Introduction on the green page as a tool for quantification of prenatal alcohol exposure in the region of La Garrotxa

Abstract

Introduction: The preconception period and pregnancy are critical periods vulnerable to environmental risk factors, such as alcohol exposure. The campaigns of the World Health Organization and the Spanish Health Ministry encourage the creation of tools to improve health during pregnancy and the pre-conception period, such as the Green Page. Alcohol has an important role in our society, the intake of this liquid has a marked cultural and social well-established character. Alcohol consumption during pregnancy and the preconception period is the leading cause of preventable school failure and developmental disorders, such as fetal alcohol syndrome and fetal alcohol spectrum disorders (FASD). Objective: Quantify the prenatal alcohol exposure in the region of La Garrotxa and determine the frequency of embryos/fetuses at high risk of developing FASD. Design and methods: Clinical, observational, longitudinal and descriptive study to evaluate prenatal

alcohol exposure in pregnant couples during their first visit of the pregnancy follow- up and control program. Exposure data obtained by a clinical interview tool, the

Green Page Results: A total of 616 pregnant couples were recruited, with an increasing number of couples each year. Along the total period of the study, a 54,8% of all pregnant women drank alcohol during the periconceptional time. Those who drank, 84,7% quit drinking during pregnancy. A 13,9% drank more than 6 drinks per week, and 2,7% had ≥20g/day. For those who kept drinking, 89,0% drank less than 1g/day, and only 1,8% drank more than 5g/day. Only one pregnant woman kept drinking more than 6 drinks per week and one drank more than 20g/day. 2% of the women had 2 or more binge-drinking episodes and 1,4% had ≥3 episodes. A 72,1% of the fathers drank during spermatogenesis. Of the whole, 10% drank ≥20g/day and 2,7% of men had a risk alcohol habit (≥40g/day). A total of 2,4% embryos/fetuses were at high risk of developing FASD (≥20g/day and/or ≥3 binge drinking episodes), but in a less restrictive criteria (>6 drinks/week and/or ≥2 binge drinking episodes) this would rise to 5,8%. The whole consumption of alcohol for both pregnant women and couples decreased during the period of study, and we found a statistically significant reduction of alcohol exposure. Conclusion: The Green Page is a useful, easy-to-use and reproducible clinical tool for detection, prevention and alcohol consumption management. Fetal alcohol exposure is high in the county of La Garrotxa