***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES : To determine the prevalence and characteristics of fetal alcohol spectrum disorders ( FASD ) among first grade students ( 6- to 7-year-olds ) in a representative Midwestern US community . METHODS : From a consented sample of 70.5 % of all first grade rs enrolled in public and private schools , an over sample of small children ( ≤25th percentile on height , weight , and head circumference ) and r and omly selected control c and i date s were examined for physical growth , development , dysmorphology , cognition , and behavior . The children ’s mothers were interviewed for maternal risk . RESULTS : Total dysmorphology scores differentiate significantly fetal alcohol syndrome ( FAS ) and partial FAS ( PFAS ) from one another and from unexposed controls . Alcohol-related neurodevelopmental disorder ( ARND ) is not as clearly differentiated from controls . Children who had FASD performed , on average , significantly worse on 7 cognitive and behavioral tests and measures . The most predictive maternal risk variables in this community are late recognition of pregnancy , quantity of alcoholic drinks consumed 3 months before pregnancy , and quantity of drinking reported for the index child ’s father . From the final multidisciplinary case findings , 3 techniques were used to estimate prevalence . FAS in this community likely ranges from 6 to 9 per 1000 children ( midpoint , 7.5 ) , PFAS from 11 to 17 per 1000 children ( midpoint , 14 ) , and the total rate of FASD is estimated at 24 to 48 per 1000 children , or 2.4 % to 4.8 % ( midpoint , 3.6 % ) . CONCLUSIONS : Children who have FASD  are more prevalent among first grade rs in this Midwestern city than predicted by previous , popular estimates Objectives To determine the prevalence , patterns , and predictors of alcohol consumption prior to and during various intervals of pregnancy in the U.S. Methods Alcohol-related , pregnancy-related , and demographic data were derived from computer-assisted telephone interviews with 4,088 r and omly selected control mothers from the National Birth Defects Prevention Study who delivered live born infants without birth defects during 1997–2002 . Alcohol consumption rates and crude and adjusted odds ratios ( OR ) were calculated . Results 30.3 % of all women reported drinking alcohol at some time during pregnancy , of which 8.3 % reported binge drinking ( 4 + drinks on one occasion ) . Drinking rates declined considerably after the first month of pregnancy , during which 22.5 % of women reported drinking , although 2.7 % of women reported drinking during all trimesters of pregnancy and 7.9 % reported drinking during the 3rd trimester . Pre-pregnancy binge drinking was a strong predictor of both drinking during pregnancy ( adjusted OR = 8.52 , 95 % CI = 6.67–10.88 ) and binge drinking during pregnancy ( adjusted OR = 36.02 , 95 % CI = 24.63–52.69 ) . Other characteristics associated with both any drinking and binge drinking during pregnancy were non-Hispanic white race/ethnicity , cigarette smoking during pregnancy , and having an unintended pregnancy . Conclusions Our study revealed that drinking during pregnancy is fairly common , three times the levels reported in surveys that ask only about drinking during the month before the survey . Women who binge drink before pregnancy are at particular risk for drinking after becoming pregnant . Sexually active women of childbearing ages who drink alcohol should be advised to use reliable methods to prevent pregnancy , plan their pregnancies , and stop drinking before becoming pregnant BACKGROUND In Canada the incidence of Fetal Alcohol Spectrum Disorder ( FASD ) is estimated to be 1 in 100 live births . FASD is the leading cause of developmental and cognitive disabilities in Canada . Only one study has examined the cost of FASD in Canada . In that study we did not include prospect i ve data for infants under the age of one year , costs for adults beyond 21 years or costs for individuals living in institutions . OBJECTIVE To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level . METHODS Cross-sectional study design was used . Two-hundred and fifty ( 250 ) participants completed the study tool . Participants included caregivers of children , youth and adults , with FASD , from day of birth to 53 years , living in urban and rural communities throughout Canada participated . Participants completed the Health Services Utilization Inventory ( HSUI ) . Key