Fetal Alcohol Syndrome Prevention Research Articles

Prenatal maternal alcohol exposure: diagnosis and prevention of fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is a developmental and congenital disorder characterized by neurocognitive impairment, structural defects, and growth restriction due to prenatal alcohol exposure. The estimated global prevalence of alcohol use during pregnancy is 9.8%, and the estimated prevalence of FAS in the general population is 14.6 per 10,000 people. In Korea, the estimated prevalence of alcohol use during pregnancy is 16%, and the prevalence of FAS is 18–51 per 10,000 women, which is higher than the global prevalence. Women’s alcohol consumption rates have increased, especially in women of childbearing age. This could increase the incidence of FAS, leading to higher medical expenses and burden on society. Alcohol is the single most important teratogen that causes FAS, and there is no safe trimester to drink alcohol and no known safe amount of alcohol consumption during pregnancy. Thus, physicians should assess women’s drinking patterns in detail and provide education on FAS to women by understanding its pathophysiology. Moreover, the prevention of FAS requires long-term care with a multidisciplinary approach.

Brief intervention aimed at fetal alcohol syndrome prevention: effectiveness study

Aim of the studyThis article represents the results of the study aimed at the research of psychological effects of a dual-focused brief intervention for prevention of fetal alcohol syndrome and alcohol-exposed pregnancy among childbearing age women in Russia.Subject or material and methods280 women took part in the research. The study used the following methods: screening, «Audit», Calendar method, baseline interview, follow-up interviews at 3, 6 and 12 months, the Big Five questionnaire, the method of motivational induction, the method of assessing the level of subjective control.ResultsThe study measured women’s knowledge about FAS and FASD, their attitudes towards alcohol consumption and in particular alcohol use during pregnancy, their real alcohol consumption level, use of contraception, the risk of alcohol-exposed pregnancy and possibly FAS or FASD, the socio-demographical characteristics and psychological features of women.DiscussionThe main factor that influences the formation of attitudes for the refusal of drinking alcohol during pregnancy and the decrease in the level of real alcohol consumption is awareness of the impact of alcohol on the fetus and the health of women, which determines the main content of the prevention program: informing and brief intervention, motivating a change in attitudes and behavior.ConclusionsThe results of the study showed the effectiveness of dual-focused brief intervention and passive informing that were designed and used for FAS prevention.

The Importance of Creating Habilitation Programs for Children with Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders

Aim of the study: to analyze the data of studies aimed at studying and substantiating the urgent need to create in Russia comprehensive habilitation programs for people with fetal alcohol syndrome, fetal alcohol spectrum disorders and other mental disorders.Methods. The results of Russian and foreign studies have been analyzed concerning the following problems: observation and diagnosis of people with fetal alcohol syndrome and fetal alcohol spectrum disorders; studying the experience of foreign countries in addressing issues of prevention and overcoming of fetal alcohol syndrome and fetal alcohol spectrum disorders; studying the experience of Russian specialists (obstetricians-gynecologists, neurologists, psychiatrists, psychologists, correctional teachers, etc.) working with the diagnosis of “Alcohol syndrome in the fetus”; assessing the socio-economic impact of organizing programs for the prevention of fetal alcohol syndrome and fetal alcohol spectrum disorders by comparison with similar indicators in other countries.Results. The presented analysis of the data indicates that there is an urgent need for timely diagnosis of the disease, the search/creation of new drugs, for the treatment of the consequences of alcohol syndrome and the organization of training of specialists in this area. The article shows the importance of providing lifelong medical and social assistance to people with fetal alcohol spectrum disorders, as well as to their families. The effectiveness of the creation of a system of measures for the prevention of fetal alcohol syndrome and fetal alcohol spectrum disorders throughout the country has been confirmed.Conclusion. The development at the state level and implementation of prevention programs will significantly reduce the birth rate of children diagnosed with “Alcohol syndrome in the fetus” and, thus, reduce the costs of the state and society on overcoming the consequences of FAS/FASD. At the same time, timely and well-organized habilitation of people with FAS/FASD will significantly improve the social situation in society as a whole, as well as reduce the psychological burden on every family faced with this problem.

