Fetal Alcohol Syndrome Prevention Research Articles

Report from the CDC. Physician and allied health professionals' training and fetal alcohol syndrome.

Maternal prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities. On the severe end of the spectrum of conditions related to drinking during pregnancy is fetal alcohol syndrome (FAS). Physicians and other health practitioners play a critical role in diagnosing FAS and in screening women of childbearing age for alcohol use during pregnancy. The Fetal Alcohol Syndrome Prevention Team at CDC's National Center on Birth Defects and Developmental Disabilities awarded funds to four medical school partners (Meharry and Morehouse Medical Colleges, St. Louis University, the University of Medicine and Dentistry of New Jersey, and the University of California at Los Angeles) to develop FAS regional training centers (RTCs). The RTCs are developing, implementing, evaluating, and disseminating educational curricula for medical and allied health students and practitioners that incorporate evidence-based diagnostic guidelines for FAS and other prenatal alcohol-related disorders.

Ethanol antagonist peptides: structural specificity without stereospecificity.

Increasing evidence suggests that ethanol damages the developing nervous system partly by disrupting the L1 cell adhesion molecule. Ethanol inhibits L1-mediated cell adhesion, and compounds that antagonize this action also prevent ethanol-induced embryotoxicity. Two such compounds are the small peptides NAPVSIPQ (NAP) and SALLRSIPA (SAL). We showed previously that NAP and SAL antagonize ethanol inhibition of L1 adhesion at femtomolar to picomolar concentrations. Here we demonstrate that, despite this extraordinary potency, both NAP and SAL lack stereospecificity. d-NAP, a peptide composed entirely of d-amino acids, was an effective ethanol antagonist in NIH/3T3 cells transfected with human L1 and in the NG108-15 neural cell line. Interestingly, Ala-substituted derivatives of d-NAP demonstrate the same structure-activity relation as the corresponding derivatives of l-NAP. The Ser-Ile-Pro motif was important for the ethanol antagonist activity of d-NAP, l-NAP, and l-SAL, with Ile being the most critical element in all three. Like l-NAP, d-NAP effectively reduced ethanol-induced growth retardation in mouse whole embryo culture. The potential resistance of d-peptides to proteases makes d-NAP a potentially attractive agent for the prevention of fetal alcohol syndrome.

A public health program for preventing fetal alcohol syndrome among women at risk in Montana

A description of an ongoing program for the prevention of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBDs) is provided. The prevention program focuses on women with increased risk factors. Paraprofessionals were added to selected professional case management teams in Montana in both rural and urban settings. The pilot program is linked with existing public health programs that are in place to help decrease the mortality of infants in Montana. A quasi-experimental design is being utilized to determine the efficacy of the prevention program in reducing risk factors that lead to alcohol use during pregnancy.

Fetal alcohol syndrome prevention: annual and cumulative cost savings

Fetal alcohol syndrome (FAS) is a common developmental disability. FAS is thought to be 100% preventable. While this is a theoretical truth, a prevention rate of 100% appears unlikely in the near future. However, several prevention strategies are available. In this paper, we examine the potential cost savings from prevention of one case of FAS each year in the state of North Dakota. We utilized the North Dakota Health Claims Database to examine annual cost of health care for children birth through 21 years of age with FAS and controls. The mean annual cost of health care for children birth through 21 years of age with FAS was US$2842 ( n=45). This is US$2342 per capita more than the annual average cost of care for children in North Dakota who do not have FAS (US$500 per year). Prevention of one case of FAS per year in North Dakota would result in a cost savings of US$128,810 in 10 years and US$491,820 after 20 years. After 10 years of prevention, the annual savings in health care costs alone for one case of FAS would be US$23,420.

Fetal alcohol syndrome

Alcohol is a physical and behavioural teratogen. Fetal alcohol syndrome (FAS) is a common yet under-recognized condition resulting from maternal consumption of alcohol during pregnancy. While preventable, FAS is also disabling. Although FAS is found in all socioeconomic groups in Canada, it has been observed at high prevalence in select First Nations and Inuit communities in Canada. This statement addresses FAS prevention, diagnosis, early identification and management for health care professionals. Prevention of FAS must occur at two levels. Primary prevention involves eliminating FAS through classroom or community education, and encouraging women to avoid consuming alcohol before conception and throughout pregnancy. Secondary prevention involves identifying women who are drinking while pregnant and reducing their consumption. This statement describes a variety of screening strategies including Tolerance-Annoyance, Cut Down, Eye Opener (T-ACE). Medical practitioners should recommend abstinence starting with the first prenatal visit. Prompt referral for alcohol treatment is recommended for pregnant individuals who are unable to stop drinking alcohol. This statement describes the diagnosis of FAS, partial or atypical FAS, alcohol-related birth defects and alcohol-related neurodevelopmental disorder. With a history of in-utero alcohol exposure, a diagnosis of FAS should be considered with current or previous growth deficiency, select facial abnormalities involving the upper lip and eyes, and neurodevelopmental abnormalities. These features are best quantified with the use of a four-digit diagnostic method. Strategies for early identification of possible alcohol-related abnormalities are outlined. Intervention focuses on optimizing development, managing behavioural difficulties and providing appropriate school programming. Of prime importance is earliest possible childhood intervention to prevent secondary disabilities that may result from delay while awaiting a definitive diagnosis of FAS.

