Alcohol and Pregnancy: Ways Health Providers Can Better Intervene

Fetal alcohol spectrum disorders (FASDs) is an umbrella term describing the range of lifelong physical, behavioral, and intellectual disabilities that can occur in an individual who was exposed to alcohol before birth. Prenatal alcohol exposure is also associated with an increased risk of miscarriage, stillbirth, prematurity, and sudden infant death syndrome. Studies show that up to 1 in 20 U.S. school children may be on the FASD spectrum, a rate more than double that of autism. FASDs can be prevented if pregnant people avoid alcohol. Recent estimates from the Centers for Disease Control and Prevention (CDC), Alcohol Consumption and Binge Drinking During Pregnancy Among Adults Aged 18–49 Years — United States, 2018–2020 (PDF), show that nearly 14% of pregnant adults reported drinking and about 5% reported binge drinking in the past 30 days.

Barriers Pregnant People Who Consume Alcohol Face in Seeking Help

There are complex social and environmental factors that might lead pregnant people to use alcohol, but the stigma that surrounds them often prevents them from disclosing their alcohol use to health care providers. This stigma stems from societal beliefs that FASDs are a product of a person’s personal decisions to drink while pregnant, even when the person doesn’t know she is pregnant or is unable to stop alcohol use without support. As a result, pregnant people feel guilt and shame and may not seek appropriate health services.

Alcohol screening and brief intervention (SBI) by health care providers is effective at reducing excessive alcohol use. Alcohol SBI involves asking a validated set of screening questions to identify patients’ drinking patterns. This is followed by a short conversation with patients who are drinking more than the recommended amounts, as well as referral to treatment when appropriate. However, many health care providers have no formal training on how to talk about alcohol use with their patients and provide them with needed resources. Furthermore, some U.S. states have laws criminalizing substance use during pregnancy, which weakens the confidential patient-provider relationship and erodes trust in the medical system, making people less likely to seek help when they need it. Such laws disproportionately impact people of color, those with less access to substance use treatment, and people with less access to economic resources, thus, exacerbating health disparities in society.

What Westat Is Doing

Westat has conducted a qualitative evaluation of an educational initiative implemented by 2 CDC-funded awardees:

• FASD United—a national organization that supports families living with FASDs
• American College of Obstetricians and Gynecologists (ACOG)—the professional association of clinicians specializing in obstetrics and gynecology in the U.S.

The 2 organizations have partnered to combat the stigma clinicians may unknowingly hold about birth mothers, and help clinicians understand the real-world implications of alcohol use during pregnancy and their role in FASD prevention. In this collaborative effort implemented in medical residency programs across the country, ACOG’s physician champions and FASD United-trained speakers, who are women stable in their recovery from alcohol use disorder and have a child with a FASD, co-present clinical facts and personal narratives about FASDs to health care providers.

Evaluation findings indicated that stigma and fear of prosecution prevent pregnant people from speaking openly, and health care providers need to take time to listen and develop trust. Alcohol SBI begins with creating a nonjudgmental, trustworthy, and safe space for their patients. Combining medical expertise from a physician with the lived experience of mothers of children with FASDs gave health care providers an empathy-based approach to learning, increasing their awareness of provider bias and the consequences of not asking patients about their alcohol use.

As September is FASD Awareness Month, it provides a great opportunity for all to learn about the issue, counter the stigma surrounding alcohol use during pregnancy, and support broader efforts toward the prevention of FASDs.

Contributed by Westat expert Saloni Sapru, PhD, Principal Research Associate for Public Health.