Page 15 - Delaware Medical Journal - February 2017
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Prenatal exposure to alcohol can cause
a broad range of adverse developmental effects including birth defects and intellectual neurodevelopmental disabilities, called fetal alcohol spectrum disorders (FASD).1 FASD can be manifested in various ways including congenital neurologic, cognitive, behavioral, and (at the extreme) morphological aspects among neonates that are directly traceable to maternal alcohol use during pregnancy. FASD is one of the leading causes of physical, intellectual, and behavioral disorders
and birth defects in the US.2 Although establishing exact rates of FASD has been challenging due to the broad range and severity of symptoms encompassed   incidence of FASD is estimated to be at least 9 per 1,000 births in the US.3
Despite the prevalence of FASD and a broad effort to educate pregnant women about the risks of alcohol use during pregnancy, more than 9 percent of pregnant women in the U.S. reported current
alcohol use, more than 2 percent reported binge drinking, and 0.4 percent reported heavy drinking.4 Large disparities exist in prenatal alcohol use with 24 percent of low-income pregnant women reporting prenatal alcohol use.5
FASD are 100 percent preventable if pregnant mothers do not consume alcohol. In this regard, there are no agreed upon safe levels of prenatal alcohol use, and
the safest medical advice at present is
complete abstinence throughout the course of pregnancy.1,6 and effectiveness of pharmacologic interventions to reduce alcohol use during pregnancy have not been established. Evidence for various psychosocial and educational interventions, mostly in form of brief interventions, is mixed likely because of a need for comprehensive
care to address a combination of needs in women’s lives.7
Case management based interventions have been tested to help pregnant
mothers at risk for having children with FASD, which provided individualized psychosocial care including home visitations, motivational interviewing, and community reinforcement approach. Such individualized and intense psychosocial  decrease in needs for addictions.8 These interventions are comprehensive to address the pregnant mothers’ needs; however,  frequent biochemical monitoring of alcohol use to examine the intervention effect directly on alcohol use during pregnancy.
Minnesota has been a leader in FASD awareness and prevention since 1997. Susan Carlson, wife of then-governor Arnie Carlson, convened the Governor’s Task Force on Fetal Alcohol Syndrome to explore the impact of FASD in Minnesota. Her experience in the juvenile court system brought her face-to-face with the reality
of prenatal exposure to alcohol and how it was impacting families, communities, and the entire state. This task force brought recommendations to the Governor and legislature, resulting in $7 million in funding for FAS education and prevention. Her leadership led to the formation of  Organization on Fetal Alcohol Syndrome
(MOFAS) in 1998. MOFAS continues
to lead the nation and world with their statewide initiatives, including screening for FASD, education, and prevention.

practice a civil commitment law to mandate reporting on prenatal alcohol use to the Department of Health and Human Services. Crow Wing County Social Services (CWCSS) was established under the umbrella of Minnesota Department
of Health and Human Services (DHS). CWCSS administers more than 70 federal  and programs totaling more than $130 million annually. CWCSS is dedicated to providing excellent customer service and  its mission of promoting and protecting the  all Crow Wing County residents. CWCSS has also provides case management services to pregnant women at risk for drinking to make sure women maintain
a healthy lifestyle and deliver healthy babies. CWCSS helps to refer at-risk pregnant women, monitor CWCSS clients in the program, and implement a follow-  Pregnant women who report prenatal alcohol use are assigned a case manager by CWCSS to enter a substance and alcohol use treatment program and prevent relapse to drinking for the remaining pregnancy period. However, the case management does not biochemically monitor prenatal alcohol use and there is no system in place to reinforce continuous abstinence from alcohol use.

organization, Healthy Brains for Children (HBC), was formed in Minnesota with
a mission to prevent prenatal alcohol exposure by increasing the awareness of
Del Med J | February 2017 | Vol. 89 |
No. 2

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