Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
6.2 International approaches to the prevention of FAS and FASD
There are few published studies evaluating strategies for prevention of FASD and most of them are from the USA. One example of a study to improve knowledge amongst African- American women about alcohol use and pregnancy was conducted in Missouri in 2002-2004 (Mengel et al. 2005). The authors used a relatively high intensity media campaign in one city, with before and after surveys of women in the target group in that city and a control city with no intervention. They found that 70 percent of women recalled the campaign, although there
was a small but statistically significant decline in knowledge about alcohol and pregnancy over time. Women needed to hear the messages 10 or more times for them to be retained. In a randomised controlled trial aiming to prevent alcohol-exposed pregnancies, women at high risk (18-44 years old, risky drinkers using no contraception) were randomly allocated to receive information only or information plus five motivational intervention sessions (Floyd et al. 2007). Nine months after the intervention, there was a reduction in risky drinking (more than five drinks per day or more than eight drinks per week) and an increase in use of effective contraception in the intervention group. Either or both of these positive outcomes were almost twice as likely to occur in the intervention compared with the control group (odds ratio 1.90; 95 percent confidence interval 1.36 to 2.66). Data from Washington State, in the USA, showed a reduction in alcohol use in pregnancy (from 14.6 percent to 3.9 percent) over an extended period (1993-1998), when there were a series of public health education and training programs and programs specifically involving women at high risk in place (Astley 2004). There was also a reduction in the number of cases of FAS identified in a foster care screening program conducted in Washington State over the time period, although this aspect of the evaluation was based on only five cases over the entire study period.
A recent study used FASD prevalence as an outcome measure and reported reductions in FASD prevalence following interventions highlighting the harms of drinking while pregnant using local media and health promotion. The study was conducted in the Northern Cape, South Africa where population knowledge of the harms of drinking while pregnant are low and FASD prevalence is high. The study assessed whether FASD prevalence would be reduced by universal interventions to raise community and health worker awareness of the harms of maternal drinking. Using a before and after design the prevalence of FASD was determined in birth cohorts of babies born in a one year period pre- and post- the universal prevention interventions. The babies were assessed at 9 and 18 months. The intervention increased knowledge levels and the prevalence of FASD decreased from 8.9% preintervention to 5.7% post-intervention. There was no change in FAS prevalence (Chersich et al. 2011). This study suggests universal prevention is beneficial in areas where knowledge of the harms of maternal drinking is low. Universal prevention needs to be supported by other intervention and treatment strategies to lower the prevalence FAS (Chersich et al. 2011).
A review of evidence for the prevention of FASD highlighted effective interventions to decrease use of alcohol and reduce alcohol-exposed pregnancies and concluded that using evidence-based alcohol screening tools and brief counselling interventions were effective population-based strategies (Floyd et al. 2009).