurements are a direct effect of alcohol on ocular development independent of its effect on growth parameters, which is consistent with animal models showing a negative effect of alcohol on developing neural crest cells. Interpupillary distance centile appeared to be the most significantly reduced ocular measure we evaluated, suggesting it may be a useful measure to be considered in the diagnosis of FASD.
To provide an analysis of multiple predictors of cognitive and behavioral traits for children with fetal alcohol spectrum disorders (FASDs).
Multivariate correlation techniques were used with ...maternal and child data from epidemiologic studies in a community in South Africa. Data on 561 first-grade children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and not FASD and their mothers were analyzed by grouping 19 maternal variables into categories (physical, demographic, childbearing, and drinking) and used in structural equation models (SEMs) to assess correlates of child intelligence (verbal and nonverbal) and behavior.
A first SEM using only 7 maternal alcohol use variables to predict cognitive/behavioral traits was statistically significant (B = 3.10, p < .05) but explained only 17.3% of the variance. The second model incorporated multiple maternal variables and was statistically significant explaining 55.3% of the variance. Significantly correlated with low intelligence and problem behavior were demographic (B = 3.83, p < .05) (low maternal education, low socioeconomic status SES, and rural residence) and maternal physical characteristics (B = 2.70, p < .05) (short stature, small head circumference, and low weight). Childbearing history and alcohol use composites were not statistically significant in the final complex model and were overpowered by SES and maternal physical traits.
Although other analytic techniques have amply demonstrated the negative effects of maternal drinking on intelligence and behavior, this highly controlled analysis of multiple maternal influences reveals that maternal demographics and physical traits make a significant enabling or disabling contribution to child functioning in FASD.
Abstract Background Previous research in South Africa revealed very high rates of fetal alcohol syndrome (FAS), of 46–89 per 1000 among young children. Maternal and child data from studies in this ...community summarize the multiple predictors of FAS and partial fetal alcohol syndrome (PFAS). Method Sequential regression was employed to examine influences on child physical characteristics and dysmorphology from four categories of maternal traits: physical, demographic, childbearing, and drinking. Then, a structural equation model (SEM) was constructed to predict influences on child physical characteristics. Results Individual sequential regressions revealed that maternal drinking measures were the most powerful predictors of a child's physical anomalies ( R2 = .30, p < .001), followed by maternal demographics ( R2 = .24, p < .001), maternal physical characteristics ( R2 = .15, p < .001), and childbearing variables ( R2 = .06, p < .001). The SEM utilized both individual variables and the four composite categories of maternal traits to predict a set of child physical characteristics, including a total dysmorphology score. As predicted, drinking behavior is a relatively strong predictor of child physical characteristics ( β = 0.61, p < .001), even when all other maternal risk variables are included; higher levels of drinking predict child physical anomalies. Conclusions Overall, the SEM model explains 62% of the variance in child physical anomalies. As expected, drinking variables explain the most variance. But this highly controlled estimation of multiple effects also reveals a significant contribution played by maternal demographics and, to a lesser degree, maternal physical and childbearing variables.
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