Alcohol misuse is a serious, worldwide public health issue that can
result in a wide range of physical, psychological, and social
problems affecting the individual, the family, and the community.
Drinking alcohol during pregnancy increases a woman's risk of
having a baby with birth defects and developmental disabilities.
Alcohol consumption during pregnancy is recognized as the cause of
fetal alcohol spectrum disorders (FASDs). FASD is a term used to
define the spectrum of physical, mental, behavioral, and/ or
learning disabilities that can result from prenatal alcohol
exposure. Fetal alcohol syndrome (FAS) is one of the most severe
outcomes of drinking alcohol during pregnancy and is characterized
by facial malformations, growth deficits, and neurodevelopmental
problems. Efforts have been underway for several decades to develop
strategies to prevent alcohol-exposed pregnancies (AEPs) and reduce
the risk of FASDs. In 2002, the National Task Force on Fetal
Alcohol Syndrome and Fetal Alcohol Effect (NTFFASFAE), a federal
advisory committee, released its first recommendations. Among these
recommendations were several items focused on prevention, including
recommending the reissuance of the U.S. Surgeon General's advisory
on drinking during pregnancy 4] and the development of a report to
review the evidence for effective prevention and treatment
strategies for women at risk for or engaging in prenatal alcohol
use. In 2004, after deliberations on and publication of Fetal
Alcohol Syndrome: Guidelines for Referral and Diagnosis 5], the
NTFFASFAE decided to focus its attention on FASD prevention. The
Task Force Prevention Working Group (PWG) was established to guide
the development of a report describing evidence-based prevention
strategies to reduce AEPs and outline recommendations to further
promote the implementation of such strategies. To accomplish this,
the staff of the Centers for Disease Control and Prevention's (CDC)
National Center on Birth Defects and Developmental Disabilities
engaged the Community Guide Branch at CDC's National Center for
Health Marketing and Research Triangle Institute International
(RTI) to assist the PWG in this work. RTI conducted a systematic
search of the literature to identify community-level FASD
interventions and policies that can prevent alcohol-exposed
pregnancies and reduce the prevalence of physical, mental,
behavioral, and learning disabilities due to prenatal alcohol
exposure. The review focused on community-level interventions and
policies because other systematic reviews either have been
completed or are currently under way to explore both clinical
interventions and population-based strategies addressing alcohol
misuse. For example, in 2004, the U.S. Preventive Services Task
Force engaged in a systematic review that resulted in clinical
recommendations on screening and behavioral counseling
interventions in primary care settings to reduce alcohol misuse 6].
Also, the Task Force on Community Preventive Services, coordinated
by CDC, is actively engaged in systematic reviews to assess the
effectiveness of population-based alcohol prevention strategies
that affect people in the general population, including women of
childbearing age. This report reviews the current evidence on
prevention strategies to reduce AEPs, provides recommendations on
promoting and improving these strategies, and offers future
research directions in the field of FASD prevention. This document
also serves as a guide for those in the research and practice
fields interested in selecting and implementing effective,
scientifically tested interventions for women at risk for an AEP.
In addition, the report also highlights the importance of continued
collaboration across federal, state, and local agencies; academia;
medical and social service delivery systems; and families to
integrate scientific findings into public health prevention
strategies.
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