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In her talking points on the surgeon general’s advisory, Damus makes the following recommendations —

1. Develop diagnostic criteria that will enable clinicians to identify children along the full spectrum of FASD.
2. Disseminate evidence-based approaches to FASD prevention in multiple venues in community-based settings.
3. Improve access to information and treatment resources for childbearing-age women at risk for an alcohol-exposed pregnancy.
4. Develop standards of care for children diagnosed with disorders on the fetal alcohol spectrum.
5. Continue research to identify the underlying mechanisms of fetal alcohol-induced injury, concurrent risk factors, and effective ways of treating alcohol abuse and dependency in pregnant and nonpregnant, childbearing-aged women.

Spread the word

Nurses in all settings can play an instrumental role in getting the message out to women who are pregnant or are planning to become pregnant. They should never assume that a patient knows the risks, and never assume that some clients are not at risk. Screening should take place for all pregnant women of all ages, all socioeconomic classes, and all cultural groups. Nurses can take the lead in educating women through a nonjudgmental, culturally connected approach. While research­ers are discovering more about the effects of alcohol during pregnancy, there is little debate about today’s information. So says the Surgeon General: During pregnancy, there is no safe time to drink nor is there a safe amount of alcohol to drink.

Diagnostic criteria for fetal alcohol syndrome

1. Facial dysmorphia – based on racial norms, individuals exhibit all three characteristic facial features: smooth philtrum, thin vermilion, and small palpebral fissures
2. Growth problems – confirmed prenatal or postnatal height or weight, or both, at or below the 10th percentile.
3. Central Nervous System (CNS) Abnormalities
   • Structural – head circumference at or below 10th percentile and clinically significant brain abnormalities observable through imaging.
   • Neurological problems
   • Functional – performance substantially below that expected
   evidenced by global cognitive or intellectual deficits or functional deficits below the 16th percentile in at least three domains: cognitive or developmental, executive functioning, motor functioning, problems with attention or hyperactivity, social skills, or other sensory, language or memory deficits.
4. Maternal Alcohol Exposure
   • confirmed prenatal alcohol exposure
   • unconfirmed prenatal alcohol exposure³

Carol Nelke Dunbar, APRN, is a contributing writer for Nursing Spectrum.

References

1. Binge Drinking in Adolescents and College Students. U.S. Department of HHS and SAMHSA’s National Clearinghouse for Alcoholg & Drug Information. Available at http://www.health.org/govpubs/rpo995/. Accessed 04/4/2005.

2. CDC: Alcohol consumption among women who are pregnant or who might become pregnant, US 2002, MMWR: 2004 53(50): 1178-81.

3. Gerbeding JL, Cordero J, Floyd RL, FAS: Guidelines for Referral and Diagnosis, July 2004. Available at http://www.cdc.gov/ncbddd/fas. Accessed 02/24/2005.

4. Agreement on terminology for FASD, News-Medical in Medical Condition News, August 17, 2004. Available at http://www.news-medical.net. Accessed 02/22/2005.

5. US Surgeon General releases advisory on alcohol use in pregnancy, US Department of HHS, news release. 02/21/2005. Available at www.hhs.gov/surgeongeneral. Accessed 02/24/2005.

6. Key facts on FASD. FAS Facts, available at http://www.fasworld.com/facts.ihtml. Accessed 02/22/2005.

7. Abel EL, Kruger M. What do physicians know and say about FAS? Alcohol Clin Exp Res. 1998, 22(9):1951-1954.