There are limitations to this study. First, the data utilized are from one unique, population where rates of FASD are the highest in the world, and alcohol is the exclusive drug of choice. Social, economic and cultural conditions associated with FASD in this population are severe and prominent. Binge drinking on weekends is normative for up to 40% of the women in this population, while drinking moderately and during the weekday is rare. This means that patterns of association, and possibly etiology, are robust, lend themselves well to discovery, and are more easily determined than in other populations where maternal drinking exists with lower prevalence, is obscured or hidden, and is likely cofounded by other drugs of abuse. While these conditions allow us to isolate the study variable, alcohol, its applicability to other populations may be questioned. Second, ZA mothers of this mixed race population are rather unique regarding their physical, nutritional, socioeconomic status, and historically unique relationship to alcohol. But, multiple studies of FASD in ZA have demonstrated that the sample mothers are extraordinarily forthcoming and reliable in reporting
