FAS Primary Prevention

In a FAS Diagnostic Clinic

Susan J. Astley, Ph.D.

Sterling K. Clarren, M.D.

Diane Bailey, M.N.

Christina Talbot, M.S.W.

Washington State

FAS Diagnostic and Prevention Network

(FAS DPN)

Primary Questions

1. What is the profile of this high-risk population?

2. What factors enhanced / hindered their ability to achieve sobriety and practice effective birth control?

Maternal Interview

3-4 hour personal interview (87% enrollment success)

Key topics

Sociodemographics (age, race, education)

Social support network

Lifetime adverse events

Mental health profile

Alcohol use and treatment history

Family planning history and preferences

Primary Questions

Age Mean Min-Max

At first drink 15 7 - 30

At maximum drinking 23 10 - 41

At first attempt to stop 26 14 - 47

At birth of child with FAS 27 18 - 41

At most successful sobriety 31 20 - 52

At diagnosis of child with FAS 35 21 - 52

At interview 38 23 - 55

Maternal Age at Key Events (n = 80)

11

60

26

3 00

10

20

30

40

50

60

Pe

rce

nt

17-19 20-29 30-39 40 50-55

Age (years)

Age (years) of Mother at Birth of Child with FAS (n = 80)

0

18

51

22

9

0

10

20

30

40

50

60

Pe

rce

nt

17-19 20-29 30-39 40-49 50-55

Age (years)

Age (years) of Birth Mother at Interview (n = 80)

Maternal Age

54

19

61

0

10

20

30

40

50

60

Nu

mb

er

Caucasian Amer/CanNative

Afr. Amer. Hispanic

Race / Ethnicity (n = 80)

18

31

11

17

3

0

10

20

30

40

Nu

mb

er

<= 8 9-11 12 13-16 >16

Highest Grade Completed

Education (n = 80)

Maternal Race, Education

1

10

28

33

24

4

0

10

20

30

40

Per

cen

t

57-60 61-69 70-85 86-100 101-115 116-120

IQ

Etimated IQ from Shipley (WAIS-R) (n = 72)

Maternal IQ

Childhood, Adult and Lifetime Abuse (n = 80)

0 20 40 60 80 100

sexual

physical

emotional

any abuse

Percent

Lifetime

Adult

Child

Lifetime Abuse of Mother

Lifetime Mental Health Disorders and Age at Onset (n = 79)

0 10 20 30 40 50 60 70 80 90

Schizophrenia

Bulimia

Panic

Manic

Generalized Anxiety

Phobia - Agora

Antisocial Personality

Phobia - Social

Phobia - Simple

Major Depression

Post Traumatic Stress

Alcohol Dependence

Percent

19 yrs

18 yrs

18

11

13

14

22

20

18

21

22

220

Maternal Mental Health

4 4

11

1716

7

15

10

8

4 4

0

5

10

15

20

Per

cen

t

0 1 2 3 4 5 6 7 8 9 10

Number of Mental Health Disorders per Woman

Maternal Mental Health

N %

Childhood (0 - 8 years) 33 (45 %)

Adolescent (9 - 17 years) 31 (42 %)

Adult (18+ years) 10 (14 %)

Earliest Age of Onset of Mental Health Disorder

Maternal Lifetime Drug Use (n = 80)

80

63

64

44

39

35

23

20

16

11

8

49

0 20 40 60 80

Marijuana

cocaine/crack

Speed/amphetamines

pain killers

LSD

tranquilizers

barbituates

heroin/opiates

PCP

Quaaludes

Methadone

None

Drugs

Percent

Maternal Drug Use

Reasons For Not Wanting To Reduce Alcohol Use (n = 80)

0 10 20 30 40 50 60 70 80 90 100

Family unsupportive

Partner unsupportive

Did not think it would help

Alcohol not a problem

In abusive relationship

Uncomfortable about alc problem

Too depressed

Alc helped her cope

Percent

Why she did not want to reduce alcohol use

Reasons for not Seeking Treatment (n = 44)

0 10 20 30 40 50 60 70 80 90 100

Family not supportive

Bad past experience

Afraid of losing house

Too far to travel

Pregnant, lose custody

Heard bad things about treat.

No access

No insurance

Too expensive

Partner not supportive

Afraid she'd lose kids

No one to care for kids

Did not want to stop

Percent

Why she did not seek Alcohol Treatment

mean maximum

Proportion of Pregnancies/woman

Unplanned 77 % 100 %

No birth control 81 % 100 %

Exposed to alcohol 73 % 100 %

Reproductive History

Preferred Method of Birth Control (n = 80)

0 5 10 15 20 25 30 35

Depo provera

Norplant

tubal ligation

the pill

no method

condom

IUD

foam

cervical cap

vasectomy

rhythm

diaphragm

abortion

Proportion

Maternal Contraceptive Preference

45

14 14

5

1

0

10

20

30

40

50N

um

be

r o

f W

om

en

Number of Children born after Index Child with FAS

Number of Children Born after Index Child with FAS (n = 80)

Total of 61 children born75% alcohol exposed80% no birth control

6+ with FAS

6

22

19

15

10

3 32

0

6

12

18

24

Nu

mb

er

of

Wo

me

n

Parity

Parity at time of Interview (n = 80)

Total of 272 children born

Children At Risk

21

35

23

9

53 3

1

0

10

20

30

40P

erc

en

t

1 2 3 4 5 6 7 8

Parity

Parity of Index Child with FAS (n = 80)

Parity of Child with FAS

Abstinent at Time of Interview

Yes (n=50) No (n=25)

Mean IQ 96 82Married 52 % 44 %

Low Income: yearly income less than $10,000 50 % 76 %

Reported a religious affiliation 72 % 44 %

Parents had a problem with alcohol use 88 % 64 %

Most # of drinks/occasion prior to pregnancy 34 17

Mean # of individuals in social support network 17 11

Mean # of mental health disorders per woman 5 5

Received mental health treatment* 52 % 26 %

Significant Contrasts Between Women Who Had And Had Not Achieved Abstinence

This study suggested women were more successful at

stopping drinking ( 75 %) than avoiding unintended pregnancy ( 22 %).

30 years after US Supreme Court legalized contraception

• 57 % of U.S. pregnancies unintended (Forrest ‘94)

• 78 % pregnancies unintended in women with FAS kids

May be due in part to lack of access to contraception.

1998 WA State Survey of Health Insurance Plans

• Only 30 % paid for contraception.

• 77 % paid for abortions

• 4 out of 5 women did not have contraceptive coverage

Unintended Pregnancies

1992 Survey of 79 King County Alcohol/Drug Treatment Agencies

33 % of clientele were women

54 % had no medical or MH services

84 % had no on-site child care

44 % had no on-site recovery support groups

Among 80 birth mothers of children with FAS

• 96 % had mental health disorders.

• Those who received MH treatment more likely to achieve abstinence.

• 70 % had children.

• Those who entered support groups more likely to achieve abstinence.

Treatment for Alcoholism