1. Maternal Alcohol Use – Fetal Alcohol Spectrum Disorders Module Overview Torin Finver, MD

2. Summary of Module Contents Slide Deck: approx 40 slides Notes for lecturer: available Handout materials: article reprints; compendium of resources Annotated bibliography: yes Test questions: 3 pretest; 3 posttest Other: webinar – being developed

3. Maternal Drinking – Prevention of FASD Are FASDs are preventable? Should we be screening at risk women of child bearing age? 2 Key points: Maternal at risk drinking is common. FASD may lead to significant impairment 2 Main Recommendations: Maternal SBIRT Screen/refer suspected FASDs

4. Key Point 1: There is high risk drinking in at risk women Among pregnant women aged 15 to 44, an estimated: 10.8 percent reported current alcohol use. 3.7 percent reported binge drinking. 1.0 percent reported heavy drinking. These rates were significantly lower than the rates for non- pregnant women in the same age group (54.7, 24.6, and 5.4 percent, respectively). ( SAMHSA’s 2010 NSDUH) Binge drinking during the first trimester of pregnancy was reported by 10.1 percent of pregnant women aged 15 to 44. (Office of Applied Studies [OAS], 2011) 49 percent of all pregnancies in the United States are unintended (Finer & Henshaw, 2006). (Binge drinking for women has been defined by NIAAA as four or more drinks on one occasion [2004]).

5. Key Point 2: FASDs can cause significant impairment Each year as many as 40,000 babies are born with FASD. Up to 2 per 1000 live births (6000/year) with FAS (on par with Down’s syndrome). Secondary conditions are common – cognitive, social, legal, substance use disorders. Lifetime cost of care for an individual with FAS is up to $2.44 million. (cost 30x less to prevent) There are guidelines for the identification of FASD and diagnosis of FAS. No universal assessment currently in use.

6. Recommendation #1 – Perform SBIRT for women of child bearing age using MI techniques. Brief interventions are associated with sustained reduction in alcohol consumption by women of childbearing age. SORT level = A References Astley, S. J. (2004a). Fetal alcohol syndrome prevention in Washington State: Evidence of success. Paediatr Perinat Epidemiol, 18(5), 344-351. Fleming, M. F., Barry, K. L., Manwell, L. B., Johnson, K., & London, R. (1997). Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. The Journal of the American Medical Association, 277(13), 1039-1045. Manwell, L. B., Fleming, M. F., Mundt, M. P., Stauffacher, E. A., & Barry, K. L. (2002). Treatment of problem alcohol use in women of childbearing age: Results of a brief intervention trial. Alcoholism: Clinical and Experimental Research, 24, 1517–1524. Project CHOICES Intervention Research Group. (2003). Reducing the risk of alcohol-exposed pregnancies: A study of motivational intervention in community settings. Pediatrics, 111, 1131-1135. Chang, G., McNamara, T. K., Orav, E. J., Koby, D., Lavigne, A., Ludman, B.,…Wilkins-Haug, L. (2005). Brief intervention for prenatal alcohol use: A randomized trial. Obstetrics & Gynecology, 105(5-1), 991- 998. Grant, T. M., Ernst, C. C., Streissguth, A., & Stark, K. (2005). Preventing alcohol and drug exposed births in Washington state: Intervention findings from three Parent-Child Assistance Program sites. The American Journal of Drug and Alcohol Abuse, 31, 471-490 O’Connor, M. J., & Whaley, S. E. (2007). Brief intervention for alcohol use by pregnant women. American Journal of Public Health, 97(2), 252-258.

7. Recommendation #2 – Screen for FASDs – in all phases of life. Early intervention can improve a child’s outcome and function in later life. SORT level = B References Streissguth, A.P. et al (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics, 5(4), 228-238 Interagency Coordinating Committee on Fetal Alcohol Spectrum Disorders.(2011).Consensus Statement.Recognizing Alcohol-Related Neurodevelopmental Disorder (ARND) in Primary Health Care of Children, Rockville, Maryland National Institute on Alcohol Abuse and Alcoholism. Streissguth, A.P., Barr, J.K., and Bookstein, F.L.(1996b).Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE).Seattle: University of Washington, Fetal Alcohol and Drug Unit. Bertrand, J. (2009). Interventions for children with Fetal Alcohol Spectrum Disorders (FASDs): Overview of findings for five innovative research projects. Research in Developmental Disabilities 30(5), 986-1006.

8. Dissemination strategy Module on FASD designed for formal didactics Incorporate FASD education into adolescent SBIRT training 1-hour classroom lecture specific to FASD Present to Students/Residents, local providers Present to at risk population Webinar Educate UB fellows on local FASD resources – include as part of community medicine rotation