FASD Prevention = [Preconception Health] OR [Alcohol + Contraception]

BSTS Blog Series: “Protecting unborn babies from alcohol-related harm”

Written by Nathalie P

The author of this series of blog posts has been an intern with the Better Safe than Sorry Project this summer since graduating from high school in Montgomery County, Maryland. She is an incoming freshman at Syracuse University with plans to study journalism and possibly psychology. Over the summer, she has attended a number of the training sessions for the “BSTS Change Agents” and participated in a few BSTS talk show sessions as well as attending an all day workshop by the “Families Affected by FASD.”

My Perspectives about Dr. Rich

As a Better Safe than Sorry intern, I’ve had the chance to get to know Dr. Susan Rich personally and professionally. What I’ve learned about her is that a 21 year passion for Fetal Alcohol Spectrum Disorder (FASD) prevention and treatment has led to her recent decision to leave her successful private practice in child/adolescent and adult psychiatry to focus on diagnosing and treating kids with FASD. In 1993 after reading the Broken Cord, by Michael Dorris, Dr. Rich transformed her career – leaving pharmaceutical research to attend public health school then medical school and psychiatry training. Over the past 8 years, she has run a home-based clinical practice, providing hands-on work with general psychiatric patients as well as those affected by FASD – many of whom are adopted from Russia or former Eastern Bloc countries.

Though our community will miss Dr. Rich providing care to a wide range of psychiatric patients, it is great to see her taking on her passion for FASD full time. In many ways, she will inspire future generations of young adults like me to better understand and prevent this tragic condition.

Read Dr. Rich’s full statement in the CAPSGW newsletter Spring Summer 2014

FASD Prevention = [Preconception Health] OR [Alcohol + Contraception]

The Centers for Disease Control and Prevention (CDC) reports FASD is more prevalent than combined rates of autism, cerebral palsy, spina bifida, and Down’s Syndrome. The effects of prenatal alcohol exposure can cause seizure disorders, cerebral palsy, spina bifida, cleft lip/palate, as well as a various other “neurodevelopmental” disabilities. Due to these ailments, people with FASD are often unable to maintain gainful employment, are influenced by negative peer pressure, and socially alienated.  In other words, FASD is an epidemic, causing social problems, learning issues, intellectual disability, and other preventable disorders.  Many of these problems occur even before you know you are pregnant.

For this reason, the CDC has begun a national campaign on Preconception Health and Health Care in order to educate people on the importance of pregnancy planning and healthy lifestyles during “preconceptional” stages (http://www.cdc.gov/preconception/planning.html ).

The Better Safe than Sorry Project has a simple solution to FASD:

If you use alcohol – avoid pregnancy (CONTRACEPT), and if you are pregnant or possibly might be (i.e., not using contraception and sexually active) – avoid alcohol entirely.

See the following websites for more information:

Zero for Nine: http://www.healthvermont.gov/adap/049/

NOFAS: http://www.nofas.org/

Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices

The Centers for Disease Control and Prevention is pleased to announce the release of their new resource, Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices.

Background

At least 38 million adults drink too much but only about 5 million are alcoholics. Drinking too much includes high daily use, binge drinking, high weekly use, and any alcohol use by pregnant women or those under age 21. It causes about 88,000 deaths in the US each year, and in 2006 cost the economy about $224 billion.

Research shows that health professionals can use alcohol screening and brief intervention (SBI) to help people who are drinking too much to drink less. Alcohol SBI consists of a few questions asked in a doctor’s office and a short conversation. It can reduce excessive drinking by up to 25%. But a recent study showed that only 1 in 6 people reported ever talking with their doctor or other health professional about their alcohol use.

CDC hopes this guide will help practices implement alcohol SBI and thus reduce the wide range of health problems related to excessive drinking.

CDC Step by step guide image

The Guide

This guide provides detailed steps and resources to help staff in any primary care practice implement alcohol SBI. It includes information on risky alcohol use, its effects on health, and how it can be addressed through alcohol SBI.

The guide consists of 10 steps arranged in four major sections.

