Fetal Alcohol Exposure
Did you know that the most common preventable cause of intellectual and developmental delay and disabilities in the U.S. is prenatal alcohol exposure (PAE)? Alcohol in the mother’s blood immediately passes to the baby through the umbilical cord and can cause miscarriage, stillbirth, and a variety of lifelong physical, behavioral, and cognitive disabilities (Denny, Acero, Naimi, & Kim, 2019, p. 366). The negative consequences of drinking during pregnancy are well-known. Despite this as well as many strategies aimed at reducing PAE, many women from all communities continue to drink alcohol during pregnancy. Therefore, health promotion and prevention strategies are urgently needed to reduce PAE.
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Drinking alcohol during pregnancy may lead to fetal alcohol spectrum disorders (FASD). FASD is an umbrella term for a variety of birth defects caused by PAE. These birth defects include brain abnormalities, central nervous system dysfunctions, and growth deficiencies of body systems and developing organs. FASD affects all communities and it’s an underestimated problem worldwide (Roozen et al., 2016, p. 229). From 2015-2017, about one in nine pregnant women reported consuming alcohol in the past 30 days, and among those, approximately one third reported binge drinking (Denny et al., 2019, p. 366). A set of Healthy People 2020 objectives, called Leading Health Indicators (LHIs), communicates high-priority health issues and actions that may be taken in order to address them. Among these high-priority health issues is PAE, which falls under the LHI topic substance abuse.
Article One Summary
The objective of the article, “Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention,” is to propose an evidence-based, six-step approach known as Intervention Mapping (IM) to develop effective programs for prevention of FASD (Roozen et al., 2016, p. 229). Many approaches have been taken to prevent FASD. Some approaches target the general public, including labels on drink containers and flyers or media campaigns. Other approaches target professionals; for example, accredited training sessions for physicians and midwives. These approaches may be ineffective or counterproductive since the number of children affected by PAE continues to be high. Due to this reason, the evidence-based approach IM is recommended in prevention of FASD. IM is based on proven principles to change behaviors. Completion of all steps creates a blueprint for designing, implementing, and evaluating an intervention model for FASD (Roozen et al., 2016, p. 230).
Article Two Summary
The purpose of the article, “Alcohol Consumption During Pregnancy: Intervention Guidance for the Prevention of Fetal Alcohol Spectrum Disorders,” is to provide clinicians with many methods to prevent FASD. Suspending alcohol use during pre-conception time and pregnancy can prevent 100% of fetal alcohol effects. Due to this reason, clinicians’ recommendations and early identification of at-risk women may be crucial. (Fiorentino, et al., 2017, p. 71). One method to prevent FASD is to screen all childbearing-aged women for alcohol use. All the women, drinking or not, should be informed about the negative consequences of PAE and, in case, be suggested to stop consumption if planning a pregnancy. Providing information regarding the consequences of PAE is strongly recommended by the CDC as a simple suggestion by a professional can persuade mild drinkers to give up consumption. Alcohol anamnesis should also be performed by clinicians’ in order to identify heavy drinkers. Also, questions regarding the occurring of alcohol abuse in partner or family can also be useful so the clinician can determine if the women lives at an at-risk environment. By performing these actions, professionals’ dealing with women health can maximize the possibility of a healthy pregnancy (Fiorentino, et al., 2017, p. 77).
