Centro di Riferimento Alcologicodella Regione Lazio
MAURO CECCANTIBrussels 9 September 2009MAURO CECCANTI
Brussels 9 September 2009
EPIDEMIOLOGY OF FASD IN A PROVINCE OF ITALYEPIDEMIOLOGY OF FASD IN A PROVINCE OF ITALY
Centro di Riferimento Alcologicodella Regione Lazio
HOW BIG IS THE PROBLEM?BACKGROUNDBACKGROUND
PASSIVE PASSIVE ASCERTAINMENTASCERTAINMENT
Clinic-basedClinic-based
Record-basedRecord-based
FAS 0,33 – 2,0/1000FAS 0,33 – 2,0/1000
FASD 9/1000FASD 9/1000
ACTIVE ASCERTAINMENTACTIVE ASCERTAINMENT
Minority, low-SES*Minority, low-SES*
Washington (Clarren KS 2001)Washington (Clarren KS 2001)
S.AFRICA FAS: 46-75/1000 S.AFRICA FAS: 46-75/1000
FAS 3.1/1000FAS 3.1/1000
UNITED STATES TODAYUNITED STATES TODAYFAS 0,6-3.0/1000FAS 0,6-3.0/1000
FASD 10/1000FASD 10/1000
Prevalence of FASD in western Countries
Accurate éstimates of the prevalence and characterìstics of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) in a Western European population are lacking.
*SES: Socioeconomic-status*SES: Socioeconomic-status
Centro di Riferimento Alcologicodella Regione Lazio
Pilot project of in-school prevalence, funded by NIH-NIAAA and Lazio Region (2003 -2005).
Italy is predominantly middle Socio-Economic Status (SES) with regular, moderate drinking, practiced during meals.
First population-based FASD epidemiology study ever in Western Europe.
EPIDEMIOLOGY OF FAS IN ITALYEPIDEMIOLOGY OF FAS IN ITALY
Centro di Riferimento Alcologicodella Regione Lazio
Centro di Riferimento Alcologicodella Regione Lazio
School physicians
Screening for height, weight, head circumference(≤ 10 Percentile)
• IPDA* (Terreni)
• DBD** (Pelham)
Behavior and learning Teachers
Parents
INITIAL DATA COLLECTION - TIER I SCREENINGINITIAL DATA COLLECTION - TIER I SCREENING
*IPDA: Questionario osservativo per l’Identificazione Precoce delle Difficoltà di Apprendimento**DBD: Parent ⁄ Teacher Pelham Disruptive Behaviour Disorder rating scale
Maternal interview: risk factors
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DIAGNOSTIC PROCEDURES - TIER IIDIAGNOSTIC PROCEDURES - TIER II
• Language comprehension (Rustioni)
• Raven-CPM*• WISC-r**
Psychological assessment
Dysmorphology Index (IOM criteria)
Dysmorphology examination 4
Dysmorphologists2 teams
Psychologists
*Raven-Colored Progressive Matrices**Wechsler Intelligence Scale for Children-Revised
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46 FASD46
FASD
416 SELECTE
D
416 SELECTE
D
976 CONSENTS
GIVEN
976 CONSENTS
GIVEN
1988 POPULATION
1988 POPULATION
TIER IMaternal InterviewH, W, OFCBehaviour
TIER IIDysmorphology examTests
CASE CONFERENCE FOR FINAL DIAGNOSISCASE CONFERENCE FOR FINAL DIAGNOSIS
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DEMOGRAPHIC AND GROWTH PARAMETERS DEMOGRAPHIC AND GROWTH PARAMETERS
Significant differences between groups, were also found Significant differences between groups, were also found for facial features: for facial features: Palpebra fissure length, philtrum length, ptosis, epicanthal folds, anteverted nostrils, long philtrum, smooth philtrum, and narrow vermilion border
OFC (cm)Mean (SD) 51.9 (1.5) 49.1 (1.0) 50.6 (1.7) 52.0 (1.3) < 0.001
BMI PercentileMean (SD) 60.9 (31.2) 20.6 (32.6) 51.4 (29.0) 65.6 (29.4) <0.001
Weight (kg)Mean (SD) 25.1 (5.2) 18.8 (3.1) 22.2 (3.7) 25.1 (4.2) <0.001
Height (cm)Mean (SD) 121.5 (5.5) 113.6 (3.6) 118.0 (5.0) 121.5 (4.9) < 0.001
