Fetal Alcohol Spectrum Disorders

  • Philip A. May (UNM Emeritus Professor; now at UNC Chapel Hill)
  • Wendy Kalberg

    Fetal Alcohol Spectrum Disorders (FASDs) result from prenatal alcohol exposure to the developing fetus. When a pregnant woman drinks during pregnancy, the alcohol she consumes acts as a teratogen on the developing fetus and the child can be born with physical differences such as a small head, growth retardation, and minor differences of the face. More importantly, though, prenatal alcohol exposure can lead to brain damage to the unborn child resulting in lifelong cognitive and behavioral impairments.

    The CASAA FASD team has led research in collaboration with teams at the University of Stellenbosch and the Cape Town in the Western Cape Region of South Africa, the University of Rome (La Sapienza), The University of North Carolina at Chapel Hill and at Greensboro, Sanford Health and the University of South Dakota School of Medicine in South Dakota, Stanford University, the State University of New York at Buffalo, the University of Mississippi, and the University of Washington. Through community-based research, these teams have been able to: better define, operationalize, and implement the Institute of Medicine (IOM) criteria for the four diagnostic categories within FASD, explore the developmental and behavioral effects of prenatal alcohol on the child, and further the understanding of the maternal physical and social risk factors associated with FASD.

    The current FASD work at CASAA focuses on school-based screenings for FASD in collaboration with the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the University of California at San Diego, UNM, and UNC Chapel Hill and Greensboro. The overall goal of this collaborative initiative is to determine a reliable prevalence figure for FASD and the specific characteristics of children with a specific diagnosis within the continuum of FASD in the general United States population.

    Work in South Africa commenced in 1997 and is ongoing today. The South African work has resulted in extensive documentation of the highest rates of FASD in the world, and has provided some of the most definitive description and analysis of the characteristics of children with an FASD, cognitive and behavioral characteristics of the children, and many factors of maternal risk for FASD. A system of comprehensive Institute of Medicine (IOM)-based FAS prevention has been implemented in the Western Cape Province of South Africa to measure effectiveness over an extended period through: (a) changes in age-specific FAS prevalence rates, (b) a formative evaluation of specific prevention components, and specific secondary (proxy) measures; (c) changes in adult drinking and associated risk factors in the target communities over time; and (d) assessment of the overall effect of comprehensive FAS prevention across sites. Research also is focused on further delineating and defining maternal risk factors for FAS, and advancing the diagnostic rigor of FASD. The preventive interventions, implemented by local staff from the target community, use knowledge of research-defined maternal risk behaviors to guide case management strategies to change unhealthy practices of high risk individuals; brief interventions using the principles of community reinforcement approach (CRA) and motivational enhancement therapy (MET); and birth control and individual skill building. In selected and universal prevention, routine screening for alcohol abuse, targeted messages to specific aggregates, policy advocacy, and community motivation are used. Results are applicable to national and international communities.

    Ongoing and proposed work in South Africa focuses on: (a) early diagnosis of affected children and following infants from the newborn period to 7 years of age; (b) nutritional and behavioral interventions with affected children, (c) a comparative study of results from alcohol biomarker (EtG and FAEE) tests and self-reported alcohol use in the prenatal period, and (d) detailed case control study of maternal nutrition in the prenatal period.