Prevention of fetal alcohol spectrum disorders.

Abstract

Alcohol use among women of childbearing age is a leading, preventable cause of birth defects and developmental disabilities in the United States. Although most women reduce their alcohol use upon pregnancy recognition, some women report drinking during pregnancy and others may continue to drink prior to realizing they are pregnant. These findings emphasize the need for effective prevention strategies for both pregnant and nonpregnant women who might be at risk for an alcohol-exposed pregnancy (AEP). This report reviews evidence supporting alcohol screening and brief intervention as an effective approach to reducing problem drinking and AEPs that can lead to fetal alcohol spectrum disorders. In addition, this article highlights a recent report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect that describes effective interventions to reduce alcohol use and AEPs, and outlines recommendations on promoting and improving these strategies. Utilizing evidence-based alcohol screening tools and brief counseling for women at risk for an AEP and other effective population-based strategies can help achieve future alcohol-free pregnancies.

Full text

Page 1

PREVENTION OF FETAL ALCOHOL SPECTRUM
DISORDERS
R. Louise Floyd,1* Mary Kate Weber,1Clark Denny,1and Mary J. O’Connor2
1Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities,
Prevention Research Branch, Fetal Alcohol Syndrome Prevention Team, Atlanta, Georgia
2Department of Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior,
David Geffen School of Medicine at UCLA, Los Angeles, California
Alcohol use among women of childbearing age is a leading, pre-
ventable cause of birth defects and developmental disabilities in the
United States. Although most women reduce their alcohol use upon
pregnancy recognition, some women report drinking during pregnancy
and others may continue to drink prior to realizing they are pregnant.
These findings emphasize the need for effective prevention strategies for
both pregnant and nonpregnant women who might be at risk for an
alcohol-exposed pregnancy (AEP). This report reviews evidence support-
ing alcohol screening and brief intervention as an effective approach to
reducing problem drinking and AEPs that can lead to fetal alcohol spec-
trum disorders. In addition, this article highlights a recent report of the
National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect
that describes effective interventions to reduce alcohol use and AEPs,
and outlines recommendations on promoting and improving these
strategies.Utilizing evidence-based
brief counseling for women at risk for an AEP and other effective
population-based strategies can help achieve future alcohol-free preg-
nancies.
Dev Disabil Res Rev 2009;15:193–199.
alcoholscreeningtoolsand
'2009 Wiley-Liss, Inc.
Key Words: pregnancy and alcohol; fetal alcohol syndrome; fetal alcohol
spectrum disorders; alcohol use screening; brief intervention; alcohol-
exposed pregnancies
A
known. Alcohol use among women of childbearing age
(18–44 years) constitutes a leading, preventable cause of birth
defects and developmental disabilities in the United States
[American Academy of Pediatrics, 2000]. Alcohol is a terato-
gen [Michaelis and Michaelis, 1994] that can affect the devel-
opment of multiple organ systems, including the central nerv-
ous system, during early and later fetal development [Coles,
1994; Streissguth and O’Malley, 2000]. Among nonpregnant
women, population-based data from the Behavioral Risk Fac-
tor Surveillance System (BRFSS) for years 1991–2005 finds
that ?52% report consuming any alcohol in the past month
and ?12% report binge drinking (five or more drinks on one
occasion) (Fig. 1). Pregnancy recognition does not occur in
many women until 4- to 6-weeks gestation [Floyd et al.,
1999], and thus many women may drink prior to realizing
lthough the causes of many debilitating developmental
disabilities are unknown, the etiology of fetal alcohol
spectrum disorders (FASDs) [Warren et al., 2004] is
they are pregnant. Upon recognition of pregnancy, most
women spontaneously reduce their alcohol use [Ebrahim
et al., 1999; Floyd et al., 1999]. A recent report of alcohol use
rates among women of childbearing age who are pregnant
showed that use of any alcohol remains stable at ?12% and
binge drinking is between 2 and 3% during pregnancy (Fig.
1). Thus, alcohol use during pregnancy continues to be an
important public health concern.
The timing of exposure and the amount of exposure are
the primary determinants of fetal morbidity and mortality
[Michaelis and Michaelis, 1994]. A strong predictor of alcohol
use during pregnancy is alcohol use levels prior to pregnancy
[Day et al., 1993; Floyd et al., 1999]. Fetal alcohol exposure
prior to and after pregnancy recognition and their effect on
pregnancy outcomes are important public health concerns.
Rates of alcohol use for both pregnant and nonpregnant
women of childbearing age have changed very little for over a
decade [Denny et al., 2009], stressing the importance of
implementing effective strategies to prevent prenatal alcohol
exposure. This report will describe evidence-based strategies
for reducing alcohol-exposed pregnancies (AEPs) that lead to
fetal alcohol syndrome (FAS) and other prenatal alcohol-
related conditions in children.
SCREENING FOR ALCOHOL MISUSE IN WOMEN
OF CHILDBEARING AGE
Although early studies of effective screening tools for
identifying individuals at risk for poor health outcomes related
to alcohol consumption included both males and females,
overall they tended to include predominantly more males.
One systematic review focusing on screening for alcohol prob-
The findings and conclusions in this report are those of the authors and do not nec-
essarily represent the official position of the Centers for Disease Control and
Prevention.
*Correspondence to: R. Louise Floyd, Fetal Alcohol Syndrome Prevention Team,
NCBDDD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta,
GA 30333. E-mail: rlf3@cdc.gov
Received 25 June 2009; Accepted 14 July 2009
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI: 10.1002/ddrr.75
DEVELOPMENTAL DISABILITIES
RESEARCH REVIEWS 15: 193–199 (2009)
' 2009 Wiley-Liss, Inc.