P
ControlChildren
(n = 116)
ChildrenWith PFAS
(n = 36)
ChildrenWith FAS(n = 8)
Children
In Study (n = 976)
Variable
NSAge
NSSex
<0.0013.6 (2.9)11.2 (4.0)
15.8 (1.9)
Dysmorphology Score***Mean (SD)
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WISC-R: children with FASD showed significantly lower scores on Verbal, Performance, Full scale IQ
Centro di Riferimento Alcologicodella Regione Lazio
Child Variables
FAS Mean Score (SD)
(n=8)
PFAS Mean Score (SD)
(n=36)
Controls Mean Score (SD)
(n=116)P
Developmental Traits
Language comprehensiona 3.1 (2.0) 3.6 (2.1) 4.8 (1.7) < 0.001
Non – verbal I.Q.b 50.6 (28.7) 55.6 (22.3) 71.0 (21.2) < 0.001
Behaviorc (FASD) 9.3 (5.8) 3.9 (3.7) < 0.001
a. Rustioni qualitative Testb. Raven Coloured Progressive Matricesc. Personal Behaviour Checklist (PBCL – 36)
DEVELOPMENTAL AND BEHAVIORAL INDICATORS
P. May, Ceccanti M., et al. in press
Centro di Riferimento Alcologicodella Regione Lazio
COMPARISONS OF MATERNAL AGE AND DRINKING MEASURES ACROSS GROUPS COMPARISONS OF MATERNAL AGE AND DRINKING MEASURES ACROSS GROUPS
Maternal Variables
FAS Mean (SD)
(n=8)
PFAS Mean (SD)
(n=36)
Controls Mean (SD)
(n=8)P
Maternal age during index pregnancy Mean (SD)
31.5 (6.0) 30.5 (5.2)29.2 (5.4)
NS
Report drinking during pregnancy (%)
50.0 54.8 40.0 NS
Mean drinks per current week (SD)*
19.0 (25.0)**
3.0 (5.3) 1.7 (2.6)<0.001
Mean drinks per current drinking day (SD)*
3.0 (3.4)**
1.0 (0.4) 0.9 (0.5)<0.001
P. May, Ceccanti M., et al. in press
*Among those who reported drinking during pregnancy; includes current non-drinkers** T-test significantly different (p< 0.01) from controls
Maternal drinking data support damage associated with physical and behavioural development problems
Centro di Riferimento Alcologicodella Regione Lazio
FASD PREVALENCE IN ITALY (‰)FASD PREVALENCE IN ITALY (‰)(May P., Ceccanti M. et al., in press)
NETOH
Confirmed%
ETOH NOT NOT
Confirmed%
Rate for
Sample* ‰‰
Rate for Entire Class**
‰‰FAS 8 62.5 37.5 8.2 4
PFAS 36 58.3 41.7 36.9 18.1
ARND 1 100.0 0.0 1.0 0.5
ARBD 1 100.0 0.0 1.0 0.5
TOTAL
46
- - 47.147.1 23.123.1
*N=976 children screened**N=1988 assuming no children with FASD were missed by the consent and screening process
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Regular drinking during meals in a well-
nourished and well-educated maternal
population, as opposed to a poorly nourished,
binge drinking population, however can
produce a number of children with FASD
FASD rates are substantially higher than
previous estimates for the general populations
of Western Europe or the U. S.
CONCLUSIONS 1/2CONCLUSIONS 1/2
Centro di Riferimento Alcologicodella Regione Lazio
This message may well resonate for other Western European populations.This message may well resonate for other Western European populations.
As children with a FASD present substantial challenges to parents, schools, and societies, there is a need to identify them early so that their development can be maximized and FASD prevention initiated for future generations.
Children with FAS or PFAS have impairment or lower scores on standard tests of intelligence, nonverbal reasoning, and language comprehension, as well as more inattentive symptoms and more behavioural problems
CONCLUSIONS 2/2CONCLUSIONS 2/2
THANK YOU!
Mauro CECCANTICentro di Riferimento Alcologico della
Regione Lazio