1. 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

2. Alcohol consumption in Korea
(Rehm J, 2009)
See http://www.who.int/globalatlas/default.asp

3. Alcohol Use among Adult Women,
1989-2007
Source: Ministry for Health, Welfare and Family Affairs
3

4. Overall Trend in Gender Differen
ce in Prevalence of AUD
Lifetime Prevalence
Alcohol
Alcohol Abuse
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)

5. Age Difference in
Prevalence of AUD
(HK Lee, et al., 2010)

6. Drinking rate in pregnant women
Alcohol Use Rate %
The year before pregnancy
Any use 77.1%
3 SD more 42.6%
This pregnancy
Any use 16.4%
12.2% of pregnant
3 SD more 2.9% women (about 1 in 8)
reported any alcohol
Previous 30 days use in the U.S.
Any use 12.2%
3 SD moer 0.5%
(SH Lee, et al., 2010)

7. 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.

8. 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

9. How could we start ?
Outreach to institution for
disabled kid
Drinking Work with disabled kid
Mother registration system
Reliable maternal drinking Difficult to getting
information information about
Barrier to getting maternal drinking
information Easy to examination
Long term follow up to about FASD with Kids
confirm FASD
Clinical based referral model Disabled
Inter referral system Kids
(OB - PD - NP)

11. Exploratory visit & Pilot study
• Un experienced specialist
• No social awareness
• No data to support the need for research
• Social stigma and denial
Develop pilot project
Work with experienced specialist
Visit various setting of institution
(High risk group)
Trial of diagnosis of FASD kids

12. Process
Selection of Institution
Institution for MR kid, Orphanage, Special
school,,,
Screening
Height or Weight is Under 10 percentile
Diagnosis
Dysmorphologic examination

13. 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.

14. 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
Uijeongbu city
11 Seoul(south) Seoul(north)
(north)
12 1 pm finish 12:00 finish
transfer & hospi
1 transfer transfer transfer
tal visit
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)

15. Overall Rate
Total After Likely to be
Institution Deffered
Subject screening Confirmed
Institution 4 site
N=21 N=11
for Kid with 142 N=50
42% 22%
MR
2 site N=15 N=2
Orphanage N=34
137 44% 6%
Special 1 site N=4 N=0
N=9
Education 28 44% 0%
N=40 N=13
307 N=93
Total 43% 14%

16. Prevalence of Fetal Alcohol Syndrome (FAS) and Partial
Fetal Alcohol Syndrome (pFAS) in Students Entering Sch
ool via Active Case Ascertainment
FAS
Location Socioeconomic
Population (FAS+pFAS)
(Reference Year) Status
Rate per 1000
United States: Mid- 75% white; 25% Middle SES with full 6 – 11
Western Medium American Indian, range from Low to (14 – 25)
Size City (May et al. African American Upper
2009) and Asian
Italy; Lazio Region Predominantly white Middle SES 4–9
(May et al. 2007) (27 – 55)
South Africa: 85% Mixed Ancestry Low Middle SES 51 – 67
Western Cape (“Coloured”), 15% White: Middle – (68 – 90)
(2007) European White Upper SES
South Africa: 64% Mixed Ancestry Low & Middle SES 6 – 11
Northern Cape 36% Native Black (14 – 25)
(Urban et al. 2008)

17. Rate of facial dysmorphology
Thin Short Rail road
Smooth Hockey stick Clino- Campo-
category Vermilion Palperbral track
Philtrum crease dactyly dactyly
border fissure
Institution N=11 N=15 N=17 N=11 N=5 N=7 N=4
for MR 21% 32% 37% 21% 10% 15% 8%
N=3
N=2 N=3 N=10 N=10 N=3 N=2
Orphanage 9%
8% 9% 30% 29% 9% 6%
Special N=0 N=0 N=2 N=1 N=2 N=1 N=0
school 0% 0% 40% 14% 28% 14% 0%
N=13 N=18 N=29 N=22 N=10 N=11 N=6
Total
15% 20% 33% 25% 10% 13% 7%

18. Rail road Track

19. Hockey Stick Crease

20. Clynodactyly & Campodactyly

21. FAS case with thin vermilion border-1

22. FAS case with thin vermilion border-2

23. Future Direction
Clinic base
case control
studies
Surveillance
system
Active case
ascertainment
approaches

24. Thanks !