The Provider’s Role in Preventing FASD

Fetal alcohol spectrum disorders are prevented when pregnant people do not drink alcohol. Health-care providers can have influence in preventing FASD, but they are not responsible for eliminating them. Key messages health-care providers can emphasize to all adolescents and adults who can become pregnant are:

• Do not drink alcohol if you are pregnant or intend to become pregnant.

• If you drink alcohol and are sexually active, use contraception.

Health-care providers can also enhance and augment their practices to mitigate the problem: “Integration of mental health services into clinical care and improving access to care might help address alcohol consumption and mental distress during pregnancy to prevent associated adverse outcomes” (Gosdin, Deputy, Kim, Dang, & Denny, 2022).

Two factors have been shown to increase the likelihood that pregnant adults may drink alcohol:

• Frequent mental distress: “Pregnant adults with frequent mental distress were 2.3 and 3.4 times as likely to report current and binge drinking, respectively, compared with those without frequent mental distress” (Ibid.). Having frequent mental distress is defined here as reporting “mental health not good” on 14 or more of the past 30 days because of depression, problems with emotions and stress.

• Lacking a usual health-care provider: “Pregnant adults without a usual health care provider were 1.7 times as likely to report current drinking as were those with a current provider” (Ibid.). Having a usual health-care provider is defined here as considering at least one person to be a personal doctor or health-care provider.

Anticipatory Guidance for Adolescents and Young Adults Who Can Become Pregnant

Adolescents and young adults who can become pregnant should receive information and guidance that discontinuing alcohol use during pregnancy prevents FASD. Individuals should be encouraged to avoid alcohol when they intend to become pregnant or are already pregnant. They should also be encouraged to use reliable contraception when they do not intend to become pregnant.

However, individuals may decide to use alcohol even with the intention to get pregnant and in the absence of contraception. Reasons can include social pressure, the desire to relax and de-stress, and incorrect information gleaned from friends, family and the media.

Preconception counseling, provided by a trusted health-care professional, can correct misunderstandings about the effects of alcohol on a pregnancy. Texas Health Steps requires age-appropriate individualized anticipatory guidance at every preventive medical checkup in the medical home. The guidance includes reproductive planning, information about contraception, and education about the risks of alcohol before and during pregnancy.

The CDC provides “5 Steps for Alcohol Screening and Counseling,” a guide for health-care providers to assess drinking among people who may become pregnant and to counsel and provide information about the harmful effects of alcohol use during pregnancy. The CDC also provides “CHOICES: Preventing Alcohol Exposed Pregnancies,” an evidence-based intervention program for individuals who are not pregnant but may become pregnant, to help them reduce or eliminate alcohol consumption. The CHOICES program calls for two to four counseling sessions and one contraceptive counseling session.