Page 2

lems in primary care settings looked at
studies conducted from 1966 through
1998 [Fiellin et al., 2000]. The authors
identified 38 articles meeting inclusion
criteria which included those that were
written in English, published in peer
review journals during the targeted time
period, compared the performance of
the screening tools to a standard clinical
criterion, and reported the performance
characteristics of the tools such as sensi-
tivity and specificity.
The majority of the studies (27)
focused on alcohol abuse or dependence
and the remainder (11) focused on at-
risk, heavy, or harmful drinking. A
varietyofscreening
investigated, but the
showedtheAlcohol
Identification Test (AUDIT) [Saunders
et al., 1993] performed best in identify-
ing individuals with at-risk, hazardous,
or harmful drinking and the CAGE
[Ewing, 1984] performed best in identi-
fying individuals with alcohol abuse and
dependence. The AUDIT is a 10-item
screening tool that asks questions about
the quantity, frequency, and maximum
level of 5 or more drinks on one occa-
sion; personal and social consequences
experienced (problems at work or with
methods
overall
Use
were
results
Disorders
the family), and dependence symptoms
(loss of control and loss of memory
about events that occurred while drink-
ing) [Saunders et al., 1993]. The CAGE
[Ewing, 1984] is a four-item screener
that includes questions on feeling the
needto
Cutdown;
criticisms about drinking; Guilty about
drinking; and need for an Eye-opener
first thing in the morning. Although
citing a number of limitations among
the studies reviewed, the authors con-
cluded that formal screening instru-
ments performed better than clinical
measures in identifying individuals with
alcohol use problems in primary care
settings.
In recognition that many standar-
dizedalcoholscreening
validated in predominantly male popu-
lations, studiesfocusing
screening in women began to appear in
the scientific literature, including the
developmentofscreening
selected populations such as pregnant
women. The first alcohol screening tool
for pregnant women was the T-ACE
[Sokol etal., 1989].
inquires about Tolerance (‘‘How many
drinks does it take to make you feel
high?’’); being Annoyed by criticisms
Annoyedby
tests were
onalcohol
toolsfor
TheT-ACE
from others about one’s drinking; hav-
ing felt the need to Cut down on
drinking; and the need for an Eye-
openerin the morning. A second
screening tool developed for use in
pregnant women, the TWEAK [Rus-
sell, 1994], is similar to the T-ACE and
includes Tolerance (‘‘How many drinks
can you hold?’’ or ‘‘How many drinks
does it take before you begin to feel the
first effects of alcohol?’’), Worry by
family membersover
behavior exhibited, Eye-opener, Amne-
sia, and need to Kut down. One review
ofalcohol usescreening
women in the late nineties concluded
that the CAGE, commonly used in
screening for heavy drinking in males,
was less accurate in identifying problem
drinking in female populations as com-
pared to the TWEAK and the AUDIT
[Bradley et al., 1998]. More recently,
the AUDIT-C, which includes the first
three items of the full AUDIT that
queries quantity, frequency, and maxi-
mum level of 5 or more drinks on any
one occasion, has been found to be
effective in screening for alcohol misuse
in women when using a cut point score
of 3 or more [Dawson et al., 2005;
Bradley et al., 2007].
thedrinking
tools for
EFFICACY OF BRIEF
INTERVENTIONS FOR
REDUCING PROBLEM
DRINKING IN WOMEN
The 1990s were characterized by
mounting evidence supporting the use
of advice and brief interventions for
problem drinkers in primary care set-
tings. Some brief interventions employ
the use of motivational counseling and
have been delivered by providers who
are not specialists in the treatment of
alcohol abuse or dependence. The main
components of these
involvefeedback
responsibility for
advice to change, strategies to help
individuals reduce or stop drinking, an
empathetic counseling style, and self-
efficacy or optimism
change on the part of the individual.
Brief intervention also involves estab-
lishing a drinking goal and follow up of
progress with ongoing support.
One early review [Bien et al.,
1993] reported on 32 studies of brief
interventions targeting problem drink-
ing behaviors conducted
nations. Among the 6,000 subjects en-
rolled in these studies, the majority
were males (75%). Although a number
of the studies found significant effects
for brief interventions over control
interventions
personal
personal
ofrisk,
control,
for behavioral
across 14
Fig. 1.
pregnancystatus—BehavioralRiskFactorSurveillanceSystem,UnitedStates,y1991–2005§.
*Defined as five or more drinks on at least one occasion.yBRFSS data were not available for 1994,
1996, 1998, and 2000. Data also were not available from Kansas, Nevada, and Wyoming for 1991;
fromArkansasandWyoming for 1992;fromRhodeIslandfor1993and1994;fromtheDistrict of Co-
lumbia for 1995; and from Hawaii for 2004.§Beginning in 2006, the definition of binge drinking by
women changed to four drinks on at least one occasion. Because of this change, data collected after
2005arenotincluded.
Percentageofwomenaged18–44yearswhoreportedanyalcoholuseorbingedrinking,*by
194
Dev Disabil Res Rev?Prevention of FASDS?Floyd Et Al.

