Fetal Alcohol Syndrome Diagnosis, Epidemiology, Prevention, and Treatment (1996) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-32
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From page 17... ...
in 1968. Researchers in the United States soon also published a landmark report describing a constellation of birth defects in children born to alcoholic women (Jones and Smith, 1973~.
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lo FETAL ALCOHOL SYNDROME D _, at, FIGURE 1-1 Photographs of children with fetal alcohol syndrome. SOURCES: Figures 4C and 4D: Reprinted with permission from Jones et al.
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The U.S. Public Health Service has spent millions of dollars in research, public education, and service programs related to the 1 Discounting is a tool used in economic analyses to assign smaller weights to costs incurred in the distant future.
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For example, well-controlled research studies on rats, mice, and nonhuman primates has demonstrated that alcohol exposure causes FAS. However, while alcohol is the necessary teratogen, it alone may not be sufficient to produce FAS in humans or birth defects in animals.
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Availability of effective prevention strategies led to public policy debates and recommendations for action. The emergence of crack cocaine as a major medical and public health problem in the 1980s led to worries about a generation of crack babies who would cost the medical care system, primarily neonatal intensive care wards, huge amounts of money and who would overburden the education and social service systems with problems attributable to prenatal exposure to cocaine.
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As with NIAAA, CDC has ancillary programs related to maternal and child health, alcohol abuse, and epidemiologic surveillance that can support and inform FAS programs.
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This program was authorized by the Anti-Drug Abuse Act, passed by Congress in 1988. The demonstration grant program focuses on the development of innovative, community-based models of drug prevention, education, and treatment, targeting pregnant and postpartum women and their infants (National Center for Education in Maternal and Child Health, 1993~.
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24 o ¢ Ct A: 3 so o _` V: _' o o Ct o Ct Cal _.
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The Committee to Study Fetal Alcohol Syndrome was convened in mid1994. Committee expertise included pediatrics, developmental psychology and neurology, obstetrics, nosology, teratology, epidemiology, sociology, substance abuse prevention and treatment, and psychiatry.
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The clinical significance of small population effects on an individual has not been demonstrated empirically for low-level prenatal alcohol exposure. Finally, these population effects suggest at least a teratologic potential for low-level prenatal alcohol exposure and can provide directions for further research.
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The committee felt it more important to discuss gaps in the knowledge base about FAS and to indicate possible directions for new research endeavors that may ultimately lead to the prevention of what some call the only 100 percent preventable birth defect. The committee met four times for a total of 10 days, reviewed the published literature, and requested and analyzed information from researchers in the field and from relevant USPHS agencies regarding past and future research efforts in this area.
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The fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV; 1994) defines alcohol use disorders as alcohol dependence and alcohol abuse.
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In particular, operational definitions of terms used to describe the level and pattern of drinking in studies of pregnant women frequently have not corresponded to definitions for women in general, which in turn often do not correspond to definitions for men. For example, a prospective study of the effects of prenatal alcohol exposure defines heavy drinking as an average of one or more drinks per day (Day et al., 1989~; a seminal FAS prevention
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. The lack of consistency in terms regarding level of alcohol consumption across studies has led to confusion regarding the relationship between specific levels of drinking and risk for fetal alcohol syndrome and alcohol-related effects (see Abel and Kruger, 1995 for a review of this problem)
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From page 32... ...
Alcohol Health & Research World [Special Focus: Alcohol-Related Birth Defects]
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