Fetal Alcohol Syndrome -- United States, 1979-1992
Fetal alcohol syndrome (FAS) is characterized by a variety of
physical and behavioral traits that result from maternal alcohol
consumption during pregnancy. Features of FAS include prenatal or
postnatal growth deficiency, abnormal facial features, and central
nervous system deficits (1). CDC's Birth Defects Monitoring Program
(BDMP) -- a national program to monitor congenital malformations --
has
collected data on the incidence of FAS among newborn infants since
1979. This report presents a rate for FAS in the United States
using
BDMP data from 1979 through 1992.
The BDMP uses hospital discharge data on newborns gathered by
the Commission on Professional and Hospital Activities (CPHA). Data
from this system include both live and stillborn infants born in
participating hospitals since 1970. Since 1979, discharge diagnosis
data have been reported to CDC by CPHA using the International
Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM). Before 1979, the CPHA used ICD-8, which did not include
a code used for FAS. During 1992, the BDMP monitored data on
approximately 10% of all births, compared with approximately 30% in
1979.
From 1979 through 1992, a total of 1782 FAS cases were
reported
among 9,057,624 births, a rate of 2.0 per 10,000 births (Figure 1).
During 1992, the BDMP identified 67 infants born with FAS,
representing a rate of 3.7 per 10,000 births. This rate is an
increase of more than threefold that for 1979 (1.0 per 10,000
births).
Reported by: Birth Defects and Genetic Diseases Br, and
Developmental Disabilities Br, Div of Birth Defects and
Developmental
Disabilities, National Center for Environmental Health, CDC.
Editorial Note
Editorial Note: FAS is a leading preventable cause of birth
defects and mental retardation in the United States. FAS represents
some of the most serious effects of alcohol to the developing
fetus.
Because FAS has not been reported in the absence of excessive
maternal alcohol consumption during pregnancy, this problem can be
prevented by the avoidance of alcohol use by women who are
pregnant.
A national health objective for the year 2000 is to reduce the rate
of FAS to no more than 0.12 per 1000 live births (i.e., 1.2 per
10,000 live births) (objective 14.4) (2).
FAS is difficult to recognize in newborns for three reasons:
1)
facial stigmata of FAS are often subtle; 2) some types of central
nervous system deficit in infants are difficult to detect; and 3)
the
birthweight of some affected infants is normal. Although the BDMP
data are derived from diagnoses made by physicians during the
neonatal period, and the sensitivity and specificity of the data
are
unknown, rates derived from BDMP data are likely to underestimate
the
true incidence of FAS. Incidence rates for FAS based on the BDMP
are
substantially lower than those based on other studies (3 ). Because
neither the sensitivity nor the specificity of the BDMP data are
known, it is difficult to interpret the increase in the incidence
of
FAS reported to the BDMP. The increase may reflect an increase in
the
recognition and reporting by physicians and/or a true increase in
incidence. Studies are under way to evaluate the sensitivity and
specificity of the BDMP data.
CDC, in collaboration with private, voluntary organizations,
is
promoting Alcohol and Other Drug Related Birth Defects Awareness
Week, May 9-15, 1993. These organizations are making available
information packets for state, federal, and voluntary
organizations;
these packets contain articles, fact sheets, and sample press
releases regarding awareness, intervention, and prevention of FAS
and
other drug-related birth defects. Information packets are available
from The Arc (formerly the Association for Retarded Citizens), P.O.
Box 6109, Arlington, TX 76005; The March of Dimes Birth Defects
Foundation, Education and Health Promotion, 1275 Mamaroneck Avenue,
White Plains, NY 10605; and the National Council on Alcoholism and
Drug Dependence, Inc., 1511 K Street, NW, Suite 926, Washington, DC
20005.
References
Sokol RJ, Clarren SK. Guidelines for use of terminology
describing
the impact of prenatal alcohol on the offspring. Alcoholism:
Clinical
and Experimental Research 1989;13:597-8.
Public Health Service. Healthy people 2000: national health
promotion and disease prevention objectives -- full report, with
commentary. Washington, DC: US Department of Health and Human
Services, Public Health Service, 1991; DHHS publication no.
(PHS)91-50212.
Abel E, Sokol RJ. Incidence of fetal alcohol syndrome and
economic
impact of FAS-related anomalies. Drug Alcohol Depend 1987;19:51-70.
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