The Effects of Alcohol on the Developing Drosophila Nervous System

Ethanol is the most common human teratogen, contributing to fetal alcohol syndrome (FAS) when effects are the most severe. Key effects of fetal alcohol syndrome are observed in the nervous system. The high prevalence of prenatal alcohol exposure necessitates novel treatment and prevention methods. However, ethical issues prevent researching humans in utero. For this reason, the fruit fly Drosophila melanogaster has emerged as a model organism for studying FAS. Because Drosophila is a small and non-placental organism, its environment can be easily controlled, allowing for specific doses and time periods of ethanol exposure to be studied. This review discusses findings related to the impact of alcohol on the developing Drosophila nervous system. Findings related to reactive oxygen species (ROS) exposure, a consequence of prenatal alcohol exposure due to the metabolism of alcohol, are emphasized. Impacts of ethanol on insulin signaling and epidermal growth factors are also mentioned. Further research on Drosophila nervous system development under ethanol exposure may prove beneficial in the treatment and prevention of FAS.

Social and Economic Effect of Comprehensive Prevention of Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders in Children: A Review

Introduction: Maternal alcohol consumption during pregnancy and its effects on the developing fetus are a serious global healthcare issue. The damage caused by alcohol goes far beyond mother’s health and spreads to the child’s physical and mental health.
 Aim of Review: Analysis of existing approaches in organizing the necessary rehabilitation programs and preventing the consequences of drinking alcohol during pregnancy, assessing the potential socio-economic effect of organizing comprehensive prevention of fetal alcohol syndrome (FAS) and fetal-alcohol spectrum of disorders (FASD).
 Materials and Methods: Children with FAS and influence of consequences of FAS/FASD on the nation’s material well-being conducted in Russia and abroad were analyzed by studying various published literature. Necessary rehabilitation measures for children with FAS/FASD were identified; analyzed international studies on the economic implications of the FAS/FASD; economic costs for medical and correctional services for children with FAS/FASD in Russia were assessed.
 Results: This review found that the Not all children with FAS/FASD are mentally retarded, they have behavioral disorders and the development of the emotional-volitional sphere is significantly behind the age norms. So, at 10-12 years of age, these children are still not contractual and cannot remain without adult supervision even for several hours. They require ongoing parental or tutor support. The range of disorders in fetal alcohol syndrome is very diverse, therefore, each child requires an individual approach in the formation of a rehabilitation program, which significantly increases costs in general and requires the involvement of highly qualified specialists.
 Conclusion: There is a need for additional economic calculations to scale up a comprehensive prevention program throughout the country. It is also important to note that the implementation of preventive measures does not eliminate the need for organizing assistance programs for families raising children with FAS/FASD.

Фетальный алкогольный синдром и краткосрочное психологическое вмешательство как метод его профилактики

This article presents brief intervention method, conducted with childbearing age women, aimed at fetal alcohol syndrome prevention. The article describes a model of intervention, provides the principles and successive steps. This method was developed in the framework of an international research grant project R01AA016234 «Prevention of fetal alcohol syndrome and neurodevelopmental disorders in Russian children».

Advances in the development of novel antioxidant therapies as an approach for fetal alcohol syndrome prevention.

Ethanol is the most common human teratogen, and its consumption during pregnancy can produce a wide range of abnormalities in infants known as fetal alcohol spectrum disorder (FASD). The major characteristics of FASD can be divided into: (i) growth retardation, (ii) craniofacial abnormalities, and (iii) central nervous system (CNS) dysfunction. FASD is the most common cause of nongenetic mental retardation in Western countries. Although the underlying molecular mechanisms of ethanol neurotoxicity are not completely determined, the induction of oxidative stress is believed to be one central process linked to the development of the disease. Currently, there is no known effective strategy for prevention (other than alcohol avoidance) or treatment. In the present review we will provide the state of art in the evidence for the use of antioxidants as a potential therapeutic strategy for the treatment using whole-embryo and culture cells models of FASD. We conclude that the imbalance of the intracellular redox state contributes to the pathogenesis observed in FASD models, and we suggest that antioxidant therapy can be considered a new efficient strategy to mitigate the effects of prenatal ethanol exposure.