Article Three Summary
The goal of the article “A Systematic Review of Prevention Interventions to Reduce Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder in Indigenous Communities,” is to review the evidence for the effectiveness of FASD prevention interventions in Indigenous populations internationally, as well as in specific populations in New Zealand and North America, and offer recommendations for future work (Symons, Pedruzzi, Bruce, & Milne, 2018, p. 1). This review rates the quality of 50 studies that have been conducted which evaluate the prevention interventions that exist. Only one of these studies was rated ‘strong’ while 12 were rated as ‘moderate,’ and 37 as ‘weak’ (Symons, Pedruzzi, Bruce, & Milne, 2018, p. 2). None of the studies identified in this review adequately evaluated FASD prevention efforts for many reasons. For one, no study examined outcomes beyond a 6- or 12-month follow-up period. This is a very short time frame as the patterns of alcohol use may change over time and alcohol dependence may be a chronic, recurring problem. Interventions of greater intensity and duration are necessary. The goal of studies in this review was to reduce FASD prevalence; however, only two of these studies reported the number of children born with FASD. Also, the absence of a control group made the significance of such figures very hard to figure out. Further studies aimed at reducing FASD rates should evaluate the impact of prevention efforts on FASD prevalence (Symons, Pedruzzi, Bruce, & Milne, 2018, p. 14). These are only a few reasons why these studies did not adequately evaluate prevention interventions of PAE.
Proven principles of health promotion could be applied to reduce PAE (Roozen et al., 2016, p. 229). Up to now, there has been little use of evidence-based strategies to reduce PAE. Evidence-based practice is very important as it entails an integration of scientific evidence and clinical expertise to form the basis for FASD prevention and management. One such approach is the six-step procedure described previously known as IM (Roozen et al., 2016, p. 230). Professionals’ dealing with women health may also be trained to perform accurate alcohol anamnesis, screening and brief counselling interventions (Fiorentino, et al., 2017, p. 78). Undergoing screening for alcohol consumption can itself lead to a reduction in PAE. Motivational sessions and brief interventions have proved to be effective in in reducing PAE as these approaches will educate the target population about its negative consequences. The acronym FRAMES may be used to resume key elements in effective interventions: feedback on personal risks; advise for a change; a menu of strategies to cut on drinking; personal responsibility, empathetic communication style; focus on self-efficacy (Fiorentino, et al., 2017, p. 77). Future work intended to evaluate prevention interventions of PAE should aim to include a control group/community and seek their guidance regarding ways to maximize follow-up, randomize the assignment of the intervention when possible, include objective outcome measures, and report results accurately and clearly (Symons, Pedruzzi, Bruce, & Milne, 2018, p. 15).
Exposing an unborn baby to alcohol has many negative consequences and may lead to FASD. Although many prevention interventions aimed at reducing PAE exist, recent statistics show that the prevalence of alcohol consumption during pregnancy is still very high. Therefore, these prevention interventions may be ineffective and need to be further evaluated. Prevention interventions should include evidence-based strategies (Roozen et al., 2016, p. 230). Future work meant to evaluate prevention interventions should include community members and seek their guidance (Symons, Pedruzzi, Bruce, & Milne, 2018, p. 15). Also, women’s health professionals should perform alcohol anamnesis, screening and brief counselling interventions (Fiorentino, et al., 2017, p. 78). These principles of health promotion may be effective in reducing PAE.
- Denny, C. H., Acero, C. S., Naimi, T. S., & Kim, S. Y. (2019). Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18–44 Years — United States, 2015–2017. Morbidity and Mortality Weekly Report, 68(16), 365–368. doi: 10.15585/mmwr.mm6816a1
- Fiorentino, D., Carito, V., Solombrino, S., Coriale, G., Scamporrino, M. C. M., Ciolli, P., … Ceccanti, M. (2017). Alcohol Consumption During Pregnancy: Intervention Guidance for the Prevention of Fetal Alcohol Spectrum Disorders. Scripta Scientifica Medica, 49(4), 71–83. doi: 10.14748/ssm.v49i4.4107
- Roozen, S., Black, D., Peters, G.-J. Y., Kok, G., Townend, D., Nijhuis, J. G., … Curfs, L. M. G. (2016). Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention. Current Developmental Disorders Reports, 3(4), 229–234. doi: 10.1007/s40474-016-0101-y
- Symons, M., Pedruzzi, R. A., Bruce, K., & Milne, E. (2018). A Systematic Review of Prevention Interventions to Reduce Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder in Indigenous Communities. BMC Public Health, 18(1), 1–18. doi: 10.1186/s12889-018-6139-5
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