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Fetal alcohol spectrum disorders from childhood to adulthood: a Swedish population-based naturalistic cohort study of adoptees from Eastern Europe
  1. Valdemar Landgren1,2,
  2. Leif Svensson3,
  3. Emelie Gyllencreutz4,5,
  4. Eva Aring5,6,
  5. Marita Andersson Grönlund5,6,
  6. Magnus Landgren2,3
  1. 1 Psychiatry, Skaraborg Hospital Skövde, Skövde, Sweden
  2. 2 Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
  3. 3 Pediatrics, Skaraborg Hospital Mariestad, Mariestad, Sweden
  4. 4 Ophthalmology, Skaraborg Hospital Skövde, Skövde, Sweden
  5. 5 Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
  6. 6 Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
  1. Correspondence to Dr Valdemar Landgren; valdemar.landgren{at}


Background Fetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest.

Objective To describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children.

Design Prospective observational cohort study

Setting Western Sweden

Participants A population-based cohort of 37 adoptees diagnosed with FASD in childhood.

Outcome measures Assessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist.

Results Out of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18–28) and a mean follow-up time of 15.5 years (range 13–17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately −1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5–21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = ‘severely ill’.

Conclusion Major cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.

  • fetal alcohol syndrome
  • attention deficit disorder with hyperactivity
  • motor skills disorders
  • mental retardation
  • adoption

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  • Contributors ML, MAG, LS and EA conceptualised the study, collected data and reviewed the manuscript for important intellectual content. EG collected data, carried out initial analyses and reviewed the manuscript for important intellectual content. VL collected data, carried out initial analyses and drafted the initial manuscript. All authors have approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The study was financed by grants from Region Västra Götaland, the Swedish state under the agreement between the Swedish government and the country councils, the ALF agreement concerning research and education of doctors grants no ALFGBG-11626, ALFGBG-211671, ALFGBG-445021, ALFGBG 509761, ALFGBG 672501 and ALFGBG 71933, and the research fund at Skaraborg Hospital.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Ethical Review Board, Gothenburg, and written informed consent was received from the participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be retrieved upon reasonable request to the first author.

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