Comprehensive local program for the prevention of fetal alcohol syndrome.

Researchers describe and provide an assessment of a hospital-based, comprehensive approach to the prevention of fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) in Native American women. The program views FAS in a systems perspective, using community, family, and individually based techniques. The program combined clinical assessment, community outreach, and epidemiologic knowledge to attack alcohol-related birth defects. It included training of clinicians and members of the community, baseline screening of children suspected of being affected, and alcohol consumption screening of pregnant women in prenatal clinics. The program piloted at Tuba City, Arizona, trained 147 Navajo and Hopi tribal agencies and schools for FAS recognition and awareness. An FAS diagnostic clinic was held 5 times between January 1988 and July 1989; a dysmorphologist examined children suspected of having FAS and provided initial counseling to the mother or caretaker regarding the ramifications of an FAS diagnosis. The hospital had in place a protocol for providers to use in the management of pregnant women abusing alcohol. Over 2,000 community members participated in other educational efforts such as health fairs, presentations and local government meetings. Screenings involved use of a 10 item self-report question on alcohol use by all prenatal patients. Of the 48 women who were referred to the program between January 1988 and July 1989, 39 became participants and 31 completed follow-up. Seventeen reported having abstained from alcohol 18 months into the program. Of the 29 women who were pregnant during that time, 21 agreed to participate; 19 reported abstaining from alcohol by the third trimester of pregnancy; and 5 accepted offers of contraceptive measures after the birth of their child.