Page 3

groups overall, others found differences
in outcomes for males versus females
with female groups more likely to show
change in both intervention and control
groups yielding no between group dif-
ferences. Differing effects by sex were
not reported uniformly in the studies
reviewed that may have been related to
small numbers of women represented in
the selected studies. Authors of the
review acknowledged some expected
methodologicalproblems
sample size, sample selection, additional
treatment (i.e., additional
sought in the months following brief
intervention), and
assessment (i.e., did the drinking assess-
ment alone alter behavior?). However,
the weight of the findings led the
authors to conclude that brief interven-
tions are far better than no interven-
tions; compare favorably in outcomes to
more extensive interventions; appear to
enhance the effects of subsequent treat-
ment; and provide encouraging evi-
dence for changing harmful drinking
patterns among adults in health care
and treatment settings.
In 1996, the World Health Orga-
nization(WHO)
Study Group [1996] reported the find-
ings of a noteworthy study focused on
the effects of simple advice and brief
counseling on hazardous drinking in
adults representing a variety of cultural
groups in eight developing and devel-
oped countries. The study was con-
ducted in diverse health care settings
including primary care. Of the 1,559
subjects enrolled, ?75% were male.
Subjects were randomized into three
groups: a control group, a simple advice
group, and a group receiving a brief
intervention. Significant results were
found in men receiving the interven-
tions (advice or brief intervention),
with a reported 17% lower average daily
drinking amount as compared to men
in the control group. Among women in
the study, significant reductions in alco-
hol use occurred in both intervention
and control groups with no significant
between group differences.
A later report reviewed random-
ized trials specifically focusing on the ef-
ficacy of brief interventions for women
in need of treatment for problem drink-
ing [Chang, 2002]. The study popula-
tions included groups composed only of
women or mixed groups that included
both men and women with substantial
numbers of women represented. One
study found a brief intervention deliv-
ered by general practitioners to be effec-
tive in reducing excessive drinking in
including
treatment
reactivityto the
BriefIntervention
both men and women who received the
intervention as compared to controls
[Wallace et al., 1988]. In four reviewed
studies, women performed significantly
better in lowering their alcohol con-
sumption than men when compared to
controls [Sanchez-Craig et al., 1989,
1991; Fleming et al., 1997; Manwell
et al., 2000]. Among the four remaining
studies that just included women, no sig-
nificant between group differences were
found when intervention and control
groupswerecompared
Anderson, 1990; WHO Brief Interven-
tion Study Group, 1996; Chang et al.,
1999; Aalto et al., 2000]. The authors
noted that the benefits for women
receiving brief intervention for problem
drinking were not consistent across the
studies reviewed. Other reviews with
meta-analyses have found brief interven-
tions effective across gender for heavy
drinking and hazardous drinking [Wilk
et al., 1997; Ballesteros et al., 2004], and
extended brief interventions effective in
women but not men [Poikolanen, 1999].
Taken together, these meta-analy-
ses have yielded somewhat contradictory
conclusions in part due to the fact that
the various studies reviewed varied
widely regarding inclusion criteria such
