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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 !
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