The Epidemiology of FASD in Italy: Progress Report, Feb., 2006 Philip A. May, Ph.D. The University of New Mexico Daniela Fiorentino La Sapienza, The University of Rome

Wave I Sample 1086 in 1st grade classes in the schools. 543 (50%) received consent to participate. 181 children picked for full dysmorphology screen because of: Growth, <25th centile (hgt., wgt. or OFC). Behavioral problems. 72 randomly-selected controls picked.

Wave I: Selected Dysmorphology Results Variable FASD* Controls** p Dysm. Score 12.5 3.3 <.001 OFC (cm) 50.8 51.9 <.001 PFL (cm) 2.4 2.5 <.003 PL (cm) 1.5 1.4 <.003 Smooth Philtrum 90.0% 10.4% <.001 Alt. Pal. Crease 45.5% 19.5% <.02 * n=22 **n= 67

Wave I Psychological Variables Prelim. dx Final dx FAS Def. Control p Lang. Comp.* 3.2 3.5 4.9 .009 Non-verbal IQ** 51.8 58.2 72.3 .005 Behavior *** 5.3 11.7 3.9 <.001 Tot. dys. Score 14.5 10.4 3.3 <.001 Maternal variables: Mean drks. Wk. 16.2 7.5 1.5 .006 Mean drks. Day 2.6 1.5 0.8 .012 *Raven, **Rustioni, ***PCBL

Wave I Maternal Variables Mothers of: FASD Control p Mean age (at int.) 37.9 36.6 ns Suburban 47.1 55.6 ns Education (h.s) 17.6% 49.2% .014 Religiosity idx. 3.9 2.4 .001 Drinkers – Drnks. Last mo. 38.1 6.5 .004 Drank 3 mos. Prior 92% 88% ns Drank Index pg. 69% 65% ns

Wave II Sample 902 in first grade classes in the randomly selected schools. 433 received consent to participate. 235 received full dysmorph. screen because of: Growth <25 centile: hgt. or wgt. or OFC. (55%) Learning/behavior problems (45%). 75 randomly selected controls picked from all children having consent to participate.

Prevalence of FASD in Italy – Wave I Rate per 1,000 n sample entire class FAS* 4 7.4 3.7 PFAS** 17 31.3 15.7 ARND 1 1.8 0.9 Total 22 40.5 20.3 *50% had all 3 facial features ** 36% had all 3 facial features

Prevalence of FASD in Italy – Wave II Rate per 1,000 n sample entire class FAS 4 9.2 4.4 PFAS 19 43.8 21.0 ARBD 1 2.3 1.1 ARND -- -- -- Total 24 55.4 26.6

Problems and Successes Maternal interviews have been improved in this study, but there are still problems of validity and underreporting. Current drinking, drinking 3 mos. prior to pregnancy, and collateral information are most valid. Consent to participate is not as high as we would like. Bias of sample is unknown. Will try to compare hgt. and wgt. of children with consent to participate with entire school samples to further estimate bias. An active case ascertainment study of FASD in school has now been completed for two waves in a developed, Western European country.

Implications of the Italy Epidemiology Research FAS and other FASD may be more common in Western Europe and the United States than previously estimated. Not all Italian women drink in the stereotypical daily fashion. The severity of FASD symptoms in Italy are mitigated by middle SES, nutrition (and mother’s BMI), and especially, low fertility. We are doing well with diagnosing FAS and PFAS in population-based studies. Estimating prevalence of ARND and ARBD are still difficult tasks without screening/testing all children.