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Fetal alcohol disorders common in Eastern Europe adoptees

By Amy Norton

NEW YORK (Reuters Health) - Many children adopted from Eastern European countries may have been exposed to damaging levels of alcohol in the womb, a new study suggests.

In a study of 71 children adopted by Swedish families between 1993 and 1997, researchers found that 52 percent had developed a fetal alcohol spectrum disorder, or FASD.

FASD is an umbrella term for the lasting developmental effects seen in some children with prenatal alcohol exposure. It's most severe manifestation is fetal alcohol syndrome, which is marked by stunted growth, facial deformity, neurological deficits -- including low IQ, learning disabilities and vision and hearing problems -- and serious behavioral problems.

But more children develop what is known as alcohol-related neurodevelopmental disorder, where only neurological and behavioral problems are present.

In the current study, however, fetal alcohol syndrome was the most common FASD; 30 percent of the children overall had the disorder, while 14 percent had "partial" fetal alcohol syndrome and 9 percent had alcohol-related neurodevelopmental disorder.

The findings, published in the journal Pediatrics, come at a time when international adoptions are suddenly under closer scrutiny.

Last week, a U.S. family created a furor when they put their adopted 7-year-old son on a plane, alone, back to Russia. Claiming the boy was violent and had severe psychological problems, they said they could no longer care for him. Moscow subsequently threatened to halt all adoptions by U.S. families.

International adoptions from Russia and other Eastern European countries took off in the 1990s. In the U.S., there were more than 47,000 adoptions from Russia alone between 1998 and 2009 -- though the yearly numbers have fallen significantly from their peak in the early 2000s, according to State Department statistics.

In Sweden, there are currently more than 2,500 children adopted from Eastern Europe, according to the researchers on the new study.

Lead researcher Dr. Magnus Landgren said his team decided to study the FASD rate in these children after noticing what appeared to be a high rate of abnormal growth and development among Eastern European adoptees.

The researchers anticipated an elevated rate of fetal alcohol problems, Landgren, of Skaraborg Hospital in Skovde, Sweden, told Reuters Health in an email. Alcohol consumption is generally high in many Eastern European countries, and it's known that many children end up in orphanages because of parents' alcohol abuse, the researcher noted.

"But we didn't expect to find quite this rate -- about half of the children affected," Landgren said.

Still, he hoped the results would not dissuade families from adopting children from these countries. "To be adopted into a caring and well functioning family is very important," Landgren said. "The children really need this support."

He added that adopted children, whatever their country of origin, frequently have "special needs," and that families considering adoption should be prepared for that prospect.

The findings are based on 71 children adopted from Russia, Poland, Romania, Estonia or Latvia. The researchers assessed them for FASDs and other neurodevelopmental problems five years after their adoption, when the children were 7 years old, on average.

The rate of FASDs -- 52 percent -- appears to be the highest yet seen in a study population, according to Landgren's team. By comparison, it's estimated that 9 or 10 children for every 1,000 born in the U.S. have an FASD.

"Our very high frequency of FASDs...implies an extremely selected population," the researchers write.

According to Landgren, the findings highlight the dire need to reduce prenatal drinking, particularly in societies with high rates of alcohol abuse.

"The findings of this study underscore the danger and risk for damage when children are exposed to alcohol during pregnancy," he said, "and also the importance of public health measures to help (expectant) parents keep away from alcohol."

SOURCE: Pediatrics, May 2010.

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