A Review of Fetal Alcohol Syndrome for Health Educators

The consumption of alcohol during pregnancy is the cause of physical and behavioral defects known as fetal alcohol syndrome (FAS). The diagnosis of FAS is determined by the following three criteria: (1) growth retardation, (2) central nervous system involvement (i.e., mental retardation), and (3) facial abnormalities. FAS is a long-term disability that requires appropriate educational interventions for high-risk women and expectant mothers. This article reviews the issues of cause, incidence/prevalence, comorbidity, educational implications for the child with FAS, those at-risk for FAS, prevention strategies, and concludes with the role health educators can play in FAS prevention.

Alcohol use prior to pregnancy recognition

Background: Frequent alcohol use during the first 8 weeks of pregnancy can result in spontaneous abortion and dysmorphologic changes in the developing organ systems of the embryo, including the heart, kidneys, and brain. However, few population-based studies are available that describe the prevalence of frequent drinking (6 or more drinks per week) among women prior to and during early pregnancy (the periconceptional period), and the sociodemographic and behavioral factors that characterize these women. Such knowledge is fundamental to the design of targeted interventions for the prevention of fetal alcohol syndrome (FAS) and other prenatal alcohol-related disorders. Methods: This cross-sectional study used survey data collected by the National Center for Health Statistics as part of the 1988 National Maternal and Infant Health Survey (NMIHS). Weighted prevalence estimates were calculated using SUDAAN, and multivariate analyses were used to determine risk factors for frequent drinking. Results: Forty-five percent of all women surveyed reported consuming alcohol during the 3 months before finding out they were pregnant, and 5% reported consuming 6 or more drinks per week. Sixty percent of women who reported alcohol consumption also reported that they did not learn they were pregnant until after the fourth week of gestation. Risk factors for frequent drinking during the periconceptional period included 1 or more of the following: being unmarried, being a smoker, being white non-Hispanic, being 25 years of age or older, or being college educated. Conclusions: Half of all pregnant women in this study drank alcohol during the 3 months preceding pregnancy recognition , with 1 in 20 drinking at moderate to heavy levels. The majority did not know they were pregnant until after the fourth week of pregnancy, and many did not know until after the 6th week. Alcohol is a teratogen capable of producing a number of adverse reproductive and infant outcomes. Public health measures needed to reduce these potentially harmful exposures include alcohol assessment , education, and counseling for women of childbearing age, with referral sources for problem drinking, and family planning services for pregnancy postponement until problem drinking is resolved.

Preventing Fetal Alcohol Syndrome: Missouri Works to Improve Alcohol-Related Assessment and Referral Skills of WIC Nutritionists

The number one preventable cause of mental retardation is alcohol consumption during pregnancy. As human service professionals, dietitians are in an ideal position to educate women regarding the dangers of alcohol use at the time of conception, throughout pregnancy, and during breastfeeding. The non-adversarial relationship that is generally present between dietitian and client provides a non-threatening opportunity for this extremely important exchange of information. The Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health, Bureau of Disabilities Prevention, have cooperatively developed a program for the prevention of Fetal Alcohol Syndrome (FAS). A training module was developed which was distributed to all WIC district offices in Missouri. The goal of the program was to improve alcohol-related assessment, referral and reporting skills of WIC workers as well as to increase awareness of problems associated with alcohol consumption during pregnancy. The training module consisted of four parts: an overview of FAS; screening for maternal alcohol use; assessing the need for a referral; and making effective individualized referrals. Each copy included the training manual, transparency masters, and slides of children with FAS. In addition to distributing the modules, workshops were conducted throughout the state to train WIC nutritionists. This program is expected to improve the identification and referral of women who are discovered during the WIC certification process to have possible alcohol-related problems. Based on national statistics, it would be expected that at least 10% of WIC clients have a problem with alcohol abuse. Because the incidence of alcohol use during pregnancy remains greatly under reported, the role of the registered dietitian in education regarding FAS and in enhancing screening skills for alcohol abuse is crucial.

Native American adolescents' views of fetal alcohol syndrome prevention in schools.