as alcohol use severity level, age and sex
of subjects, clinical setting used for
recruitment, and differences in the com-
ponents of the brief interventions. How-
ever, in spite of a number of differing
findings from studies using different
methodologies, some general conclu-
sions can be derived from this research. It
appears that both men and women bene-
fit from brief interventions; women ben-
efited more than men in some trials that
may reflect lower levels of alcohol use
and higher motivation for behavioral
change in women, and, in the context of
a therapeutic situation, women may
change their behavior regarding alcohol
use simply in response to questions about
their drinking. This latter conclusion is
based on the finding that, in some stud-
ies, women in the control groups who
were just asked about their drinking lev-
els performed similarly to the women in
the brief intervention groups.
[Scott and
INTERVENTIONS
FOR PREVENTING
ALCOHOL-EXPOSED
PREGNANCIES (AEP) IN
WOMEN OF CHILDBEARING
AGE
In2004,
Services Task Force (USPSTF) report
provided a summary of the evidence
upon which the USPSTF would base
aU.S. Preventive
their recommendations for identifying
and intervening with risky or harmful
drinkers [Whitlock et al., 2004]. The
evidence summary was derived from a
review of 12 randomized, controlled
trials of brief interventions in adults. All
but one was conducted in primary care
practices. Most had more than 300 par-
ticipants (one-third
women) and a 12-month follow-up
period. The review concluded that
behavioral counseling
were effective for risky or harmful
drinking among adult primary care
patients. The official recommendation
statement released by the USPSTF rec-
ommended screening and behavioral
counseling interventions to reduce alco-
hol misuse by adults, including pregnant
women, in primary care settings [U.S.
Preventive Services Task Force, 2004].
The statement acknowledged that there
was limited evidence to support the
effectiveness of counseling to reduce
alcohol use during pregnancy, but stated
that studies did show that behavioral
counseling interventions were effective
in reducing alcohol use among women
of childbearing age in general. For
example, one study from the USPSTF
review found that two 15-min physi-
cian-delivered brief intervention sessions
resulted in a 20–25% reduction in
drinks per week and binge drinking
episodes among
women 18–40 years who screened posi-
tive for problem drinking at study
enrollment [Manwell et al., 2000].
Since the USPSTF review was
conducted, two well-controlled studies
have been reported on the use of brief
interventions in pregnant women of
childbearing age. A 2005 randomized
study of pregnant women found that a
single brief intervention counseling ses-
sion that included partners was effica-
cious in reducing alcohol use among
the heaviest drinkers in the treatment
group [Chang et al., 2005]. A later
randomized trial of a brief intervention
targeted pregnant
Women, Infants, and Children Centers
and followed them through the third
trimester [O’Connor
2007]. Reported results showed that
women in the brief intervention group
were five times less likely to continue
drinking during pregnancy than women
in the assessment only group. In addi-
tion, newborns of mothers who were
heavier drinkers in the intervention
group had better growth (higher birth
weights and longer birth lengths) and
lower fetal mortality rates than those in
the assessment only group. This study
of whichwere
interventions
childbearing-aged
womenattending
andWhaley,
Dev Disabil Res Rev?Prevention of FASDS?Floyd Et Al.
195

