Extreme Rate of Prenatal Alcohol Disorders in Poor

Deborah Brauser

March 10, 2015

The prevalence of neurodevelopmental disorders associated with prenatal alcohol exposure (ND-PAE) is extreme in low-income patients, new research suggests.

A study of 611 low-income, mainly African American, psychiatric outpatients attending a single family medicine clinic on Chicago's South Side between May 2013 and January 2014 showed that 39% had clinical profiles consistent with ND-PAE. The prevalence of ND-PAEs in children in the study was 57%. In contrast, research shows that the prevalence of ND-PAEs in the general US population is 2% to 5%.

If replicated, "these findings should bring about substantial changes in medical practice for low-income patients," write the researchers, led by Carl C. Bell, MD, from Jackson Park Hospital Family Medicine Clinic in Chicago.

They note that screening is particularly important because postnatal treatment with essential nutrient choline has been shown to "ameliorate some of the sequelae" in children with ND-PAE.

The researchers also report that many of the participants with ND-PAE had received a prior diagnosis of schizophrenia, bipolar disorder, or depression that may have been erroneous.

"Clinicians need to become more adept at obtaining patients' historical information and identifying physical characteristics of neurodevelopmental disorders," they write.

The study was published online March 2 in Psychiatric Services in Advance.

Largest Preventable Cause of Intellectual Disability

Currently, proposed criteria for neurobehavioral disorders associated with prenatal alcohol exposure are listed in section 3 of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) for "emerging measures and models" for conditions needing further study.

"This disorder is aligned with concepts of fetal alcohol syndrome, the most severe outcome of fetal alcohol exposure, and fetal alcohol spectrum disorders," write the investigators.

In addition, it is considered "to be the single largest preventable cause of intellectual disability," they add.

Using "active case ascertainment methodology," the researchers examined 590 adult psychiatric outpatients between the ages of 19 and 78 years (mean age, 45 years; 61% women) and 21 youth outpatients between the ages of 4 and 18 years (mean age, 13 years; 76% boys). A total of 96% of the adults and 100% of the youth were black; 98% of all participants lived in an area with a median household income of $33,809.

The researchers asked specific questions developed from the DSM-5 to screen for possible ND-PAE and looked for any physical signs of fetal alcohol exposure in all patients.

When possible, questions about maternal drinking during pregnancy were also asked. Most of the mothers who reported drinking noted that they were young at the time and did not realize they were pregnant until after the first or second month.

"Commonplace" Disorder

Results showed that 297 of all participants (49%) had been diagnosed with some type of neurodevelopmental disorder during childhood.

Of these, 237 had ND-PAE (39% of entire patient population) and 53 (9%) were classified as having "other neurodevelopmental disorders," such as autism spectrum disorder, intellectual disability, or attention-deficit/hyperactivity disorder. The neurodevelopmental disorders in the remaining seven participants (1%) were unclassified.

When looking specifically at age, 226 of the 590 adult patients had ND-PAE (38%), whereas 11 of the 21 younger patients examined (57%) had profiles consistent with the disorder.

"Even though this study focused on a large convenience sample, it found that [ND-PAE] was commonplace ― 388 per 1000 population," write the investigators.

"Researchers need to replicate and extend these findings so that the significance of the problem is recognized and clinicians' awareness of it increases."

They add that several organizations, including the American Academy of Pediatrics, the National Institute of Child Health and Human Development, and the Office of Juvenile Justice and Delinquency Prevention, are working together and apart to develop mobile apps and public service announcements that tackle these issues.

"Prevention is coming of age in psychiatry," they note.

The study authors have reported no relevant financial relationships.

Psychiatr Serv. Published online March 2, 2015. Abstract

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