B SMART

Prenatal exposure alcohol (PAE) is notably the most common preventable cause of intellectual and developmental disabilities in the US.¹ Alcohol is a teratogen and exposure to alcohol in utero can result in a range of developmental and physical challenges across a spectrum of disorders- FASDs. Alcohol at any stage in a pregnancy can have negative impacts as alcohol readily crosses the placenta.² Therefore, this is a considerable issue as alcohol use among pregnant people and before pregnancy occurs commonly. One challenge in gaining precise data and information is shame and stigma surrounding prenatal alcohol exposure.³ As nearly half of pregnancies are unplanned it is important to have a discussion about alcohol use before pregnancy.⁴ 

Fetal alcohol spectrum disorders is an umbrella term and the impact of PAE exists across a spectrum of conditions within the umbrella of FASDs. These conditions include Fetal Alcohol Syndrome (FAS) and partial FAS (pFAS), Alcohol-Related Birth Defects (ARBD), Alcohol-Related Neurodevelopmental Disorder (ARND), and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE).⁵ Each varies in characteristics and occurrence. FASD impact as much as 5% of school aged children.⁶  Diagnosis criteria can vary for each of the FASD.⁷

According to a recent CDC MMWR, it is evident the drinking during pregnancy continues to be a significant problem. In the pregnant adults surveyed:

• 13.5% reported current drinking
• 5.2% reported binge drinking

This reflects a 2 percent increase in both categories since the 2015-2017 period.

During the Covid-19 pandemic there are reports of increases in heavy drinking and increases in alcohol-related problems independent of consumption level. Participating in a B SMART training can provide skills and knowledge that will make an important impact on your patients.

Education & Technical Assistance

• Trainings will provide up-to-date information about FASDs and skills in substance use screening, brief intervention and referral to treatment (SBIRT) including motivational interviewing (MI) techniques.
• Continuing Medical Education (CME/CNE) credits offered for most trainings.

• Podcast: This 3-part podcast features interviews with a variety of individuals to explore the many facets of FASDs. We meet with a medical expert in the field of FASDs, a patient advocate, a mother whose child is affected by prenatal alcohol exposure, and a public health social worker specializing in counseling patients in unhealthy alcohol use.  https://cme.bu.edu/fasdpodcast

Communication Resources

• Online and hardcopy FASD & SBIRT resources for providers, patients and clinic administrators.
  • Creation of infographics
  • SBIRT Cards

Reporting and Data

• Real-time virtual feedback on provider training, SBIRT implementation and FASD prevention metrics.
• Robust process and outcome evaluation based on a mixed-methods approach

Funding provided by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, cooperative agreement number NU84DD000002

• Check out our new podcast!
• About FASDs from the CDC
• About getting continuing education credit

Text

1. Popova S, Dozet D, Burd L. Fetal alcohol spectrum disorder: can we change the future? Alcohol Clin Exp Res. 2020;44(4):815-819. https://doi.org/10.1111/acer.14317
2. Center for Disease Control and Prevention. Alcohol Use in Pregnancy. https://www.cdc.gov/ncbddd/fasd/alcohol-use.html. Accessed May 10, 2018.
3. Tan C, Denny C, Cheal N, Sniezek J, Kanny D. Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2011–2013. Morb Mortal Wkly Rep. 2015;64(37):1042-1046. https://www.jstor.org/stable/24856791
4. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016;374(9):843-52. https://www.nejm.org/doi/full/10.1056/nejmsa1506575
5.  Centers for Disease Control and Prevention. Basics about FASDs. https://www.cdc.gov/ncbddd/fasd/facts.html. Accessed May 10, 2018.
6.  Popova S, Dozet D, Burd L. Fetal alcohol spectrum disorder: can we change the future? Alcohol Clin Exp Res. 2020;44(4):815-819. https://doi.org/10.1111/acer.14317
7. Proof Alliance. Diagnostic Terms: Fetal Alcohol Spectrum Disorders (FASD). https://www.proofalliance.org/resource/diagnostic-terms-fetal-alcohol-spectrum-disorders-fasd. 2021.
8. Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol Consumption and Binge Drinking During Pregnancy Among Adults Aged 18–49 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2022;71:10–13. DOI: http://dx.doi.org/10.15585/mmwr.mm7101a2

Images

1. CDC Vital Signs. https://www.cdc.gov/vitalsigns/pdf/2016-02-vitalsigns.pdf ; 2016. 
2. May PA, Chambers CD, Kalberg WO, et al. Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA. 2018;319(5):474-482. doi:10.1001/jama.2017.21896
3. SAMHSA. 2014.
4. Centers for Disease Control and Prevention. Basics about FASDs. https://www.cdc.gov/ncbddd/fasd/facts.html. Accessed May 10, 2018.
5. CDC, Denny CH, Acero CS, Naimi TS, Kim SY. Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18–44 Years — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:365–368. DOI: http://dx.doi.org/10.15585/mmwr.mm6816a1
6. http://www.fasdcenter.org/projects/educational-equity/1-in-20-more-common-than-autism