Page 4

was one of the few studies that have
been conducted in a community, rather
than a primary care setting using non-
medical professionals for the administra-
tion of the brief intervention.
Given the high rates of hazardous
use of alcohol among childbearing-aged
women in the United States (Fig. 1),
the ideal time to reach them with infor-
mation, advice, and assistance is prior to
conception. A randomized trial of a
brief motivational intervention to do
this was reported in 2007 [Floyd et al.,
2007]. This study, conducted in diverse,
community-based
four counseling sessions and a contra-
ception consultation and services visit
to women at high risk for an AEP.
Women in the control group received
information and resources for addressing
problem drinking and for family plan-
ning services. At 3, 6, and 9 months,
the odds of reducing the risk for an
AEP were twofold higher in the inter-
vention group over the information
(control) group.
The evidence base for use of brief
interventions in preventing AEPs in
women of childbearing age led the
Clinical Working Group of the Select
Panel on Preconception Care, Centers
settings,provided
for Disease Control and Prevention
(CDC), to put forth the following rec-
ommendation in 2008 for women in
the preconception period:
All childbearing-aged women should be
screened for alcohol use and brief interventions
should be provided in primary care settings includ-
ing advice regarding the potential for adverse health
outcomes. Brief interventions should include accu-
rate information about the consequences of alcohol
consumption including the effects of drinking dur-
ing pregnancy, that effects begin early during the
first trimester and that no safe level of consumption
has been established. Contraception consultation
and services should be offered and pregnancy
delayed until it can be an alcohol-free pregnancy.
[Floyd et al., 2008, p. S335].
MOVING SCIENCE TO
PRACTICE THROUGH POLICY
DEVELOPMENT AND
IMPLEMENTATION
In 1996, the Institute of Medicine
(IOM) stressed the importance of inte-
gration and coordination at the federal
level in order to prevent and treat the
full spectrum of individuals with alco-
hol-related problems [Stratton et al.,
1996]. Since that time, there have been
several national efforts that have facili-
tatedadvances in
National Institute on Alcohol Abuse
thisarea. The
and Alcoholism created the Interagency
Coordinating Committee on FAS in
1996 comprised of various federal agen-
cies conducting research and program
activities on prenatal alcohol exposure.
The committee helps to foster exchange
of information and ideas across federal
agencies and encourages collaborative
projects. The National Task Force on
Fetal Alcohol Syndrome was mandated
by the U.S. Congress in 1998 to advise
and foster coordination among agencies,
academic bodies, clinicians, and com-
munity groups regarding research, pro-
grams on prenatal alcohol exposure,
surveillance, and to address the needs of
individuals with FASDs and their fami-
lies. In 2002, the Substance Abuse and
Mental Health Services Administration’s
FASD Center for Excellence was cre-
ated to support the development of
FASD prevention, treatment, and care
systems at the state and community
level. Other national groups, including
the National Organization on FAS and
its state affiliates, the Arc, the March of
Dimes, the Center for Science in the
Public Interest, the American Academy
of Pediatrics, and the American College
ofObstetricians and
along with other state and local organi-
zations, have also worked together and
with federal agencies to raise awareness
and visibility about FASDs as an impor-
tant public health problem.
Recognizing the need to identify
effective interventions to reduce AEPs,
the National Task Force on Fetal Alco-
hol Syndrome and Fetal Alcohol Effect,
congressionally mandated and convened
by the CDC, established a prevention
working group in 2004 to develop a
report on evidence-based strategies for
FASD prevention. Several task force
meetings focused on prevention, high-
lighting both population-based and clin-
ical intervention strategies to reduce
alcohol use and AEPs. A review of the
literature to identify effective commu-
nity-level FASD prevention interven-
tions and policies, evidence from exist-
ing systematic reviews on brief alcohol
interventions, and deliberations among
task force members and the report writ-
ing group helped lay the groundwork
for the information and recommenda-
tions (Fig. 2) put forth in the recent
Task Force Report, Reducing Alcohol-
Exposed Pregnancies: A Report of the
National Task Force on Fetal Alcohol
Syndrome and Fetal Alcohol Effect [Barry
et al., 2009]. The report categorized
interventionsusing
frameworkdeveloped
[Stratton et al., 1996]. This framework
Gynecologists,
the
by
prevention
theIOM
Fig. 2.
alcohol effect.
Recommendations from the National Task Force on fetal alcohol syndrome and fetal
196
Dev Disabil Res Rev?Prevention of FASDS?Floyd Et Al.