cost components were elicited : direct costs : medical , education , social services , out-of-pocket costs ; and indirect costs : productivity losses . Total average costs per individual with FASD were calculated by summing the costs for each in each cost component , and dividing by the sample size . Costs were extrapolated to one year . A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD . RESULTS Total adjusted annual costs associated with FASD at the individual level was $ 21,642 ( 95 % CI , $ 19,842 ; $ 24,041 ) , compared to $ 14,342 ( 95 % CI , $ 12,986 ; $ 15,698 ) in the first study . Severity of the individual 's condition , age , and relationship of the individual to the caregiver ( biological , adoptive , foster ) were significant determinants of costs ( p < 0.001 ) . Cost of FASD annually to Canada of those from day of birth to 53 years old , was $ 5.3 billion ( 95 % CI , $ 4.12 billion ; $ 6.4 billion ) . CONCLUSIONS Study results demonstrated the cost burden of FASD in Canada was profound . Inclusion of infants aged 0 to 1 years , adults beyond the age of 21 years and costs associated with residing in institutions provided a more accurate estimate of the costs of FASD . Implication s for practice , policy , and research are discussed . Key words : Alcohol , pregnancy , cost , economic burden , fetal alcohol spectrum disorder OBJECTIVE We examined the use of alcohol during early pregnancy in urban Swedish women , the ability of Swedish antenatal care to identify alcohol-related risk pregnancies and the utility of some potential tools for improving its performance . METHOD Women attending regular antenatal care were r and omized to regular assessment only ( control , n = 156 ) or intensified screening ( intervention , n = 147 ) . In the intervention group , alcohol use was determined using the  Timeline Followback ( TLFB ) interview  ,  alcohol use habits with  the Alcohol Use Disorder Inventory Test ( AUDIT )  , and  biomarkers for  alcohol use were analyzed . Data were typically obtained in pregnancy week 12 . RESULTS In the intervention group as a whole , average absolute alcohol consumption during the first 6 weeks of pregnancy was low but highly variable ( mean [ SD ] = 24.9 [ 50.5 ] g/week ; 4.8 [ 6.0 ] episodes for the entire 6 week period ) ; 22 women ( 15 % ) drank at levels exceeding 70 g/week during any 2 or more weeks and /or in a heavy episodic drinking pattern , 60 g/episode , on 2 or more episodes . The AUDIT had a moderate sensitivity ( 54 % ) to identify these subjects . Biomarkers identified subjects with somatic illness rather than high alcohol consumption . In the control group , only 4 ( 3 % ) were identified as using alcohol , indicating a probable underestimation of alcohol use by regular antenatal screening procedures ( p = .0001 ) . CONCLUSIONS An unexpected proportion of pregnant women in urban Sweden consume alcohol at levels likely to produce adverse effects . Regular antenatal care did not identify most of these risk pregnancies . The TLFB identified pregnant women with risk use of alcohol during pregnancy who were only partly identified by analyzing prepregnancy alcohol use patterns with the AUDIT . Elevated laboratory markers likely indicated somatic illness rather than harmful drinking BACKGROUND The prevalence and characteristics of fetal alcohol spectrum disorders ( FASD ) were determined in this fourth study of first- grade children in a South African community . METHODS Active case ascertainment methods were employed among 747 first- grade pupils . The detailed characteristics of children within the continuum of FASD are contrasted with r and omly selected , normal controls on ( i ) physical growth and dysmorphology ; ( ii ) cognitive/behavioral characteristics ; and ( iii ) maternal risk factors . RESULTS The rates of specific diagnoses within the FASD spectrum continue to be among the highest reported in any community in the world . The prevalence ( per 1,000 ) is as follows : fetal alcohol syndrome (FAS)-59.3 to 91.0 ; partial fetal alcohol syndrome (PFAS)-45.3 to 69.6 ; and alcohol-related neurodevelopmental disorder (ARND)-30.5 to 46.8 . The overall rate of FASD is therefore 135.1 to 207.5 per 1,000 ( or 13.6 to 20.9 % ) . Clinical profiles of the physical and cognitive/behavioral traits of children with a specific FASD diagnosis and controls are provided for underst and ing the full spectrum of FASD in a community . The spectral effect is evident in the characteristics of the