Preliminary Results of Pilot Research on FASD in Korea

Hae Kook Lee

The Catholic University of Korea

Uijeongbu St.Mary’s Hospital

Department of Psychiatry

Alcohol consumption in Korea

(Rehm J, 2009)See http://www.who.int/globalatlas/default.asp

Alcohol Use among Adult Women, 1989-2007

3Source: Ministry for Health, Welfare and Family Affairs

Overall Trend in Gender Difference in Prevalence of AUD

Lifetime Prevalence

Alcohol AbuseAlcohol

Dependence

male female male female

1991 23.6 1.4 17.2 1.0

2001 12.6 1.8 16.0 4.6

(HK Lee, et al., 2010)

Age Difference in Prevalence of AUD

(HK Lee, et al., 2010)

Drinking rate in pregnant women

Alcohol Use Rate %

The year before pregnancyAny use

3 SD more77.1%42.6%

This pregnancyAny use

3 SD more 16.4%2.9%

Previous 30 daysAny use

3 SD moer12.2%0.5%

(SH Lee, et al., 2010)

12.2% of pregnant women (about 1 in 8) reported any alcohol use in the U.S.

And then,,,

• The rate of drinking and alcohol use disorders are increasing especially in younger women in Korea.

• Therefore, we could expect that there might be substantial risk of FASD in number of kids with FASD in Korea.

However, we have just several case reports on kids with FAS,,,

• Hong KD, Yoo IC, Choi HS, Lee DH, Lee SJ. A case of fetal alcohol syndrome. Korean J Pediatr 1988;31:375-80.

• Kim EJ, Yang SM, Yun J, Lee HK, Yu YH, Lee HS. A Case of Fetal Alcohol Syndrome. J Korean Pediatr Soc. 1998 Jul;41(7):1001-1005.

• Kim JH, Han MK, Kim JL, Park YI, Lee JJ. A Case of Fetal Alcohol Syndrome.J Korean Child Neurol Soc. 2001 Oct;9(2):393-397.

• Chang JH, Namgung R, Park MS, Park Kin, Lee JS, Lee Chul : A Case of Fetal Alcohol Syndrome with Persistent Pulmonary Hypertension of the Newborn. Korean J Pediatr. 2004 Nov;47(11):1220-1224.

• Cho YY, Oh HJ, Han SJ, Sung SH, Bae GH, Shon HS, Yoon HD : A Case of Fetal Alcohol Syndrome with Secondary Amenorrhea. J Korean Soc Endocrinol. 2005 Oct;20(5):524-530.

• Cho YK, Chang SD, Kim YC, Lee SY. A Case of Fetal Alcohol Syndrome with Esotropia. J Korean Ophthalmol Soc. 2005 Oct;46(10):1756-1759.

• Bhang SY, Ahn DH, Lee YJ, An HY, Ahn JH The First Report of Fetal Alcohol Effect in a 12 Year-Old Child in Korea. Psychiatry Invest 2009;6:50-53.

8

How could we start ?

DrinkingMother

Disabled Kids

Reliable maternal drinking information

Barrier to getting information

Long term follow up to confirm FASD

Difficult to getting information about maternal drinking

Easy to examination about FASD with Kids

Clinical based referral modelInter referral system

(OB - PD - NP)

Outreach to institution for disabled kid

Work with disabled kid registration system

Exploratory visit & Pilot study

• Un experienced specialist

• No social awareness

• No data to support the need for research

• Social stigma and denial

Develop pilot projectWork with experienced specialistVisit various setting of institution

(High risk group)Trial of diagnosis of FASD kids

Process

Selection of Institution

Institution for MR kid, Orphanage, Special

school,,,

Screening

Height or Weight is Under 10 percentile

Diagnosis

Dysmorphologic examination

Inclusion criteria for diagnostic examination

• Age – from 5 to 16 yrs

• Kids with Mental Retardation

• Exclusion of Kids with Cerebral palsy, Down syndrome, and so forth…

• Also, behavioral referrals were solicited from teachers.

Visiting Schedule

Aug 2nd (Mon) Aug 3rd (Tue) Aug 4th(Wed) Aug 5th(Thur)

9 Ins for MR kid Orphanage Break Ins for MR

10 7:30 departure 8:30 departure 8:00 departure

11Uijeongbu city

(north)Seoul(south) Seoul(north)

12 1 pm finish 12:00 finish

1transfer & hospi

tal visittransfer transfer transfer

2 Orphanage Ins for MR kid Special edu. FASD workship

3 2:30 start Day care Hotel

4 Uijeongbu city(north)

5 Ins for MR

6 5:30 finish Seoul(north)

Overall Rate

InstitutionTotalSubject

After screening

DefferedLikely to be Confirmed

Institution for Kid withMR

4 site142 N=50

N=2142%

N=1122%

Orphanage2 site137

N=34N=1544%

N=26%

SpecialEducation

1 site28

N=9N=444%

N=00%

Total307 N=93

N=4043%

N=1314%

Prevalence of Fetal Alcohol Syndrome (FAS) and Partial Fetal Alcohol Syndrome (pFAS) in Students Entering Sch

ool via Active Case Ascertainment

Location

(Reference Year)Population

Socioeconomic

Status

FAS

(FAS+pFAS)

Rate per 1000

United States: Mid-

Western Medium

Size City (May et al.

2009)

75% white; 25%

American Indian,

African American

and Asian

Middle SES with full

range from Low to

Upper

6 – 11

(14 – 25)

Italy; Lazio Region

(May et al. 2007)

Predominantly white Middle SES 4 – 9

(27 – 55)

South Africa:

Western Cape

(2007)

85% Mixed Ancestry

(“Coloured”), 15%

European White

Low Middle SES

White: Middle –

Upper SES

51 – 67

(68 – 90)

South Africa:

Northern Cape

(Urban et al. 2008)

64% Mixed Ancestry

36% Native Black

Low & Middle SES 6 – 11

(14 – 25)

Rate of facial dysmorphology

categorySmooth Philtrum

Thin Vermilion border

ShortPalperbralfissure

Rail road track

Hockey stick crease

Clino-dactyly

Campo-dactyly

Institutionfor MR

N=1121%

N=1532%

N=1737%

N=1121%

N=510%

N=715%

N=48%

OrphanageN=28%

N=39%

N=1030%

N=1029%

N=39%

N=39%

N=26%

Specialschool

N=00%

N=00%

N=240%

N=114%

N=228%

N=114%

N=00%

TotalN=1315%

N=1820%

N=2933%

N=2225%

N=1010%

N=1113%

N=67%

Rail road Track

Hockey Stick Crease

Clynodactyly & Campodactyly

FAS case with thin vermilion border-1

FAS case with thin vermilion border-2

Future Direction

Active case

ascertainment

approaches

Surveillance

system

Clinic base

case control

studies

Thanks !