Prevention of fetal alcohol syndrome.

The fetal alcohol syndrome (FAS) is the most avoidable handicap of newborns. It describes prenatal damages which result from the alcohol consumption of the mother. These can be: reduced body length and weight (pre- and postnatal), microcephaly, musculoskeletal, mental and statomotoric developmental retardations and impaired coordinative ability. There are preventive measures of which the efficiency is examined. Already, short counseling interviews, so-called short interventions, increase the abstinence of pregnant women.

Factors associated with contraceptive use in a rural area in Western Cape Province

Safe and effective contraceptive use can substantially improve women's reproductive health. Although the contraceptive prevalence rate (CPR) in South Africa is comparable to rates globally, inequalities in CPR affect poor and rural women. This study aimed to determine the CPR and factors associated with contraceptive use in a rural district of Western Cape Province. Cross-sectional survey data based on 412 face-to-face interviews with female participants between 18 and 44 years of age were collected in 2006 for a primary fetal alcohol syndrome prevention study in a rural district in Western Cape Province. The study used effective contraception (ECC) as the outcome variable. ECC included use of oral contraceptives, condoms, injectables or sterilisation. Independent variables included socio-demographic factors, substance use, psychosocial factors, community factors, childbearing characteristics and partner characteristics. Women were more likely to use ECC if they reported high self-esteem (compared with low or moderate self-esteem (prevalence risk ratio (PRR)=1.23; 95% confidence interval (CI) 0.99 - 1.53); if they strongly or moderately agreed that their culture entitled men to make decisions regarding child-bearing compared with those who disagreed (PRR=1.28; 95% CI 0.96 - 1.71); and if they had one child or more compared with no children (PRR=1.62; 95% CI 1.24 - 2.11). The CPR for sexually active women in this study was low at 39.3%. To promote contraceptive use in similar rural populations, family planning programmes should focus on increasing men's approval of contraception, improving partner communication around family planning and bolstering women's confidence in their reproductive decision-making, and particularly their self-esteem. There should be greater focus on nulliparous women.

Evaluation of a Service Provider Short Course for Prevention of Fetal Alcohol Syndrome

South Africa has among the highest reported rates of Fetal Alcohol Syndrome (FAS) globally. Primary prevention targeting women at risk for alcohol-exposed pregnancies could substantially reduce the incidence of FAS. We evaluated the effectiveness of a short training intervention to improve service providers' screening, identification, and management of women at risk for alcohol-exposed pregnancies. Training to screen and counsel women at risk for alcohol-exposed pregnancies was offered to 86 service providers (95% of whom were female) in two municipalities in the Western Cape Province, South Africa. Effectiveness was evaluated through a before-after study of service providers' knowledge and confidence levels and a comparison of service providers' practices (assessed indirectly via service user exit interviews) at intervention and control clinics. The proportion of service providers indicating that alcohol use during pregnancy is harmful to the fetus increased after training (23% vs. 67%; p < .001). After training, providers expressed significantly more confidence for four skills indicators related to the identification and management of women at risk for an alcohol-exposed pregnancy. Female clients at intervention clinics were more likely than those at the control clinics to receive alcohol advice (odds ratio [OR] = 2.13, 95% CI [1.27, 3.53]), counseling (OR = 1.3, 95% CI [1.05, 1.56]), and an offer of family planning (OR = 1.1, 95% CI [1.06, 2.10]) after the training. Time × Group interaction variable analysis in multiple logistic regression modeling confirmed these effects as related to training. A short training course based on brief motivational interviewing principles appears to be effective in building service provider capacity to better prevent and manage women at risk for alcohol-exposed pregnancies.

