Prevention Publications    

Below are Abstracts of four published articles summarizing our work to date on prevention of FAS(D).
  ABSTRACT - Fetal alcohol syndrome is a permanent birth defect syndrome caused by maternal consumption of alcohol during pregnancy. Fetal alcohol syndrome is characterized by growth deficiency, central nervous system damage/dysfunction, and a unique cluster of minor facial anomalies. The prevalence of fetal alcohol syndrome in the U.S. is estimated to be 1 to 3 per 1,000 live births and is the leading known cause of mental retardation/developmental disabilities in the Western World. To prevent fetal alcohol syndrome, maternal alcohol consumption during pregnancy must be avoided. To assess the effectiveness of fetal alcohol syndrome prevention efforts, one must be able to accurately estimate the prevalence of fetal alcohol syndrome over time in population-based samples. Accurate estimates of prevalence, in turn, require accurate diagnostic methods. With the establishment of the Washington State Fetal Alcohol Syndrome Diagnostic and Prevention Network of clinics, the development of the Fetal Alcohol Syndrome Facial Photographic Screening/Diagnostic Tool, the creation of the Fetal Alcohol Syndrome 4-Digit Diagnostic Code, the establishment of the Foster Care Fetal Alcohol Syndrome Screening Program, and the collection of Pregnancy Risk Assessment Management System data on maternal use of alcohol during pregnancy, the tools, methods and infrastructure for assessing the effectiveness of fetal alcohol syndrome primary prevention efforts in Washington State are in place. A cross sectional study was conducted to determine if the prevalence of fetal alcohol syndrome among children in a foster care population, born between 1993 and 1998, decreased with the documented decrease in prevalence of maternal use of alcohol during pregnancy from 1993 and 1998 in Washington State.

The prevalence of maternal drinking during pregnancy in Washington State declined significantly (p < 0.001) from 1993 to 1998 as did the prevalence of fetal alcohol syndrome among foster children born from 1993 to 1998 (p < 0.03). These observations strongly support that fetal alcohol syndrome prevention efforts in Washington State are working.

  Abstract - A 5-year, FAS primary prevention study was conducted in Washington State to: 1) assess the feasibility of using a FAS Diagnostic and Prevention Clinic as a center for identifying and targeting primary prevention intervention to high-risk women (namely, women who had given birth to a child with FAS), 2) generate a comprehensive, lifetime profile of these women and 3) identify factors that have enhanced and/or hindered their ability to achieve abstinence. The results of this study are presented in two parts: Objective 1 is summarized in Part I below; Objectives 2 and 3 are summarized in Part II, published separately. This project demonstrated that a multidisciplinary FAS Diagnostic and Prevention Clinic (FAS DPN) could successfully attract and meet the diagnostic and treatment planning needs of patients presenting with prenatal alcohol exposure. One out of every three patients evaluated in the FAS DPN clinics was diagnosed with FAS or static encephalopathy/alcohol exposed. The birth mothers of one out of every three of these children diagnosed with FAS or static encephalopathy/alcohol exposed could be located and directly contacted. Half of the birth mothers directly contacted were still at risk for producing more children damaged by prenatal alcohol exposure. Thus, one out of every 18 children evaluated in the FAS DPN clinics had a birth mother who could be found and was at risk for producing more children damaged by prenatal alcohol exposure. Primary prevention programs targeted to this high-risk population could lead to measurable, cost-effective reductions in the incidence of FAS. Using this approach, the cost of raising a child with FAS would be roughly thirty times the cost of preventing FAS in the child. The benefit to the children, their mothers and society would be immeasurable.
  Abstract - A 5-year, FAS primary prevention study was conducted in Washington State to: 1) assess the feasibility of using a FAS Diagnostic and Prevention Clinic as a center for identifying and targeting primary prevention intervention to high-risk women, 2) generate a comprehensive, lifetime profile of these women and 3) identify factors that have enhanced and/or hindered their ability to achieve abstinence. The results of this study are presented in two parts. Objective 1 is summarized in Part I and is published separately. Objectives 2 and 3 are summarized in Part II below. Comprehensive interviews were conducted with 80 women, who had given birth to a child diagnosed with FAS, to document their sociodemographics, reproductive and family planning history, social and health care utilization patterns, adverse social experiences, social support network, alcohol use and treatment history, mental health and intelligence quotient. This high-risk population of women was diverse in racial, educational and economic background, was often victims of abuse and was challenged by mental health issues. Despite their rather harsh psychosocial profile, many demonstrated the ability to overcome their alcohol dependence over time. The women who had achieved abstinence had significantly higher I.Q.s, higher household incomes, larger more satisfactory social support networks, were more likely to report a religious affiliation and were more likely to be receiving mental health treatment for their mental health disorders relative to the women who had not achieved abstinence. The rate of unintended pregnancies and alcohol-exposed pregnancies was substantial. Key barriers to achieving effective family planning were maternal alcohol and drug use, lack of access to birth control and lack of support by their partner to use birth control. A FAS Diagnostic and Prevention Clinic can be used to identify women at high risk for producing children damaged by prenatal alcohol exposure. Primary prevention programs targeted to this population could lead to measurable reductions in the incidence of FAS.

 

  • Carmichael Olson H, Gendler B, Kraegel P, Rosengren D, Clarren SK, Astley SJ. A Targeted Approach to FAS Prevention: The FAS DPN First Bridges Program. Clinical & Experimental Research, 2002.
  Abstract - The FAS Diagnostic & Prevention Network (FAS DPN) is a network of diagnostic and referral clinics in Washington. A clinically feasible protocol was developed in the FAS DPN to identify and reach out to birth mothers of children born alcohol-affected. A tailored brief intervention of targeted FAS prevention services was then created and linked to the central FAS DPN clinic. This "First Bridges Program" (FB) was aimed at accomplishing FAS prevention by helping the women "bridge" the gap to needed alcohol treatment, family planning, or mental health services after being identified because of their children's alcohol-related diagnosis. This FB program involved up to 4 sessions between birth mother and social worker over a 3-month period, using motivational interviewing (MI) techniques. A pilot study examined the feasibility and efficacy of FB services. 16 fertile, still-drinking women were identified in the FAS DPN database, and 50% enrolled: 4 in the FB intervention group and 4 in a comparison group receiving standard of care (no FAS prevention outreach). Groups were similar on key matching variables and linkage to community services at baseline, but comparison subjects had lower IQs and more environmental stress. Participants were aged 24 to 35 years, averaged 10.8 years of education, 50% were of minority status, addiction severity ranged from mild to severe, and all had complex psychiatric histories. These women had already borne 26 children, but 7 of 8 had lost custody of all or some of their children. Three intervention subjects participated in all 4 possible MI sessions; the remaining subject was linked via FB to a long-term advocacy program. All were positive about FB at exit interview, and FB services appeared feasible and cost-effective. As hypothesized, group difference findings revealed improvement in readiness to change drinking behavior, one indicator of alcohol use, and improvement in a measure of general distress among intervention subjects. Intervention subjects typically reported receiving 1-2 community referrals (most from FB), while comparison women obtained no referrals. Significant change was not seen on other measures, but statistical power in this study was low. These women were effectively contracepting at baseline, so improvement in birth control attitudes and behavior could not be discerned. Yet one comparison subject began drinking heavily and ceased birth control to become pregnant. Discussion will focus on setting up MI-based brief intervention for FAS prevention in diagnostic clinic, public health and other settings.
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