Our goal was to find out whether there was a prevalence of maternal use of alcohol during pregnancy and incidence of physical signs of FAS in confined young males. In other words we wanted to know how much FAS or fetal alcohol exposure (FAE) may be contributing to juvenile criminal behavior in our society. FAS and FASD are not rare in occidental societies. May et al. (2009)
estimated that in the U.S., the prevalence of FAS is in the range of 2–7 per 1000, and for FASD their estimates were as high as 2–5% of school children in the US and Western Europe.
FASD is an umbrella term for a wide range of possible consequences of prenatal alcohol exposure. Although the physical expression of this syndrome is not always present, the damage caused in the brain and consequently in behavior is long lasting (Momino et al., 2008
). A current discussion in the literature presently is to better characterize the specific behavioral phenotype associated to FASD (Nash et al., 2008
; Kodituwakku, 2009
), and more specifically criminal behavior. There are few studies in this area, but all of these agree that FAS in the criminal justice system is under diagnosed (Fast et al., 1999
; Burd et al., 2004
Some studies have identified a dose-response effect between prenatal alcohol exposure and behavioral problems taking together both the effects of environmental factors and prenatal alcohol exposure when evaluating the association with behavioral difficulties and psychiatric disorders in affected children (Hill et al., 2000
; O’Connor and Paley, 2006
; Guerri et al., 2009
; Rodriguez et al., 2009
). A recent observational cohort study including 592 adolescents observed that those exposed to an average of one or more drinks of alcohol per day in the first trimester of pregnancy were three times more likely to meet criteria for a lifetime diagnosis of conduct disorders than were adolescents whose mothers drank less than that amount or abstained (Larkby et al., 2011
). A study performed by Staroselsky et al. (2009)
showed that parental psychopathology and prenatal exposure to maternal alcohol can contribute to the child’s behavioral phenotype.
We also included in our analyses, the presence of other environmental risk factors that could be related to criminal behavior. Maternal intake of alcohol was admitted by almost 48% of the mothers of adolescents with criminal behavior. Although this seems high, it was not different from the control group (40%). Data in the literature denote the use of alcohol in pregnancy from 28% to 41% in Brazil (Gama et al., 2004
). The 2009 Morbidity and Mortality Weekly Report (MMWR, 2009
) showed that in the period from 1991 to 2005, approximately 12% of pregnant women used alcohol and near 1.9% engaged in binge drinking or frequent use of alcohol. Ethen et al. (2009)
found that nearly one third of women drank alcohol at some time during pregnancy.
Abortion attempts were admitted by almost 10% of the women. Induced abortion is not legally allowed in Brazil but nonetheless it is quite common practice (Faundes, 2010
). Other risk factors present during pregnancy or delivery were concordant with literature data for Brazil (Momino et al., 2003
The multiple logistic regression test revealed three variables as related to maternal drinking behavior during pregnancy. These were criminality among relatives, being abused during infancy, and a positive history of alcoholism in another member of the family. Domestic violence against the woman was inversely correlated to drinking behavior. Our hypothesis is that domestic violence means that the woman was beaten by her husband mostly when he was drunk, thus generating in the woman avoidance to the use of alcohol.
To obtain an accurate maternal history of alcohol consumption is not always easy or possible. In this sense we tried to detect individuals with FASD regardless of maternal information by using physical sings and neurobehavioral data only. To do so we compared the measurements of the physical examination and the intelligence points of the institutionalized males with those of the public schools students. We opted here to use the percentile for height and head circumference.
Most of the physical measurements showed a significant difference between those two groups regardless of the maternal use of alcohol. Height and philtrum length were affected as expected by a stronger exposure to alcohol among the institutionalized adolescents. Even though the achievement on Raven Progressive Matrices was not different between probands and controls, the very poor results presented by the institutionalized boys are worthy of note, with 35 points being considered the low end of the normal intelligence curve. The low height and low intelligence scores are very heterogeneous in their etiology and therefore with low specificity for prenatal alcohol exposure.
Palpebral fissures, however, were significantly smaller in the control group, which was in the direction opposite from the expected. The fact that the difference was observed only in individuals of European ancestry could be contributing to this result, but we cannot yet explain why.
In conclusion, we could not identify in this sample of adolescents, individual cases with a clear diagnosis of FAS, but signs suggestive of FASD were more common in institutionalized adolescents. The high maternal history for drinking in both groups is also noteworthy. Furthermore, social factors like domestic and familial violence, which are frequent in this group, are also predictors of maternal drinking during pregnancy. From the herein compiled information the inference is that in Brazil criminal behavior is more related to complex interactions among environmental and social issues, these including prenatal alcohol exposure.