Elsevier

Brain and Development

Volume 44, Issue 10, November 2022, Pages 706-714
Brain and Development

Original article
Fetal alcohol syndrome and the risk of neurodevelopmental disorders: A longitudinal cohort study

https://doi.org/10.1016/j.braindev.2022.08.002Get rights and content

Abstract

Background

This hypothesis-testing study evaluated the relationship between fetal alcohol syndrome (FAS) and neurodevelopmental disorder (ND) diagnoses within the Independent Healthcare Research Database (IHRD).

Methods

De-identified eligibility and claim healthcare records prospectively generated from the 1990–2012 Florida Medicaid system were analyzed using SAS software. There were 89,766 children continuously eligible with ≥10 outpatient office visits during the 120 month period following birth in the cohort examined. A total of 321 children were diagnosed with FAS. Autism spectrum disorder (ASD) (n = 922), tics (n = 551), attention deficit disorder/attention deficit-hyperactivity disorder (ADD/ADHD) (n = 20,260), mental retardation (MR) (n = 915), and specific delays in development (SDD) (n = 24,630) incidence rates were examined using frequency risk ratio (RR) and logistic regression models.

Results

The incidence rate of tics (RR = 5.68), ADD/ADHD (RR = 2.30), MR (RR = 7.83), SDD (RR = 2.88), and ASD (RR = 6.74) were significantly increased among FAS diagnosed children as compared to undiagnosed children. Adjusted (for gender, race, residency, and date of birth) odds ratios (ORs) were significantly increased for tics (OR = 4.87), ADD/ADHD (OR = 3.40), MR (OR = 7.91), SDD (OR = 9.56), and ASD (OR = 6.87) when comparing the FAS diagnosed children to undiagnosed children.

Conclusion

Tens of thousands of American children with lifetime costs in the billions of US dollars were estimated to be impacted by FAS-associated NDs. These impacts are particularly tragic because FAS is dependent upon lifestyle.

Section snippets

Background

It is well established that prenatal exposure to alcohol can result in significant damage to the developing organs within the fetus [1]. Fetal alcohol spectrum disorders (FASDs) are known to be induced by prenatal alcohol exposure [2]. Among the diagnoses encompassed by FASD diagnoses, include: fetal alcohol syndrome (FAS), partial FAS, alcohol-related neurodevelopmental disorder (ARND), and neurobehavioral disorder associated with prenatal alcohol exposure [3].

The US Centers for Disease

Independent Healthcare Research Database (IHRD)

As described in previous studies, the Independent Healthcare Research Database (IHRD) contains de-identified healthcare records from the Florida Medicaid system [8], [9], [10], [11], [12]. Florida’s Agency for Health Care Administration was the source for the eligibility and claim data within the IHRD. Unique recipient identifier codes for each person allow for linkage of their eligibility and claim records. Month and year of enrollment, gender, date of birth, race, and county of residency are

Results

Table 1 displays the demographic characteristics for children diagnosed with FAS and undiagnosed children. There was a similar gender distribution and mean date of birth in both groups of children examined. The racial distributions among the groups of children examined were significantly different. There was a significant overrepresentation of white children diagnosed with FAS (51.40 %) as compared to undiagnosed children (31.23 %), whereas Hispanic children diagnosed with FAS (5.61 %) were

Discussion

The results of this study provide important insights into the potential relationship between FAS diagnoses and the long-term risk of NDs. The children examined were continuously enrolled from birth until 10 years-old and were selected to be actively utilizing health services from the Florida Medicaid program. The data examined were independently collected from the present study design and were prospectively collected as part of the routine medical care provided to participants in the Florida

Conclusion

This cohort study of prospectively collected healthcare data from the IHRD provides important new evidence supporting the hypothesis that FAS diagnoses are associated with an increased risk of NDs diagnosed within the first 10 years of life as compared to children not diagnosed with FAS. It was estimated that FAS-associated NDs among American children born in the 1990s/early 2000s impacted tens of thousands of children with lifetime care costs in the billions of US dollars. Tragically, these

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

This research was funded by the non-profit Institute of Chronic Illnesses, Inc. Mark R. Geier and David A. Geier are co-directors of the Institute of Chronic Illnesses, Inc.

Authors’ contributions

(I) Conception and design: All authors.

(II) Administrative support: All authors.

(III) Provision of study materials or patients: All authors.

(IV) Collection and assembly of data: All authors.

(V) Data analysis and interpretation: All authors.

(VI) Manuscript writing and review: All authors.

(VII) Final approval of manuscript: All authors.

The authors are accountable for all aspects of the work and for ensuring that questions related to the accuracy or integrity of any part of the work are

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