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University of Colorado Denver

Colorado Area Health Education Center, University of Colorado Denver
 

Alcohol Use in Pregnancy

Universal, Indicated and Selected Prevention


Universal, Indicated and Selected Prevention

Fetal Alcohol Spectrum Disorders are 100% preventable and are the leading known cause of preventable mental retardation in the US.

Colorado Fetal Spectrum Disorder(s) Prevention Outreach Project (COFAS-POP) addresses all three Institute of Medicine (IOM) prevention interventions – universal, selective and indicated -- at the service provider level.

Universal prevention and intervention is to include all Coloradans and help the whole community understand that drinking alcohol can have hazardous consequences, particularly during pregnancy.  The universal prevention message for FASD is to ensure all women of childbearing age understand that risk drinking is more than seven drinks in a week and more than three drinks at a sitting.  All women who are planning a pregnancy should avoid alcohol while attempting to get pregnant, and they should abstain from all forms of alcohol during the pregnancy.

Strategies used in universal prevention include public education through media, flyers, brochures and newspaper articles.  Signage is a method used in universal prevention, download one of these signage messages and place in your restaurant, bar, casino or liquor store.
Poster 1
Poster 2
Poster 3
Poster 4

The family practitioner and obstetrician gynecologist can provide these brief messages in their office.  Please see the video Between Girls and the other educational materials we have created for the clinic office.  It is important to share brief messages about responsible alcohol use and provide general information about the risks of alcohol to the fetus in every clinic that serves women and families.

Selective prevention interventions are to include Coloradans who are of childbearing age.  The goal is to target women who are at greater risk for an alcohol-exposed pregnancy because they are a sub-group of the population known to be at higher risk than the general population.  These interventions strategies will involve different levels of targeting and intensity compared to universal preventive interventions.

Physicians, other health care providers, substance abuse counselors and other human services workers should be prepared to talk to all women of childbearing age about their alcohol use, screen women for indication of alcohol use/abuse, conduct further assessments as necessary, and be prepared to offer brief interventions.  If appropriate, referral for formal treatment of alcohol dependence should be made.  In general, the strength of the intervention should be proportional to the level of risk.  Studies show that some pregnant women who drink moderately or heavily are amenable to interventions offered in conjunction with prenatal care (for more information, please visit the Colorado Clinical Guidelines Collaborative.  COFAS offers Personal DECISIONS, a brief self-guided intervention for women using/abusing alcohol who want to change their current drinking patterns.  For more information contact COFAS Personal DECISIONS at 1-888-724-FASD (3273).

Indicated prevention interventions are to include the Coloradans who are at highest-risk for an Alcohol Exposed Pregnancy (AEP).  A small proportion of Colorado women will give birth to most of the state’s FAS children and a somewhat larger portion give will give birth to children with the spectrum of FASD.  The target group for indicated prevention is women who engage in heavy drinking while pregnant or at risk for being pregnant, particularly the pregnant or pre-conceptional woman who drinks alcohol and who has already given birth to a child with an FASD (please see CCGC Preconception and Inter-conception guidelines.  As with selective interventions, indicated interventions are also aimed at the partner, significant friends or family members of a woman who fits the profile just described.  Indicated prevention of FASD includes treatment for alcohol abuse or dependence for a pregnant woman or for a woman highly likely to become pregnant.

Because, in many cases, women do not seek obstetric services until delivery, any health care provider who comes in contact with women who abuse alcohol should consider brief intervention therapies and referral to more formal alcohol abuse treatment.  Women of reproductive age who abuse alcohol should also be offered referral and access to birth control information and services.
For the comparatively small group of women who continue to drink heavily during pregnancy, formal treatment of alcohol dependence may be needed.  Treatment programs described are typically broad, multimodal interventions that are intended to address the complex problems exhibited by this population.  The Colorado Division of Behavioral Health’s Special Connection Treatment program is designed to meet the needs of this group.  For more information, please contact Karen Mooney, Women’s Treatment Coordinator at karen.mooney@state.co.us   or 303-866-7492.

The literature in recent years suggests that one effective way to help alcohol-abusing women who have had an FASD child might be through intensive case management.  Case management involves all members of the extended family and should include enlisting the positive action of the male partner.  Children benefit from such efforts, too.  Often children of FASD-producing mothers are in foster placement because of neglect or abuse.  A major motivator for maintenance and after-care is to improve the social and health status of the mother so that she can regain or retain custody of her children.*

*Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. 1996. Edited by K. Stratton, C. Howe, and F. Battaglia. Board on Biobehavioral Sciences and Mental Disorders.Washington, DC: National Academy Press.

Between Girls Videos

Chapter One - Introduction

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