Fetal Alcohol Spectrum Disorder (FASD) Prevention

Given the incredible impact of FAS/FASD on both individuals and society as a whole, the prevention of PAE and its effects is crucial. Despite ongoing health warnings, pregnant women continue to use alcohol, particularly in patterns that significantly increase the risk of prenatal injury. In 2004, the Center for Disease Control (CDC) reported that 13% of women in the US continue to use alcohol even after knowledge of their pregnancy, and 3% report binge drinking and/or drinking at levels that are known to produce adverse effects in the developing fetus (Bertrand et al., 2004).

Furthermore, approximately 55% of women of childbearing age in the US report drinking alcohol, and 12.4% report binge drinking (Rasmussen et al., 2009). As over 50% of pregnancies in the US are unplanned (Finer and Henshaw, 2006), these women are particularly high-risk. Unaware of their pregnancies, women will likely continue their alcohol use during the early stages of embryonic development. These data suggest that more effort must be made to develop effective, evidence-based prevention strategies to reduce the number of alcohol-exposed pregnancies. The first step of prevention must address the disparity between knowledge and behavior, understanding why some women – despite being aware of FAS – continue to engage in high - risk drinking behaviors.

Different levels of prevention fall along a continuum ranging from universal to selective to indicated intervention; as risk behaviors increase, prevention measures become more targeted and intensive (Barry et al., 2009).

Universal prevention attempts to promote the health of the general public, targeting all members of a population or particular group, regardless of risk. Examples of universal approaches include encouraging the abstinence from alcohol during pregnancy, raising public awareness of FASD, and creating alcohol policy and educational programs that minimize the risks of alcohol consumption during pregnancy. Methods to disseminate information include media campaigns, educational materials, and alcoholic beverage labeling. Research into the impact of the U.S. Federal Beverage Labeling Act in several different populations, including a sample of inner-city African-American pregnant women (Hankin et al., 1996 ; Hankin et al., 1993 ; Hankin, Sloan, and Sokol, 1998), has revealed an increased awareness of alcohol beverage warning labels since the law's inception in 1989.

However, despite this increasing awareness, drinking rates have not necessarily followed suit. Within this sample, Hankin et al. (1993) observed a slight decrease in alcohol consumption, although the decline was apparent only among lighter drinkers; the warning labels did not have any significant effect on high-risk drinkers (Hankin et al., 1993). Furthermore, whilst there was a significant decrease in drinking behaviors post-label for women who had not previously given birth, no change was evident for those women who had already given birth to a child (Hankin et al., 1996). Ultimately, the observed decrease in drinking rates appears to be only short-lasting, and the effectiveness of the labels may lose their impact as women become habituated to them (Hankin, Sloan, and Sokol, 1998).