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 MeanMin-Max At first drink At maximum drinking At first attempt to stop At birth of child with FAS At most successful sobriety At diagnosis of child with FAS At interview Maternal Age at Key Events (n = 80)

Maternal Age

Maternal Race, Education

Maternal IQ

Lifetime Abuse of Mother

Maternal Mental Health

N% Childhood (0 - 8 years)33(45 %) Adolescent ( years)31(42 %) Adult (18+ years)10(14 %) Earliest Age of Onset of Mental Health Disorder

Maternal Drug Use

Why she did not want to reduce alcohol use

Why she did not seek Alcohol Treatment

meanmaximum Proportion of Pregnancies/woman Unplanned77 %100 % No birth control81 %100 % Exposed to alcohol73 %100 % Reproductive History

Maternal Contraceptive Preference

Children At Risk

Parity of Child with FAS

Abstinent at Time of Interview Yes (n=50)No (n=25) Mean IQ9682 Married52 % 44 % Low Income: yearly income less than $10,00050 % 76 % Reported a religious affiliation72 % 44 % Parents had a problem with alcohol use88 % 64 % Most # of drinks/occasion prior to pregnancy3417 Mean # of individuals in social support network1711 Mean # of mental health disorders per woman55 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 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