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Philip A. May, PhD, J. Phillip Gossage, PhD, Lesley E. Brooke, BA(Hons), Cudore L. Snell, Dsw, Anna-Susan Marais, RN, Loretta S. Hendricks, Julie A. Croxford, RN, BA(Hons) and Denis L. Viljoen, MD

Philip A. May and J. Phillip Gossage are with The University of New Mexico Center on Alcoholism, Substance Abuse and Addictions, Albuquerque. Lesley E. Brooke, Anna-Susan Marais, and Loretta S. Hendricks are with the University of Cape Town and the Foundation for Alcohol Related Research, Cape Town, Republic of South Africa. Cudore L. Snell is with the Department of Social Work, Howard University, Washington, DC. Julie A. Croxford is with the Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Johannesbury, Republic of South Africa. Denis L. Viljoen is with the Department of Human Genetics, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Service, and the Foundation for Alcohol Related Research, Johannesbury.

Correspondence: Requests for reprints should be sent to Philip A. May, PhD, The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, 2650 Yale Blvd SE, Albuquerque, NM 87106 (e-mail: pmay{at}unm.edu).

Objectives. We defined risk factors for fetal alcohol syndrome (FAS) in a region with the highest documented prevalence of FAS in the world.

Methods. We compared mothers of 53 first-grade students with FAS (cases) with 116 randomly selected mothers of first-grade students without FAS (controls).

Results. Differences between case and control mothers in our study population existed regarding socioeconomic status, religiosity, education, gravidity, parity, and marital status. Mothers of children with FAS came from alcohol-abusing families in which heavy drinking was almost universal; control mothers drank little to no alcohol. Current and past alcohol use by case mothers was characterized by heavy binge drinking on weekends, with no reduction of use during pregnancy in 87% of the mothers. Twenty percent of control mothers drank during pregnancy, a rate that declined to 12.7% by the third trimester. The percentage who smoked during pregnancy was higher for case mothers than for control mothers (75.5% vs 30.3%), but the number of cigarettes smoked was low among case mothers. The incidence of FAS in offspring of relatively young women (28 years) was not explained by early drinking onset or years of drinking (mean, 7.6 years among case mothers). In addition to traditional FAS risk factors, case mothers were smaller in height, weight, head circumference, and body mass index, all anthropomorphic measures that indicate poor nutrition and second-generation fetal alcohol exposure.

Conclusions. Preventive interventions are needed to address maternal risk factors for FAS.

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