Preventing alcohol-exposed pregnancies in underserved women attending a safety-net inpatient/outpatient healthcare system

Background: Fetal alcohol exposure is the leading known cause of preventable intellectual disability in the U.S. Lack of effective contraception and concurrent high-risk alcohol use may lead to an alcohol-exposed pregnancy (AEP). Denver Public Health (DPH) is a department of Denver Health (DH), a large urban safety-net inpatient/outpatient system. AEP prevention work being done in DPH served as a springboard for development of DH-wide prevention efforts. Purpose: Create a multi-disciplinary collaborative to prevent AEP at DH. Methods: DPH took leadership in creating a collaborative at DH, with technical assistance provided by CityMatCH. Two half-day planning sessions identified the current siloed state of prevention efforts and care at DH, analyzed the gaps, and developed solutions. DPH clinic data were used to assess the prevalence of high-risk alcohol use in reproductive age women, defined as 4 or more drinks on one occasion or 8 or more in a week, and their rates of effective contraception. Results: We successfully convened a stakeholder group of Ob/Gyn, Pediatric, Family Medicine, Emergency Medicine, Public Health and community partners. Assessment revealed lack of alcohol screening questions across departments. 16% of women attending the DPH clinic were both drinking at high-risk levels and not using effective contraception (816/4976). Pilot education about alcohol use screening was delivered to 63 people (nurses, Ob/Gyn residents, students, Public Health workers). Conclusion: Large healthcare systems can begin to implement AEP prevention by convening appropriate stakeholders. Tasks include standardizing questions in the medical record; education of providers; and coordination of resources for intervention.