diagnostic groups and summarized by the total ( mean ) dysmorphology scores of the children : FAS = 18.9 ; PFAS = 14.3 ; ARND = 12.2 ; and normal controls , alcohol exposed = 8.2 and unexposed = 7.1 . Documented drinking during pregnancy is significantly correlated with verbal ( r = -0.253 ) and nonverbal ability ( r = -0.265 ) , negative behaviors ( r = 0.203 ) , and total dysmorphology score ( r = 0.431 ) . Other measures of drinking during pregnancy are significantly associated with FASD , including binge drinking as low as 3 drinks per episode on 2 days of the week . CONCLUSIONS High rates of specific diagnoses within FASD were well documented in this new cohort of children . FASD persists in this community . The data reflect an increased ability to provide accurate and discriminating diagnoses throughout the continuum of FASD OBJECTIVE To study the activities of serum gamma-glutamyltransferase ( GGT ) , aspartate and alanine aminotransferases ( AST , ALT ) , and their ratio ( AST/ALT ) , mean erythrocyte cell volume ( MCV ) and urinary dolichol output in alcohol-abusing pregnant women , and compare the results to those of abstinent pregnant women . DESIGN Prospect i ve descriptive study . SETTING Special outpatient clinic for pregnant problem-drinkers in the department of Obstetrics and Gynaecology , Helsinki University Central Hospital , Finl and . SUBJECTS 25 pregnant women referred to the special clinic at between 12 and 24 weeks gestation , they consumed at least 150 g of ethanol weekly , and a control group of 20 abstinent pregnant women matched for age , parity and smoking habits . INTERVENTIONS The women were encouraged to visit the clinic at 2 - 4 week intervals . At each visit blood and urine sample s were obtained , and the women were interviewed on their alcohol consumption during the previous weeks and encouraged to abstain in the future . MEAN OUTCOME MEASURES Neonatal condition , fetal alcohol effects ( FAE ) in the newborn . Serum activities of GGT , AST and ALT , the AST/ALT ratio , the MCV , and the urinary concentration of dolichol in alcohol-abusing women with either healthy or FAE infants , compared with those of abstinent women with healthy infants . RESULTS Of the 25 alcohol-abusing women 13 gave birth to infants with FAE and 12 to healthy infants . All the women in the control group gave birth to healthy infants . GGT , AST and ALT activities were increased in all alcohol-abusing women , regardless whether the infant had FAE or not . GGT was the best of these markers , GGT activities above the 95th normal centile were found in 33 % of the sample s from all alcohol-abusing women . The AST/ALT ratio , MCV and urinary dolichol concentration were poor indicators of abusive drinking . CONCLUSIONS Maternal alcohol abuse is difficult to assess by laboratory tests . Of the commonly used and easily available tests , GGT proved to be the best in our study In order to investigate prospect ively in pregnant women a correlation between serum levels of a biological marker of alcohol and the clinical status of the newborn , we measured the  gamma-glutamyltransferase ( GGT )  in 630 women between 14 and 20 weeks of pregnancy . In 7 % of the cases , an elevated value was observed while history confirmed alcohol consumption in only 1 % . Preliminary statistical analysis established upon the blind examination of 308 newborns show a correlation between maternal GGT levels and birthweight as well as the pre- and perinatal complications . However , the sensitivity of this test is weak BACKGROUND The prevalence and characteristics of fetal alcohol syndrome ( FAS ) and partial FAS ( PFAS ) in the United States ( US ) are not well known . METHODS This active case ascertainment study in a Rocky Mountain Region City assessed the prevalence and traits of children with FAS and PFAS and linked them to maternal risk factors . Diagnoses made by expert clinical dysmorphologists in multidisciplinary case conferences utilized all components 
    Output:
    
Although all of the studies were rated of good method ological quality , none of the biomarkers had both high sensitivity and specificity when compared to self-report .
There was some evidence that a combination of biomarkers , or combining biomarkers with self-report , increases accuracy .
In summary , the blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report .
However , certain biomarkers , such and CDT and PEth may complement self-report and help improve the accuracy of diagnosis