Trajectory of FASD across the Lifespan: New Understandings in Intervention

描述（由申请人提供）：在南非（ZA）的这些城镇及其周围的农村地区，发现了世界上胎儿酒精谱系障碍（FASD）的最高发病率，在过去的四年中，一直在进行全面的预防研究。流行病学研究早在10年前就开始了预防工作，目前仍在进行中。在预防社区（Wellington IV）已经确定的最新浪潮中，基于人群的特定FASD诊断率为：胎儿酒精综合征（FAS）为千分之94，部分胎儿酒精综合征（PFAS）为千分之56，酒精相关神经发育缺陷（ARND）为千分之30。在另一波最终确定的比较区域（BRAM I）中，FAS、PFAS和ARND的发病率更高：分别为千分之61、千分之46和千分之30。FASD的发病率在这个地区一直很高，我们的临床团队对6-20岁儿童的全谱诊断能力现在是熟练的。由于FASD在这些社区的高患病率，以及广泛的流行病学研究正在进行中，预防和干预研究可以有效地建立和评估效果。此外，新的研究试验和病因学研究现在可以以一种系统的、富有成效的和有效的方式进行，以更好地了解整个生命周期的FASD，并为基础科学提供信息。提高对这些ZA人群中FASD的具体特征和模式的理解，对大多数每个人群的公共卫生具有广泛的意义。通过这一持续应用，我们寻求启动：1)对24个月大的儿童进行早期干预研究（发育和营养），这可能会减少或改善已经确定的儿童队列（FASD和对照组）产前酒精暴露的许多负面影响；2.)产前酒精生物标志物（EtG和FAEE）测试结果与自我报告的酒精使用情况的比较研究；3)产前产妇营养状况的详细病例对照研究。我们将在上述队列中继续研究FASD从出生到7岁的发展轨迹，并招募新的新生儿队列。对这些年幼儿童的了解将增加已经在多个其他横断面研究中收集的数据，以告知我们从出生到23岁的FASD。所有建议的研究都是可行和可能的，继续研究所

DESCRIPTION (provided by applicant): The highest rates of fetal alcohol spectrum disorders (FASD) in the world have been found in these South African (ZA) towns and their surrounding rural areas where comprehensive prevention research has been ongoing for the past four years. Epidemiology research preceded the prevention for a decade and it is also ongoing. Population-based rates of specific FASD diagnoses in the most recent wave already finalized for the prevention community (Wellington IV) were: 94 per 1,000 for fetal alcohol syndrome (FAS), 56 per 1,000 for partial fetal alcohol syndrome (PFAS), and 30 per 1,000 for alcohol-related neuro-developmental deficits (ARND). In another finalized wave of the comparison areas (BRAM I), the rates were even higher: 61, 46, and 30 per 1,000 respectively for FAS, PFAS, and ARND. Rates of FASD have been persistently high in this region, and our clinical team's ability to diagnose the full spectrum for children age 6-20 years is now proficient. Because of the high prevalence of FASD in these communities, and the extensive epidemiology studies ongoing there, prevention and intervention research can be effectively instituted and evaluated for efficacy. Furthermore, new research trials and etiologic research can now be instituted in a systematic, productive, and potent manner for a refined understanding of FASD across the lifespan and to inform basic science. Improved understandings about the specific characteristics and patterns of FASD in these ZA populations have broad implications for public health in most every human population. With this continuation application, we seek to initiate: 1.) early intervention research (developmental and nutritional) for children as young as 24 months of age that may reduce or ameliorate many of the negative effects of prenatal alcohol exposure in an already-identified cohort of children (FASD and controls); 2.) a comparative study of results from alcohol biomarker (EtG and FAEE) tests and self-reported alcohol use in the prenatal period; and 3.) a detailed case control study of maternal nutrition in the prenatal period. We will continue to research the developmental trajectory of FASD from birth to 7 years in the above cohort and recruit a new newborn cohort. Understandings from these younger children will add to data already collected in multiple, other, cross-sectional studies to inform us about FASD from birth to 23 years. All proposed research is both feasible and possible by continuing Institute of Medicine (IOM)-recommended prevention services and efficacy research, targeting especially the selected and indicated levels established and provided by our current team living and working in the communities. Finally, to fully evaluate the net effect of the comprehensive prevention over 9 years, we will repeat linked evaluation (community survey and in-school prevalence studies) to assess any impact the overall prevention model, particular prevention techniques, and participatory research may have had on risk factors for and actual rates of FASD.