Session: Case Ascertainment for Fetal Alcohol Spectrum Disorders: Implications for Screening and Preventive Intervention in Diverse Populations (Society for Prevention Research 24th Annual Meeting)

Introduction: Widely recognized measures of the prevalence of Fetal Alcohol Spectrum Disorders (FASD) as derived from traditional data sources, such as vital statistics and birth defects monitoring programs, can result in severe underestimation of alcohol-affected children. Given high reported rates of unplanned pregnancies, and binge drinking among pregnant women in the U.S., many women of childbearing age are at high risk for prenatal alcohol exposure prior to pregnancy recognition. This situation is in part due to challenges in clinical assessment of maternal alcohol exposure, the lack of clinical expertise required to recognize the characteristic physical features of alcohol-affected children, and variability of expression in the neurobehavioral effects of prenatal alcohol. To address this problem, epidemiologic studies using cross-sectional, population-based approaches and comprehensive evaluation of school-age children in settings throughout the world have been conducted to estimate the prevalence of FASD. However, this approach had not been systematically applied in U.S. populations. To meet this critical void, the Collaboration for Fetal Alcohol Spectrum Disorders Prevalence (CoFASP) study was initiated in 2010 to develop a prevalence estimate for FASD among diverse populations in five locations in the U.S.

Methods: Three CoFASP investigators will discuss use of standard alcohol screening tools within the previously developed active case ascertainment methods across three domains: expert dysmorphological examination of physical features and growth in first grade age-range children; maternal or collateral report of quantity, frequency, pattern and timing of alcohol consumption; and child neurobehavioral assessment to measure performance in key areas known to be affected by prenatal alcohol.

Results: Data analysis will derive weighted, pooled, site-specific FASD prevalence estimates, while accounting for population and community-based differences and development of a public use dataset to facilitate future FASD research.

Conclusions: Presenters will discuss promotion of the use of standardized assessments for FASD in clinical practice to reduce drinking during pregnancy, and appropriate referral of alcohol-exposed children to follow-up intervention. Particular attention will be given to synthesis of data from the three domains to develop diagnostic classifications of Fetal Alcohol Syndrome (FAS), partial Fetal Alcohol Syndrome (pFAS) and Alcohol Related Neurobehavioral Disorder (ARND). The discussant will provide context on dissemination of methods in clinical settings and challenges for expanding assessment and preventive intervention among women of childbearing age.