FAS Prevention Strategies: Passive and Active Measures.

When a pregnant woman drinks heavily,(10 she increases the risks to her fetus for physical abnormalities. mental retardation, and behavior and learning problems, collectively called fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE). Severe effects of alcohol consumption can occur during the first trimester of pregnancy, before many women even realize that they are pregnant (see the article by Jacobson and Jacobson, pp. 30-36). Debate continues as to whether the risk to the fetus is a function of the amount of alcohol the woman consumes throughout pregnancy or if it is a function of the woman's blood alcohol level at a particular phase in fetal development (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1991). Some women may consume large amounts of alcohol during pregnancy without causing obvious harm to the fetus, whereas others may drink moderate amounts of alcohol and see severe effects. Given these uncertainties, the Surgeon General has advised all women to abstain from alcohol consumption during pregnancy (Public Health Service 1981). Even with this warning, however, some pregnant women still drink (an estimated 20 percent of pregnant women drank some amount of alcohol during pregnancy in 1988 [NIAAA 1993]); either they are unaware of the warning or they do not heed the advice. Prevention efforts attempt to reduce the incidence of FAS and FAE by making women in their childbearing years aware of the hazards of drinking during pregnancy. Because abstaining from alcohol prior to and throughout pregnancy is the only way to guarantee the birth of a child free of FAS/FAE, prevention programs try to target women before they become pregnant. However, the programs also should target women who are drinking during pregnancy, to increase their likelihood of having healthy babies in the current as well as subsequent pregnancies. This article examines FAS and FAE prevention efforts in the United States. One such measure, alcoholic beverage warning labels, reaches all drinkers but is a passive technique that relies on the drinker to read, understand, remember, and comply with the warning. Also at issue is whether the woman sees the label (some are hard to find) and whether someone else pours the drink from the bottle for the woman (e.g., a waiter in a bar). Other measures, such as intensive prenatal clinic programs, training programs for health care providers and teachers, and community-based programs, reach a smaller audience but are more active in educating women and the people who give women advice about prenatal health. Because not every prevention program can be described in this article, several programs that illustrate the range of approaches currently available are discussed. THE ALCOHOLIC BEVERAGE WARNING LABEL On November 18, 1989, Public Law 100-690 was implemented, requiring warning labels on all alcoholic beverage containers sold or distributed in the United States. The law was instituted as a prevention strategy aimed at warning the public about the risks related to consuming alcohol. One of the warnings on the label addresses pregnant women. It states: "(1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects." Now that the warning label has been in place for several years, it is appropriate to evaluate its effectiveness. Specifically, has drinking during pregnancy decreased with the advent of warning labels? As there has been only one other study of the effect of the warning label on the behavior of pregnant women (an unpublished paper by Kaskutas and Graves), this discussion will focus on our study--the only study with pre- and post-test data on a large number of pregnant women. DETROIT STUDY OF PREGNANT WOMEN Our ongoing study in Detroit examines the impact of alcoholic beverage warning labels on African-American women who are pregnant. The study focuses on two questions: Has awareness of the warning label increased over time, and has drinking by pregnant women decreased since the alcoholic beverage warning label law took effect? …