Alcohol consumption during pregnancy can have numerous adverse health consequences for the developing fetus, including fetal alcohol syndrome (FAS) and alcohol-related effects, and therefore is a significant public health problem. A variety of programs have been developed to prevent drinking during pregnancy and the resulting health problems. Some of these efforts, such as public service announcements and beverage warning labels, are universal and strive to increase the public's knowledge about FAS. Selective prevention approaches target women of reproductive age who drink alcohol. Such approaches may involve screening all pregnant women for alcohol consumption and counseling those women who do drink. Indicated prevention approaches target high-risk women (e.g., women who have previously abused alcohol or have had a child with FAS or other alcohol-related effects) and typically offer repeated counseling over several years. Both selective and indicated prevention efforts can reduce maternal alcohol consumption and improve the outcome of the offspring. KEY woRDs: Fetal alcohol syndrome; prevention research; indicated prevention; selective prevention; universal prevention; targeted prevention; mass media prevention approach; public service announcement; warning label; prevention effort directed at people at risk; prevention outcome
Drinking during pregnancy, which can result in serious birth defects, remains a significant public health problem despite a variety of prevention efforts that have been implemented in recent years. According to national data collected in 1999 by the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of the noninstitutionalized U.S. population, 12.8 percent of pregnant women consumed at least one alcoholic drink during the past month, a decrease from 16.3 percent reported in 1995 (Centers for Disease Control and Prevention [CDC] 2002a). The survey also assessed the prevalence of binge and frequent drinking (i.e., five or more drinks on one occasion or at least seven drinks per week) by pregnant women. Comparing data from 1995 and 1999, the investigators found that binge drinking and frequent drinking remained "substantially unchanged." A total of 3.3 percent of pregnant women interviewed in 1999 reported frequent drinking and 2.7 percent reported binge drinking (CDC 2002a). These findings are subject to at least three limitations, however. First, BRFSS data are self-reported and might be subject to reporting biases, especially among pregnant women who are aware that alcohol use is not advised. Second, homeless women, women in homes without telephones, and women who were institutionalized were not surveyed. Both of these limitations could have an impact on prevalence rates. Third, because the proportion of pregnant women who were drinkers was limited in this sample, these estimated prevalence rates are subject to statistical limitations. Thus, the prevalence rates of drinking, frequent drinking, and binge drinking among pregnant women may actually be even higher than indicated in the BRFSS study.
The potential consequences of drinking during pregnancy-the most serious of which are fetal alcohol syndrome (FAS) and other manifestations collectively called alcohol-related effects-are preventable birth defects. Nevertheless, only limited evaluation research exists on FAS prevention programs (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 2000a). After briefly describing the harmful effects of alcohol on the fetus, this article reviews the spectrum of FAS prevention efforts and summarizes recent research on FAS prevention activities.
CONSEQUENCES OF DRINKING DURING PREGNANCY
Alcohol ingested during pregnancy can have a range of deleterious consequences for the developing fetus. The most severe condition caused by prenatal alcohol exposure is FAS, which is characterized by a particular pattern of facial anomalies, growth retardation, and developmental abnormalities in the central nervous system that often include, but are not limited to, mental retardation. …