Conversation with Raul Caetano

In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas in the Journal's field of interest. Raul Caetano qualified in medicine in Brazil. While retaining close academic and cultural links with his native country, he has developed a career as an alcohol epidemiologist with research positions first in Berkeley,California and then at the University of Texas. He has contributed very widely to epidemiological research on drinking but with a sustained ability to develop the important ethnic dimensions of such studies.

Field trial of alcohol-server training for prevention of fetal alcohol syndrome.

An alcohol-server training program to prevent fetal alcohol syndrome was developed, implemented, and evaluated in a comparison study of public drinking establishments in New Mexico and Oregon. The management and serving staffs of 148 establishments licensed for on-premise alcohol sales in the two states studied were trained to discourage alcohol consumption by pregnant customers. Pre- and post-tests of server responses to pregnant-appearing "pseudo-patron" actors ordering alcohol in experimental (n = 148) and comparison (n = 183) establishments were a key method of evaluating the efficacy of this intervention. Within-group chi-square analyses compared rates of service refusal at baseline with 1-month, 6-month, and 12-month follow-up points for both the trained (experimental) and the comparison establishments. No differences were found between experimental and comparison establishments at baseline at either site, but significant differences were found for New Mexico at each posttraining measurement point. In Oregon, the refusal rate at baseline increased from 1.5% at baseline to 8.3% at 1 month, which only approached significance. In New Mexico, at baseline the refusal rate was 8.6%, and it rose to 39.2% at 6 months (p < .0001, odds ratio = 6.83) and remained high at 28.2% at 12 months (p < .001, odds ratio = 4.15). No similarly significant gains were recorded at control establishments. Supplemental responsible beverage service training for alcohol servers to aid in the prevention of fetal alcohol exposure can be effective in reducing the serving of alcohol to visibly pregnant women, with robust effects continuing over the subsequent year in the New Mexico establishments.

Epidemiology as a Guardian of Children's Health: Translating Birth Defects Research into Policy

The intentional coupling of epidemiology with the practical implications of policy has been a much desired, but often elusive, goal. At times, information provided by sound epidemiologicalresearchhasgoneunnoticed;thevoicesofcelebrities, public opinion, or industries have held sway in health policy development. This lost influence of epidemiology can result in inaction, wasted resources and/or failure to develop effective health initiatives. It can even harm those whom public health was meant to protect. However, when solid epidemiological research has been provided to, understood, used and implemented by policy makers, the efforts of epidemiologists and policy makers can result in truly effective health initiatives. Examples abound of such successful epidemiologically based policy initiatives related to children’s health, in particular children with special health care needs like birth defects. Some of the most successful examples include folic acid dietary supplements during pregnancy for preventionofneuraltubedefects,newborntestingforphenylketonuriaanddietarymanagement,andrecommendationsfor the limitations on alcohol ingestion during pregnancy for the prevention of fetal alcohol syndrome. Despite epidemiological and medical advances in the causes and treatment of children with birth defects and despite an increase in health policy initiatives, additional work must be done to improve the health of the nation’s children with special health care needs like birth defects. A better understanding and increased knowledge of the epidemiology of children with birth defects is a high priority due to the maternal and child health indicators in Healthy People 2010 (1). It is also important for needs assessment, program planning and development, service delivery, and program evaluation for Medicaid and the State Children’s Health Insurance Program and other State Title V Maternal and Child Health Block Grant related activities for this population (2). This is particularly salient issue given the current climate of health care reform and the need to assure children with special health care needs like birth defects have health insurance coverage. The purpose of this commentary is to describe some past and current research and policy initiatives regarding children with birth defects. We also explain the role epidemiologists can play in translating birth defects research into policy.

