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Alcohol consumption and other maternal risk factors for fetal alcohol syndrome among three distinct samples of women before, during, and after pregnancy: The risk is relative


  • Philip A. May,

    Corresponding author
    • University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Blvd. SE, Suite 100, Albuquerque, NM 87106-3202.
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    • Philip A. May is a Professor of Sociology and Associate Director of the University of New Mexico (UNM) Center on Alcoholism, Substance Abuse, and Addictions (CASAA). A major focus of Dr. May's over the past 24 years has been FAS epidemiology and prevention.

  • J. Phillip Gossage,

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    • J. Phillip Gossage is a Senior Research Scientist at UNM/CASAA. FAS has been a major focus of his work over the past 12 years.

  • Mary White-Country,

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    • Mary White-Country is a FAS Prevention and Research Site Director for UNM/CASAA at one research location in South Dakota.

  • Karen Goodhart,

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    • Karen Goodhart is a Case Manager and Research Aide at the same research site in South Dakota.

  • Sara Decoteau,

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    • Sara DeCoteau is the Health Coordinator for the Sisseton-Wahpeton Oyate of the Lake Traverse Reservation. She has been the Health Coordinator for the tribe for 29 years and has long had an interest in preventing FAS and long-term care.

  • Phyllis M. Trujillo,

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    • Phyllis Trujillo is an Administrative Coordinator at UNM/CASAA. She is the maternal interviewer for the Plains FAS study described in this paper.

  • Wendy O. Kalberg,

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    • Wendy Kalberg is an Educational Diagnostician and Senior Program Manger at UNM/CASAA. Her primary professional focus for the past seven years has been FAS diagnosis and educational planning.

  • Denis L. Viljoen,

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    • Denis Viljoen is the Chair of the Department of Human Genetics, University of Witswatersrand; he is also with the South African Institute for Medical Research and the Foundation for Alcohol Related Research. Dr. Viljoen is the primary person responsible for identifying the high prevalence of FAS in South Africa.

  • H. Eugene Hoyme

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    • H. Eugene Hoyme is the Chair of the Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine. He has experience with a broad range of issues in genetics and teratology and has worked with the diagnosis of FAS for over 20 years.


Data were obtained from three samples of women of childbearing age. One sample of women is from prenatal clinics serving Plains Indian women. The second sample is of women from the Plains whose children were referred to special diagnostic developmental clinics, as their children were believed to have developmental issues consistent with prenatal alcohol consumption. The third sample is of women from South Africa, each of whom has given birth to a child diagnosed with full fetal alcohol syndrome (FAS). Data across samples conform to expected trends on many variables. For example, the maternal age at time of pregnancy, a major risk factor for FAS, ranged from a mean of 23.5 years for the prenatal clinic sample, to 23.8 years for the developmental clinic sample, to 27.6 for the sample of women who have delivered children with FAS. Other variables of maternal risk for FAS expected from the extant literature, such as high gravidity and parity, binge drinking, heavy intergenerational drinking in the mother's extended family and immediate social network, and length of drinking career, were compared across the three samples with variable results. However, normative measures of drinking problems are unreliable when reported across cultures. An unexpected finding from this three-sample comparison was the differential risk found when comparing U.S. women to South African women. Women in the U.S. Plains Indian samples report a high consumption of alcohol in a binge pattern of drinking, yet there is less detectable damage to the fetus than among the South African women. Body mass index (BMI) and lifelong and current nutrition may have a substantial impact, along with the above factors, in relative risk for an FAS birth. The level of risk for producing a child with FAS is influenced by environmental and behavioral conditions that vary between populations and among individual women. Also, because many syndromes are genetically based, there is a need for full behavioral and genetic histories of the mother, family, and child being studied. Collecting extensive behavioral information as well as genetic histories will provide the requisite information for making an accurate diagnosis of FAS. © 2004 Wiley-Liss, Inc.