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On behalf of Coleen Boyle, PhD, MS hyg, Director, National Center on Birth Defects and Developmental Disabilities, CDC

American Bar Association Resolution on FASD: A Call to Action for the Criminal Justice System

A high percentage (60-80%) of individuals with FASD are arrested by age 18.  Due to their special needs, they require unique treatment and services to help improve their success rate in the community and prevent future trouble with the law.  For this reason, Washington State, Minnesota, and Alaska have established “FASD courts,” similar to local specialty courts for veterans, individuals with substance use disorders, and other  issues that require specialized referral and follow up.   The American Bar Association passed the following resolution in 2012 to recommend training on FASD for judges, attorneys, social workers, probation officers and others involved in the criminal justice system. http://www.americanbar.org/content/dam/aba/administrative/mental_physical_disability/Resolution_112B.authcheckdam.pdf.

RESOLVED, That the American Bar Association urges attorneys and judges, state, local, and specialty bar associations, and law school clinical programs to help identify and respond effectively to Fetal Alcohol Spectrum Disorders (FASD) in children and adults, through training to enhance awareness of FASD and its impact on individuals in the child welfare, juvenile justice, and adult criminal justice systems and the value of collaboration with medical, mental health, and disability experts.

FURTHER RESOLVED, That the American Bar Association urges the passage of laws, and adoption of policies at all levels of government, that acknowledge and treat the effects of prenatal alcohol exposure and better assist individuals with FASD.

BSTS Talk Show Episode 4: Ideas for Raising Awareness About the Dangers of Prenatal Alcohol Exposure”

Our fourth episode of “Better Safe Than Sorry – Alcohol and Unprotected Sex Don’t Mix!” sheds light on the recent Alaska initiative to prevent FASD by placing pregnancy test dispensers in the women’s bathrooms of bars. This campaign is designed to help women know whether they are pregnant to avoid prenatal exposure from that point on.  While it is a novel approach to FASD prevention, what happens when the woman finds out she’s already pregnant and she had already been drinking?

[For more information on Alaska’s recent campaign, read the article Alaska to offer free pregnancy tests in bars to curb fetal alcohol syndrome on foxnews.http://www.foxnews.com/health/2014/06/16/alaska-to-offer-free-pregnancy-tests-in-bars-to-curb-fetal-alcohol-syndrome/?intcmp=obnetwork]

In our show, we discuss the idea of passing out a condom to customers at bars along with their first alcoholic beverage purchased for the night. If a person is drinking alcohol, they will hopefully stop and think about preventing pregnancy when they see the condom and read the large print warning message placed strategically on the wrapper.

Our motto is: “If you’re pregnant or planning a pregnancy, avoid alcohol. If you’re using alcohol, avoid pregnancy.” Use contraceptives!

There are plenty of methods that we discussed such as condoms, the spermicide sponge, birth control pills, implanted contraception, etc.  Sadly, since just after the development of oral contraceptives in the 1970s, the rates of unplanned pregnancy have stayed relatively the same – at about 50% for all socioeconomic groups.

We believe that the FASD epidemic causing brain damage to children before women know they are pregnant is as much a public health crisis as the AIDS epidemic.  Just like with HIV/STD prevention, make conscious decisions when talking about alcohol and sex potentially leading to a pregnancy.

In this episode, we also discuss the man’s role in preventing (or causing) FASD. A man who drinks heavily causes “epigenetic” changes in his sperm. This means that the alcohol causes molecular changes in the DNA of the sperm.  There are also some studies showing low birth weight and prematurity as outcomes of alcoholic fathers even when the mother abstains. Since it takes 3 months for sperm to develop prior to being able to fertilize an egg, men have a responsibility along with women to avoid alcohol when planning pregnancy – both for the safety of their child and out of respect and support for their partner.  We like to point out that alcohol may boost libido, but heavy use can cause “faulty plumbing” and lowers a man’s fertility. It’s better to be safe than sorry!

– This week’s BSTS Ghost Writer:  Sydnie Butin from Salisbury University, Maryland.