Treatment of alcohol problems in pregnancy and prevention of fetal alcohol syndrome

Treatment of alcohol problems in pregnancy and prevention of fetal alcohol syndrome

Novel Molecular Targets for the Prevention of Fetal Alcohol Syndrome

Alcohol abuse produces damaging effects on the CNS that leads to several types of disorders. When consumed during pregnancy, alcohol may cause craniofacial malformations, growth retardation and brain damage in offspring. These symptoms are grouped by the term fetal alcohol syndrome (FAS). FAS is the most common cause of non-genetic mental retardation in the western world. Substantial efforts to elucidate the molecular basis of these impairments are currently in progress. Whereas FAS is totally preventable by avoiding alcohol intake during pregnancy, efficient therapies to prevent or mitigate the effects of prenatal alcohol exposure are still not available but many pharmacological treatments have been developed to avoid alcohol intake and dependence in adults. The present article reviews the most relevant mechanisms of alcohol injury in developing brain and the strategies and patents that are currently available and in progress to prevent therapy for FAS.

An Investigation into Health Program for the Prevention of Fetal Alcohol Syndrome in Shizuoka

An Investigation into Health Program for the Prevention of Fetal Alcohol Syndrome in Shizuoka

Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy

Objective: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy.Method: A postal survey of a representative random sample of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians).Results: Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy.Conclusion: Health professionals have identified the need for educational materials for themselves and their clients.Implications: FAS is likely to be under‐ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed, opportunities for diagnosis and prevention of FAS will be limited.

Recognition and Prevention of Fetal Alcohol Syndrome

Alcohol use among women of childbearing age is prevalent in the United States, with approximately 1 in 5 nonpregnant women reporting binge drinking (5 or more drinks on any one occasion) and 1 in 25 pregnant women reporting binge drinking. Alcohol use during pregnancy results in a spectrum of adverse outcomes known as fetal alcohol spectrum disorders. Fetal alcohol syndrome (FAS) is one of these disorders. Fetal alcohol syndrome is characterized by specific facial abnormalities and significant impairments in neurodevelopment and physical growth. Early identification of children with FAS has been shown to enhance their long-term outcomes. In an effort to improve clinical recognition of children with this condition, Centers for Disease Control and Prevention (CDC) was directed by Congress in 2002 to lead the development of uniform diagnostic criteria for FAS and other prenatal alcohol-related conditions. The purpose of this commentary is to provide clinicians a summary of the report released by CDC describing the current diagnostic criteria for FAS. In addition, advancements have been made in screening and brief interventions for alcohol use disorders in women who have the potential to make significant strides in the prevention of FAS spectrum disorders. Knowledge of the diagnostic criteria for FAS can lead to increased identification of the syndrome in infants and children and the provision of appropriate medical and support services. Screening for and intervening with women at risk for an alcohol-exposed pregnancy can prevent FAS and other fetal alcohol spectrum disorders.

Fetal Alcohol Syndrome Prevention in South Africa and Other Low-Resource Countries

For decades South Africa has endured an epidemic of fetal alcohol syndrome (FAS) that requires immediate and decisive public health attention. The prevalence rates of more than 40 cases per 1000 children in the Western and the Northern Cape Provinces and more than 20 cases per 1000 children in Gauteng Province represent some of the highest rates of FAS in the world. May et al.’s article on maternal risk factors for FAS in South Africa should be a call to action to identify and apply strategies that can prevent this syndrome. It should also alert other lowresource nations in which alcohol is available and used by women of childbearing age to the possibility of a similar problem. (excerpt)

Fetal alcohol syndrome prevention in Washington State: evidence of success.

Fetal alcohol syndrome (FAS) is a permanent birth defect syndrome caused by maternal consumption of alcohol during pregnancy. It is characterised by growth deficiency, central nervous system damage/dysfunction, and a unique cluster of minor facial anomalies. To assess the effectiveness of fetal alcohol syndrome prevention efforts, one must be able to estimate accurately the prevalence of fetal alcohol syndrome over time in population-based samples. 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 Analysis Software, the creation of the Fetal Alcohol Spectrum Disorders (FASD) 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 whether 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 1993-98 (P < 0.03). These observations support the likelihood that fetal alcohol syndrome prevention efforts in Washington State are working successfully.