Validation of the FASD-Tree as a screening tool for fetal alcohol spectrum disorders

Background

As many as 80% of individuals with fetal alcohol spectrum disorders (FASD) are misdiagnosed or not diagnosed. This study tests the accuracy and validity of a web-based screening tool (the FASD-Tree) for identifying children and adolescents with FASD.

Methods

Children with histories of prenatal alcohol exposure (PAE) and controls (N = 302, including 224 with PAE and 78 controls) were examined for physical signs of fetal alcohol syndrome (FAS), and parents completed behavioral questionnaires. Data were entered into the FASD-Tree, a web-based decision tree application. The FASD-Tree provided two outcomes: a dichotomous indicator (yes/no) and a numeric risk score (0 to 5), which have been shown separately to identify children with PAE and neurobehavioral impairment and to correlate with neurobehavioral outcomes. Overall accuracy (ACC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the decision tree, risk score, and their combination. Misclassified cases were examined for systematic bias.

Results

The FASD-Tree was successful in accurately identifying youth with histories of PAE and the subgroup of individuals with FASD, indicating its validity as an FASD screening tool. Overall accuracy rates for FASD-Tree components ranged from 75.0% to 84.1%, and both the decision tree outcome and risk score, and their combination, resulted in fair to good discrimination (area under the curve = 0.722 to 0.862) of youth with histories of PAE or FASD. While most participants were correctly classified, those who were misclassified differed in IQ and attention. Race, ethnicity, and sex did not affect the results.

Conclusion

The FASD-Tree is not a biomarker of PAE and does not provide definitive evidence of prenatal alcohol exposure. Rather it is an accurate and valid screening tool for FASD and can be used by clinicians who suspect that a patient has a history of PAE, even if the exposure is unknown.     

Maternal anthropometry-based screening and pregnancy outcome: a decision analysis

Summary objective  To assess the impact of screening and intervention based on maternal height, prepregnancy weight and weight during weeks 16–19 or 24–27 in reducing adverse pregnancy outcomes (IUGR, preterm birth and assisted delivery) in developing country settings. methods  Decision analysis based on a recent multicentre WHO collaborative study of maternal anthropometry and pregnancy outcomes and meta-analyses of controlled clinical trials of balanced energy/protein supplementation (for IUGR and preterm birth) and support from caregivers during labour (for assisted delivery). Subjects for the analysis comprised pregnant women from Cali, Colombia (1989, n = 4598); urban and rural Pune, India (1990, n = 4307); and urban and rural Myanmar (1981–82, n = 3542) followed until delivery. results  Seven to 45% of pregnant women had positive screens, with preventive fractions (PFs) ranging from 0.034 to 0.109 for IUGR, 0.027–0.082 for preterm birth and 0.011–0.105 for assisted delivery. Screening prevention ratios (SPRs = ratios of the number of women treated to the number of cases of adverse outcome prevented) are high in all three study settings for preterm birth and assisted delivery (range 22.8–115.7) and low in settings with a high prevalence of the adverse outcome and high specificity of the anthropometric measure (India for IUGR, range 7.0–8.0). Sensitivity analyses demonstrate a marked linear fall in PF and an exponential rise in the SPR as the relative risk associated with intervention increases (i.e. as the protective benefit of intervention decreases) from 0.60 to 0.95. conclusions  A maternal anthropometry-based 'risk approach' is unlikely to result in a major reduction in adverse pregnancy outcomes in developing country settings. For risk-free and inexpensive interventions (e.g. caregiver support during labour), a better strategy would be to forego screening and instead treat all pregnant women.     

孕期铅暴露对鼠胎盘组织NO及MDA/SOD水平的影响

目的探讨孕期铅暴露对鼠胎盘组织NO及丙二醛／超氧化物歧化酶（MDA／SOD）水平的影响。方法将108只大鼠随机分为对照组和实验A、B、C组,每组27只,雌雄2：1合笼饲养,发现阴栓当日为妊娠第0天。对照组孕1～20d饮服蒸馏水;实验A组：孕1～10d饮服0．025％浓度的醋酸铅蒸馏水（染毒）,孕11～20d饮服蒸馏水;实验B组：孕1～20d饮服蒸馏水,孕11～20d染毒;实验C组：孕1～20d染毒。分娩后检测血铅水平,取胎盘测定NO、MDA含量和SOD活性。结果实验A和B组NO含量显著高于对照组（P〈0．01）;胎盘组织MDA含量与血铅水平呈剂量-效应关系;SOD活性随血铅水平升高呈现动态变化。结论孕期铅暴露造成的胎盘组织氧化与抗氧化系统平衡失调是导致胎盘组织损伤的病理机制之一,尤以孕早期铅暴露损害较重;NO、MDA和SOD是铅致胎盘组织损伤的重要因素。     

Balancing the story of fetal alcohol spectrum disorder: A narrative review of the literature on strengths

For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain- and body-based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also supported advocacy efforts and highlighted the necessity of providing FASD services and supports. However, with the focus on deficits and needs, there is a considerable gap in the literature on the strengths and successes of individuals with FASD. The lack of strengths-based FASD research has likely perpetuated the stress and stigma experienced by individuals with FASD and their families. Thus, there is a critical need to shift the direction of the field. Here we provide a narrative review of the literature on strengths in FASD. Our goals are to: (1) understand the state of strengths-based research related to individuals with FASD across the lifespan, and (2) describe positive characteristics, talents, and abilities of individuals with FASD that may be cultivated to promote their fulfillment and well-being. We identified a total of 19 studies, most of which were conducted to explore the lived experiences of adults with FASD. This preliminary but critical body of evidence highlights the intrinsic strengths of individuals with FASD, including strong self-awareness, receptiveness to support, capacity for human connection, perseverance through challenges, and hope for the future. Despite the importance of this emerging evidence, appraisal of the literature indicates a need for more intentional, methodologically rigorous, participatory, and theory-driven research in this area. Findings from this study, including the identified gaps in the literature, can be used to inform research, practice, and policy to meaningfully advance the field of FASD and promote positive outcomes in this population.