Page 5

consists of universal, selective, and indi-
cated strategies for prevention. Below is
a summary of the findings and recom-
mendations from this report.
Universal Prevention Strategies
Universal prevention interventions
attempt to promote the health of the
general public or a particular group,
regardless of risk. Although there has
been some important work in this area,
including media campaigns [Kaskutas
and Graves, 1994; Glik et al., 2001],
point-of-purchase signage [Prugh, 1986],
and alcoholic beverage labeling [Hankin
et al., 1993, 1996], the outcomes of these
efforts do not demonstrate reductions in
alcohol use or FASDs. The Task Force
recognized the important role these
kinds of strategies play in educating the
general public and raising awareness
about FASDs as part of a comprehensive
FASD prevention approach; however,
they recommended that more research is
needed to determine the effects of uni-
versal approaches on alcohol use patterns
and reproductive health outcomes of
women of childbearing age. The Task
Force also supported the implementation
of effective broad-based alcohol preven-
tion strategies, such as increasing alcohol
taxes and reducing access to alcohol, to
reduce alcohol-related harm in the gen-
eral population [Babor et al., 2003;
Guide to Community Preventive Ser-
vices, 2009].
Selective and Indicated Prevention
Strategies
Selective and
strategies are targeted and intensive fall-
ing along a continuum of care depend-
ing on the severity of the alcohol-
related problem. As the Task Force
reviewed the evidence, the science to
date pointed to brief alcohol interven-
tion as an effective approach to reduc-
ing alcohol use and AEPs. As previously
outlined, research indicates that alcohol
screening and brief interventions have
been found to be effective in multiple
settings, including primary care [Bien
et al., 1993; Wilk et al., 1997; Poikola-
nen, 1999; Ballesteros et al., 2004;
Whitlock et al., 2004], emergency room
[D’Onofrio and Degutis, 2002], com-
munity [O’Connor and Whaley, 2007],
and college settings
Cronce, 2002]. The Task Force recom-
mended promoting the use of evidence-
based strategies in these types of settings
for women of childbearing age at risk
for an AEP.
Two task force recommendations
focused specifically on the implementa-
indicated prevention
[Larimerand
tion and improvement of screening and
brief intervention efforts for women of
childbearing age. Effective interventions
exist for both pregnant [Chang et al.,
2005; O’Connor and Whaley, 2007]
and preconceptional women [Ingersoll
et al., 2005; Floyd et al., 2007]. Thus,
the Task Force recognized the impor-
tance of establishing formal alcohol
screening and brief intervention pro-
grams that are culturally and linguisti-
cally appropriate for women of child-
bearing age. Related to this, the Task
Force also recommended the expansion
of education and training of health and
social service professionals in the areas
of screeningand
woman at risk for an AEP.
interveningwith
The greatest
opportunities for healthy
pregnancy outcomes,
however, lie in prevention
strategies implemented
prior to conception.
Effective indicated approaches to
FASD prevention among the highest
risk women, including mothers who
have previously given birth to a child
with an FASD, could have a significant
effect on the problem of prenatal alco-
hol exposure.However,
