FETAL ALCOHOL SYNDROME AMONG SHELTERED CHILDREN: AN EPIDEMIOLOGIC STUDY

Objectives: Fetal alcohol syndrome (FAS) is caused by ethanol exposition during pregnancy and has three main clinical symptoms: 1. Facial abnormalities, including small eyelid fissures, hypoplastic maxilla, long nasal philtrum and thin upper lip; 2. pre and post-natal growth retardation, affecting both weight and height; and 3. Neurological abnormalities, as microcephaly, developmental delay and behavioral problems. The aim of this study was to evaluate the prevalence of FAS and related conditions in an Institution that admits children at-risk for mental and physical abuse by their families in Sao Paulo metropolitan region.

Methods: After informed consent given by legal responsible, children were evaluated using a standard protocol developed for diagnosis of FAS and related conditions in children. The cohort was examined without previous information regarding alcohol exposition at pregnancy; lately, social and medical files were reviewed. All children that stayed more than two months at the Institution were included in this study.

Results: In total, 203 children (118 males) with age varying from 2 months to 18 years were evaluated. For 34 children, a history of maternal alcoholism was present and for another 35 it was denied; in 134 individuals this information was not available. Eight in 203 children fulfilled criteria for FAS and 4 others were diagnosed as atypical FAS, in which only growth retardation was not present at evaluation. None of them had a previous diagnosis of FAS. Among 34 children with confirmed alcohol exposure, 8 had FAS (typical or atypical) and only 12 were normal. Presence of facial abnormalities, growth retardation or neurological or behavioural problems were 3 three times more frequent in the alcohol exposed group than among non-exposed or without known alcohol exposition. Prevalence of FAS (typical or atypical) in this population was 59/1,000; in the group in which maternal alcohol exposure was confirmed, prevalence climbed to 382/1,000.

Conclusion: Maternal alcoholism is common and FAS is a major unrecognized co-morbidity among sheltered children from socially deprived families in Brazil.