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Fetal alcohol spectrum disorders among children living in Russian 'Baby Homes'

February 23, 2006

Researchers have examined a sample of children living in Russian "Baby Homes" for features that are indicative of fetal alcohol spectrum disorders (FASD).

- More than half of the Baby-Home residents were found to have intermediate (45%) or high (13%) phenotypic expression scores, consistent with a diagnosis of FASD.

- Long-term outcomes of children with FASD can be improved by early diagnosis and targeted interventions.

Alcohol use in Russia is among the highest in the world, according to the World Health Organization. Yet the prevalence of fetal alcohol spectrum disorders (FASD) among Russian children is not well known. In the March issue of Alcoholism: Clinical & Experimental Research, researchers closely examine a small number of children living in Russian "Baby Homes" for features that might indicate prenatal alcohol exposure. More than half of the Baby-Home residents were found to have features consistent with a diagnosis of FASD.

"More than 600,000 children in Russia reside in various state-run institutions, including Baby Homes, from birth to four years of age, and/or orphanages, for children four years of age and older," said Laurie C. Miller, associate professor of pediatrics at the New England Medical Center and corresponding author for the study. "Although it is recognized that many children residing in Baby Homes and orphanages have been exposed to alcohol prenatally, the information we have is incomplete. For example, the medical records of only 40 percent of the children in our survey indicated that their birth mothers consumed alcohol during the pregnancy. In 56 percent of the cases, no information about alcohol use was available."

For this study, Miller and her colleagues conducted phenotypic screening of 234 Baby-Home residents (121 males, 101 females; gender unknown for 12 children) in the Murmansk region of Russia. "We carefully examined each child residing in the Baby Homes," said Miller, "looking for specific features known to be associated with prenatal alcohol exposure. We paid special attention to the shape of the upper lip and philtrum (the area between the nose and the upper lip), which can show changes in appearance after prenatal alcohol exposure. We also looked at some less specific features, such as mobility of the upper extremities, appearance of the fingernails and hands, etc."

At the time of assessment, the children ranged in age from 1.5 to 72 months. Researchers calculated phenotypic expression "scores" based on facial dysmorphology and other physical findings.

More than half of the Baby-Home residents had phenotypic expression scores that were consistent with a diagnosis of FASD. "Thirteen percent of the children had scores highly compatible with prenatal alcohol exposure," said Miller, "and four percent of the children had intermediate scores."

Claire D. Coles, professor of psychiatry and behavioral sciences at the Emory University School of Medicine, was not surprised by the study's findings. "Although there is not a huge amount of data out there on FASD among Russian children," she said, "when we conducted a study in Russian boarding schools - the equivalent of residential schools, for kids with social problems - we found a high number of children with FAS."

And this is hardly unexpected, she added. "When you're talking about Baby Homes and orphanages, you're not talking about middle-class people who've got their lives together, you're talking about the foster-care system. The higher incidence of FASD in this group reflects parents with social problems, especially alcohol problems, and doesn't really reflect on the rest of Russian society. I would not expect that the general Russian population has the same incidence of problems."

Miller concurs. "We do not know how the Baby-Home scores would compare to scores of children in other settings in Russia or elsewhere," she said. "We suspect that the scores of children not residing in Baby Homes would be considerably less indicative of prenatal alcohol exposure."

The purpose of this study, added Miller, was to provide supporting information for a planned intervention to provide developmental stimulation and support to children residing in Russian Baby Homes. "We wanted to know the prevalence of FASD, as this will influence the types of interventions that are provided," she said. "We now have a simple screening tool that can be used to collect epidemiologic data on possible FASD. We also now know that many of these children have likely been exposed to prenatal alcohol, and could benefit from specialized attention to identify and address medical and developmental issues which may arise from such exposure. Furthermore, these findings highlight the need for prevention programs and other social supports to reduce alcohol use during pregnancy."

Both Miller and Coles emphasized that the long-term outcomes of children with FASD can be improved by early diagnosis and targeted interventions. "Of course these findings indicate that this is a high-risk group that's going to need services," said Coles. "And certainly anyone adopting a child from a Baby Home should be aware of the potential for having a child with alcohol effects. However, this is not one of the worst disorders there is, such children can with appropriate care lead decent lives, but you need to be aware that this is a possibility and have appropriate expectations."

Alcoholism: Clinical and Experimental Research