women at highest risk for an AEP is
challenging and their treatment is com-
plex. Substance abuse treatment pro-
grams designed for women that include
support services such as child care, pre-
natal care, and mental health treatment
can affecttreatment
Improvements can include changes in
substance use, mental health symptoms,
perinatal or birth outcomes, employ-
ment, self-reported health status, and
HIV risk reduction [Ashley et al., 2003;
Brady and Ashley, 2005]. There has also
been success with intensive case man-
agement approaches for women at high-
est risk for having a child with a FASD
and women who themselves have a
FASD [Grant et
although more research in this area is
warranted. The Task Force recognized
this and also stressed the importance of
assuring access to substance abuse treat-
ment services and the availability of
appropriate substance abuse treatment
options for women of childbearing age.
Additional research is also needed to
reaching
outcomes.
al., 1996,2004],
explore interventions focused on the
potentialintergenerational
prenatal alcohol use on children of
women who have FASDs.
effects of
CONCLUSIONS
Studies cited in this review have
documented the efficacy of screening
and brief interventions for women of
childbearing age
drinking and AEPs, and in improving
fetal growth and decreasing fetal mortal-
ity among risky drinkers. Brief inter-
ventions should include clinical advice
and counseling regarding the risk posed
by prenatal alcohol exposure, discussion
of the woman’s readiness to change, and
assistance in helping the woman to de-
velop strategies and goals for reducing
hazardous use of alcohol during preg-
nancy. In addition to providing brief
interventions, follow-up should be con-
ducted for every high-risk woman, and
any woman who is unable to achieve
herdrinkinggoals
stepped up care including referral to
formal treatment programs or commu-
nity group interventions that provide
support to women seeking to reduce
hazardous alcohol use.
The greatest
healthy pregnancy outcomes, however,
lie in prevention strategies implemented
prior to conception. Importantly, health
care providers should understand that
early prenatal care is often too late for
many women and babies particularly
given that approximately half of the
pregnancies inthis
unplanned [Finer and Henshaw, 2006].
Evidence-based interventions
mendedfor implementation
pregnancy would be most beneficial if
implemented before conception. Brief
behavioral interventions to reduce alco-
hol use prior to conception and coun-
seling regarding effective contraceptive
options when not planning a pregnancy
have been proven to be effective meth-
ods for preventing an AEP.
The National Task Force on Fetal
Alcohol Syndrome and Fetal Alcohol
Effect has proposed many strategies for
the future. These strategies include test-
ing the effectiveness of universal preven-
tion methods and promoting the imple-
mentation of empirically validated meth-
ods on the general population, including
women of childbearing age. Regarding
selective and indicated prevention, it is rec-
ommended that funded studies include
analyses of individual differences, pro-
mote the use of culturally sensitive evi-
dence-based intervention methods in
multiple settings in which women are
inreducingrisky
shouldreceive
opportunitiesfor
country are
recom-
during
Dev Disabil Res Rev?Prevention of FASDS?Floyd Et Al.
197