title: Reducing fetal alcohol exposure in the United States.
abstract: Fetal alcohol exposure is the leading preventable cause of birth and developmental defects in the United States. Despite a growing body of knowledge about the spectrum of disorders resulting from fetal alcohol exposure, 1 in 9 pregnant women continues to drink alcohol during pregnancy, and a small percentage of pregnant women continues to binge drink. Health care providers do not consistently screen pregnant women for alcohol use, nor do health professionals necessarily know how to counsel pregnant women effectively about the risks of fetal alcohol exposure. In this article, we review the epidemiology of fetal alcohol exposure and discuss current strategies for screening and prevention of fetal alcohol exposure. We also explore the multiple barriers that exist toward reducing alcohol-exposed pregnancies from the patient, provider, and systems perspectives. Finally, we make recommendations for improved clinical and public health strategies to eliminate fetal alcohol exposure in the United States.
  
  
  BACKGROUND
  Obstetricians and gynecologists, family physicians.
  
  
  OBJECTIVE
  After completing this CME activity, physicians should be better able to describe rates of fetal alcohol exposure in the United States, describe the demographic characteristics of women at highest risk for fetal alcohol exposure, counsel patients appropriately regarding the risk of poor fetal outcomes in association with fetal alcohol exposure, and understand the barriers to effective counseling about fetal alcohol exposure.
authors.affiliation: Department of Family Medicine, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA. watermae@ohsu.edu
authors.forename: Emily H
authors.initials: EH
authors.lastname: Waterman
authors.forename: Dawn
authors.initials: D
authors.lastname: Pruett
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D037001:Directive Counseling; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008425:Maternal Behavior; D010353:Patient Education as Topic; D016742:Preconception Care / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy; D049168:Pregnancy, Unplanned; D011295:Prenatal Care / Q000379:methods*; D014481:United States / Q000453:epidemiology