2. 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

3. 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.

4. Wave I: Selected Dysmorphology Results
Variable FASD* Controls** p
Dysm. Score <.001
OFC (cm) <.001
PFL (cm) <.003
PL (cm) <.003
Smooth Philtrum 90.0% % <.001
Alt. Pal. Crease % % <.02
* n=22 **n= 67

5. Wave I Psychological Variables
Prelim. dx Final dx
FAS Def. Control p
Lang. Comp.*
Non-verbal IQ**
Behavior *** <.001
Tot. dys. Score <.001
Maternal variables:
Mean drks. Wk
Mean drks. Day
*Raven, **Rustioni, ***PCBL

6. Wave I Maternal Variables
Mothers of:
FASD Control p
Mean age (at int.) ns
Suburban ns
Education (h.s) % %
Religiosity idx
Drinkers –
Drnks. Last mo
Drank 3 mos. Prior 92% % ns
Drank Index pg % % ns

7. 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.

8. Prevalence of FASD in Italy – Wave I
Rate per 1,000
n sample entire class
FAS*
PFAS**
ARND
Total
*50% had all 3 facial features
** 36% had all 3 facial features

9. Prevalence of FASD in Italy – Wave II
Rate per 1,000
n sample entire class
FAS
PFAS
ARBD
ARND
Total

10. 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.

11. 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.