Prevention and Diagnosis of Perinatal Alcohol Exposure and Fetal Alcohol Spectrum Disorders in the US Military Health System: A Mixed Methods Study

Alcohol use and alcohol use disorders (AU/AUD) during pregnancy, perinatal alcohol exposure (PAE) and fetal alcohol spectrum disorders (FASD) are urgent public health issues. FASD includes the broad range of diagnosable effects in an individual prenatally exposed to alcohol, and is a disability that requires diagnosis, support, and intervention along its spectrum. Alcohol use and alcohol-related burdens on the United States’ health care system are on the rise, with 1 in 7 pregnant people consuming alcohol in 2022, up from 1 in 9 in 2020. The most conservative prevalence estimates of FASD are 1 in 20 children in the US. Although early pediatric screening for prenatal alcohol exposure has been shown to lead to better childhood outcomes, the average diagnostic age of FASD has stubbornly remained around 10 years. Elevated alcohol consumption has deep roots in the culture of some military populations. The Military Health System (MHS) cares for approximately 2 million children who are nationally representative of the Nation’s children. As FASD goes largely un- or misdiagnosed, the Center for Health Services Research at the Uniformed Services University is leading inter-professional, collaborative research to investigate the full FASD continuum of care in the MHS using an integrated public health approach to maximize lessons learned from the translatable, actionable knowledge that is generated. The project’s goal is to develop FASD-informed prevention trainings and clinical guidelines for diagnosis, and adapt existing service delivery mechanisms to provide support for individuals with FASD and their military families. Through three tightly interlocking lines of effort, we will 1) conduct an environmental scan including the inventory and synthesis of existing DoD alcohol use focused programs and of national and DoD clinical practice guidelines; 2) adopt a community needs assessment methodology using qualitative methods to understand the lived experiences and needs of patients, caregivers and diverse inter-professional providers in the MHS with respect to prevention and early diagnosis; and 3) apply modeling and predictive analytic methods to longitudinal military electronic health record data to rigorously examine population health outcomes and risk factors across to improve identification of individuals who may benefit from further screening. Particular topics such as the increasing rates of alcohol use and alcohol use disorder among women with and without children,
identification of at-risk women, and early identification of at-risk infants and children including the investigation of race-based health disparities are timely and relevant, and present an opportunity to contribute to national discussion around health system improvement and reform of clinical practice. The MHS patient population and associated healthcare records afford an ideal setting to develop improved understanding and resources to address the FASD care continuum. Findings are expected to be generalizable to the general population and other large health systems given the ‘universal’ nature of the MHS.