Centro di Riferimento Alcologico della Regione Lazio MAURO CECCANTI Brussels 9 September 2009 MAURO...

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


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


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


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


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


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


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)


WISC-R: children with FASD showed significantly lower scores on Verbal, Performance, Full scale IQ


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


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


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


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


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

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