Academic journal article Alcohol Health & Research World

Tracking the Prevalence of FAS

Academic journal article Alcohol Health & Research World

Tracking the Prevalence of FAS

Article excerpt

Fetal alcohol syndrome (FAS) is a birth defect that causes significant lifetime disabilities (Abel 1990). But unlike many other birth defects, FAS, which is caused by maternal alcohol abuse during pregnancy, is preventable (Abel 1990). In fact, prevention of FAS is a national health priority included in the Healthy People 2000 objectives for health promotion and disease prevention (U.S. Department of Health and Human Services 1990 [USDHHS]). The specific health objective is to reduce the rate of FAS to no more than 1.2 cases per 10,000 live births by the year 2000.

Baseline data for this objective were derived from a national hospital-based epidemiologic surveillance program of birth defects--the Birth Defects Monitoring Program (BDMP) of the Centers for Disease Control and Prevention (CDC). Although the rate of 5.2 cases per 10,000 live births in 1992 seems to be an increase over the baseline rate of 2.2 cases per 10,000 (USDHHS 1990), it more likely represents improvements over recent years in recognition and reporting of FAS at birth.

In this article, we review the challenges of developing simple and efficient State-based and national epidemiologic surveillance that can track what progress is being made toward meeting the Healthy People 2000 objective for FAS.

EPIDEMIOLOGIC SURVEILLANCE

CDC defines epidemiologic surveillance as the ongoing systematic collection, analysis, and interpretation of health data that are essential to the planning, implementation, and evaluation of public health practice (Thacker et al. 1989). Such surveillance is closely integrated with timely dissemination of these data to anyone who requires this information. To monitor progress in meeting the FAS prevention objective, epidemiologic surveillance is needed to evaluate changes in the rate of FAS over time.

METHODOLOGICAL PROBLEMS

DIAGNOSING FAS. Developing surveillance of FAS presents unique challenges. Because there is no simple, objective laboratory test for diagnosing FAS, diagnosis is based primarily on clinical definitions developed for the purpose of clinical practice and research (Sokol and Clarren 1989). To meet the clinical FAS case definition, the patient must exhibit symptom! in each of the following three categories: (1) prenatal or postnatal growth retardation; (2) central nervous system abnormalities; and (3) characteristic abnormal facial features (dysmorphology), including short palpebral fissures (eye openings), an elongated midface, a long and flattened philtrum (area between the nose and mouth), and a thin upper lip (see the photograph on p. 13, in the article by Becker et al.). It is also helpful to determine if the patient was exposed prenatally to alcohol, but diagnosis can still be made if such information is unavailable (Sokol and Clarren 1989).

Applying these diagnostic criteria requires expertise in recognizing dysmorphic features. Moreover, the clinical features of a child with FAS may change with age (Streissguth et al. 1991; see the article by Streissguth, pp. 74-81). There is encouraging evidence that the clinical recognition and reporting of FAS is improving (CDC 1993a). However, such improvements may prove troublesome by clouding the true changes in the rate of FAS over time.

COLLECTING DATA. CDC includes FAS in its two birth-defects surveillance programs. The first program is the BDMP, which relies on reported hospital discharge diagnoses of newborns that use the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-M) (World Health Organization 1989). This program started monitoring FAS after 1979 when the ICD-9 introduced a code (760.71) that could be applied to the syndrome.

The second program is the Metropolitan Atlanta Congenital Defects Program (MACDP) (Lynberg et al. 1990), which started in 1968 and is the oldest active case-ascertainment birth-defects surveillance program in the United States. It monitors all births occurring in the five-county metropolitan Atlanta area--currenly about 38,000 per year. …

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