Alcohol is the most commonly abused substance among adolescents in the United States. Adolescent females are recognized as one group at risk for giving birth to babies with fetal alcohol syndrome (FAS). Sixth through eighth grade Native Americans were surveyed about their attitudes toward and knowledge of FAS risk factors and prevention strategies. Data revealed that 52% of students drank alcohol prior to the survey. Though sexually active, students lacked knowledge about the relationship between alcohol and FAS. The study revealed 1) limited prevention programs in middle schools and 2) the most influential factor in determining attitudes and decisions about alcohol use was the immediate family. Students felt FAS prevention is an important topic in school health education, noting the important role peers play in teaching and role modeling. Various strategies incorporating music and communication technology such as videotape and computer-assisted interactive tools into prevention materials are discussed.

A Multiple-Level, Comprehensive Approach to the Prevention of Fetal Alcohol Syndrome (FAS) and Other Alcohol-Related Birth Defects (ARBD)

A comprehensive program for the prevention of fetal alcohol syndrome (FAS) and alcohol-related birth defects (ARBD) must consider multiple approaches and utilize knowledge from a variety of academic disciplines. Issues related to culture, society, behavior, belief systems, and medicine must all be considered for both etiology and solutions. A broad paradigm such as a public health model integrates various elements of approach. Because FAS and other levels of ARBD form a spectrum, from severe to negligible damage, a variety of drinking patterns with various characteristics and etiologies have to be addressed. This paper describes a multiple-level, comprehensive program with primary, secondary, and tertiary prevention components. Practical recommendations are proposed for addressing ARBD in a variety of arenas. While secondary and tertiary prevention hold promise for short-term reduction of FAS and ARBD prevalence, comprehensive prevention serves both short- and long-term effects. Multiple level prevention efforts are well served by clear and compelling vision and mission statements, and require careful evaluation.

Interpretations of risk: the use of scientific information in the development of the alcohol warning label policy.

In 1988 the US Congress passed a law requiring a health warning label on alcoholic beverage containers, to include the message that pregnant women should not drink alcohol. This paper addresses the role that scientific knowledge played in the formation and passage of the alcohol warning label policy. The constellation of birth defects implicated in the fetal alcohol syndrome (FAS) (including fetal alcohol effects) is sketched, and the FAS-related legislative events leading to the law's passage are described. A synopsis of the state of knowledge in 1988 regarding the effects of alcohol on the fetus is presented, and a snapshot of the social climate at that time is offered. The paper concludes with an update of relevant FAS research since the legislation was passed, and considers implications for future research and policy in the prevention of FAS.

A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: description and evaluation.

Presented here are a detailed description and outcome evaluation of a comprehensive, macro-level Fetal Alcohol Syndrome prevention program for Native Americans and Alaska Natives. The program was designed to provide native communities throughout the United States with the knowledge, skills and strategies to initiate primary, secondary and tertiary prevention measures on their own. The key to the program was the training of a cadre of trainers/advocates in all local Native American and Alaska Native communities served by the Indian Health Service. These people were then supported and assisted in their efforts through a variety of means. Evaluation results of knowledge gained indicate that the local trainers had substantial success in imparting FAS information to a variety of audiences (prenatal groups, school children and community groups). Further, the evaluation samples also indicate that the knowledge was retained by the groups over time (2-4 months) and that there may have been some general diffusion of knowledge among peers in local communities. This program is presented in the hope that it will be replicated and improved upon by similar programs using this model as a base.

Focusing Prevention of Fetal Alcohol Syndrome on Women at Risk

Focusing Prevention of Fetal Alcohol Syndrome on Women at Risk

Fetal Alcohol Syndrome Prevention in American Indian Communities of Michigan's Upper Peninsula

Attitudes and knowledge about Fetal Alcohol Syndrome (FAS) were examined among American Indian communities of Michigan's Upper Peninsula. Indian health workers and community women were interviewed. Education about FAS was provided in each community. The results indicate that information on FAS is reaching many women in these communities and that traditional cultural patterns can support the development of a strong Indian women's health program. At the same time, more must be done in the near term to help those women who are at greatest risk.

The fetal alcohol syndrome — Recent international statistics

The Incidence of Fetal Alcohol Syndrome (FAS) in some twenty nations was published in 1982. Further studies of incidence have been published over the past five years and these will be compared with the 1982 figures. Brief reference will be made to Program Strategies for the prevention of FAS in the United States of America. A study of alcohol effects on the ovum before fertilization made at the Edinburgh University Medical School, Scotland, over the past five years, will be examined.

Prevention of Fetal Alcohol Syndrome: a model program.

This article describes a new 3-yr demonstration program, funded by NIAAA, to intervene in female alcohol abuse during pregnancy and to prevent fetal alcohol syndrome.