酒精和怀孕:健康提供者可以更好地干预的方法

Fetal alcohol spectrum disorders (FASDs) is an umbrella term describing the range of lifelong physical, 行为, and intellectual disabilities that can occur in an individual who was exposed to alcohol before birth. Prenatal alcohol exposure is also associated with an increased risk of miscarriage, 死胎, 早产, 还有婴儿猝死综合症. 研究表明，每20个美国人中就有1个.S. school children may be on the FASD spectrum, a rate more than double that of autism. 如果孕妇不喝酒，就可以预防时尚. Recent estimates from the Centers for Disease Control and Prevention (CDC), Alcohol Consumption and Binge Drinking During Pregnancy Among Adults Aged 18–49 Years — United States, 2018 - 2020 (PDF), show that nearly 14% of pregnant adults reported drinking and about 5% reported binge drinking in the past 30 days.

孕妇在寻求帮助时面临的障碍

There are complex social and environmental factors that might lead pregnant people to use alcohol, but the stigma that surrounds them often prevents them from disclosing their alcohol use to health care providers. This stigma stems from societal beliefs that FASDs are a product of a person’s personal decisions to drink while pregnant, even when the person doesn’t know she is pregnant or is unable to stop alcohol use without support. As a result, pregnant people feel guilt and shame and may not seek appropriate health services.

Alcohol screening and brief intervention (SBI) by health care providers is effective at reducing excessive alcohol use. Alcohol SBI involves asking a validated set of screening questions to identify patients’ drinking patterns. This is followed by a short conversation with patients who are drinking more than the recommended amounts, 以及在适当的时候转诊治疗. 然而, many health care providers have no formal training on how to talk about alcohol use with their patients and provide them with needed resources. 此外，一些U.S. 各州都有法律将怀孕期间使用药物定为犯罪, which weakens the confidential patient-provider relationship and erodes trust in the medical system, 使人们在需要帮助时不太可能寻求帮助. 这些法律对有色人种的影响尤为严重, 那些较少获得药物使用治疗的人, 以及获得经济资源较少的人, 因此, 加剧了社会上的健康差距.

韦斯特在做什么

趣赢平台 has conducted a qualitative evaluation of an educational initiative implemented by 2 CDC-funded awardees:

• FASD United—a national organization that supports families living with FASDs
• American College of Obstetricians and Gynecologists (ACOG)—the professional association of clinicians specializing in obstetrics and gynecology in the U.S.

The 2 organizations have partnered to combat the stigma clinicians may unknowingly hold about birth mothers, and help clinicians understand the real-world implications of alcohol use during pregnancy and their role in FASD prevention. In this collaborative effort implemented in medical residency programs across the country, ACOG的医师冠军和FASD联合培训的演讲者, who are women stable in their recovery from alcohol use disorder and have a child with a FASD, co-present clinical facts and personal narratives about FASDs to health care providers.

评价 findings indicated that stigma and fear of prosecution prevent pregnant people from speaking openly, 医疗保健提供者需要花时间倾听和建立信任. Alcohol SBI begins with creating a nonjudgmental, trustworthy, and safe space for their patients. Combining medical expertise from a physician with the lived experience of mothers of children with FASDs gave health care providers an empathy-based approach to learning, increasing their awareness of provider bias and the consequences of not asking patients about their alcohol use.

9月是时尚与流行病学宣传月, 它为所有人了解这个问题提供了一个很好的机会, 消除孕期饮酒带来的污名, 并支持更广泛的预防fasd的努力.

Contributed by 趣赢平台 expert Saloni Sapru, PhD, 首席研究助理 for 公共卫生.