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Epi Special Seminar

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Tuesday, October 5, 2010
Health Sciences Building K-069
3:30 to 4:50pm

Fetal Alcohol Spectrum Disorder (FASD): From Discovery to Prevention in WA State. A Model of Translational Research.

Susan Astley  

Susan J. Astley, PhD

Professor, Department of Epidemiology
School of Public Health, UW

Adjunct Professor, Pediatrics, School of Medicine

WA State Fetal Alcohol Syndrome Diagnostic & Prevention Network

Dr. Astley has conducted laboratory, clinical, and public health research in the field of FASD since 1981. She received her PhD in epidemiology from the UW in 1990.  Current work has been in the development, implementation, and dissemination of FASD diagnostic, screening, surveillance, and prevention tools and programs. This work includes the development of the FASD 4-Digit Diagnostic Code and FAS Facial Photographic Analysis Software; establishment of the WA State FAS Diagnostic and Prevention Network of clinics and Foster Care FAS Screening Program, and establishment of the FASD diagnostic training program and Online Course. She and her colleagues have recently published a comprehensive study of the diagnostic utility of MRI, MR-spectroscopy and functional MRI for FASD. A focal publication documents Washington State’s success in preventing FAS through reduction of maternal alcohol use during pregnancy.

Fetal alcohol syndrome (FAS) is a permanent birth defect syndrome caused by maternal use of alcohol during pregnancy. It is characterized by growth deficiency, CNS damage/dysfunction, and a unique cluster of minor facial anomalies. FAS is the leading known cause of developmental disabilities and is entirely preventable. FAS was first identified here at the University of Washington in 1968, spawning the development of two large FASD clinical research programs: the FAS Diagnostic and Prevention Network (FAS DPN) and the Fetal Alcohol and Drug Unit (FADU). These two programs have worked at the State, national and international levels to develop, implement, and disseminate FASD prevention programs.  Over the past 40 years, Washington State prevention efforts have spanned the full continuum of strategies from public health policy and education to direct intervention with high-risk women. To assess the effectiveness of FAS prevention efforts, one must be able to estimate accurately the prevalence of FAS over time in a population-based sample. With the establishment/development of the WA FAS DPN diagnostic clinics, the FASD 4-Digit Diagnostic Code, the FAS Facial Photographic Analysis Software, the Foster Care FAS Screening Program, and the collection of PRAMS data on maternal use of alcohol during pregnancy, the tools, methods, and infrastructure for assessing the effectiveness of FAS primary prevention efforts in Washington State are in place. The prevalence of FAS in the general population is 1/1000. The prevalence of FAS in King County foster care is ten-fold greater (1/100). Data from WA PRAMS and the Foster Care FAS Screening Program document significant declines in both the prevalence of maternal drinking during pregnancy and the prevalence of FAS. This decades-long collaboration between the University, DOH, DSHS and the WA State Legislature exemplifies what can be achieved through translational research (the rapid translation of clinical research into public health practice).

Learning Objectives

  1. Understand how public health education, public health policy, screening, diagnosis, intervention, and surveillance have lead to the prevention of FASD in WA State.
  2. Learn how the simple act of data collection can transform an entire field of clinical practice.
  3. Understand how important free, open access to information and technology is to translational research.


Suggested Reading: (These and others are posted on  www.fasdpn.org)

  1. Astley SJ. Fetal alcohol syndrome prevention in Washington State: Evidence of success.  Paediatric and Perinatal Epidemiology, 2004;18:344-351.
  2. Astley SJ. Profile of the first 1,400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network. Canadian Journal of Clinical Pharmacology, Vol 17 (1) Winter 2010:e132-e164:March 26, 2010.
  3. Astley SJ, Clarren SK.Diagnosing the full spectrum of fetal alcohol exposed individuals: Introducing the 4-Digit Diagnostic Code. Alcohol and Alcoholism, 2000;35 (4): 400-410.
  4. Astley SJ, Stachowiak J, Clarren SK, Clausen C.Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. Journal of Pediatrics, 2002;141(5):712-7.


Updated on October 5, 2010