Purpose: To support efforts to prevent fetal alcohol syndrome (FAS), population-based data are needed on the prevalence of alcohol use at any time during gestation, particularly among women who were recent and at-risk drinkers. Methods: We used National Longitudinal Survey of Labor Market Experiences in Youth (NLSY) files to estimate the prevalence of any drinking during pregnancy and to evaluate alcohol history risk factors among 6676 births reported by women with prepregnancy drinking data. Prevalence estimates were obtained for 2-year intervals for all 1982-1995 births and for subsets with prepregnancy recent and at-risk drinking.Results: Among all births, drinking during pregnancy declined from 38.3% in 1982-1983 to 23.0% in 1994-1995 (p Ͻ 0.0001). Drinking during pregnancy also declined over time among recent and at-risk drinkers (p Ͻ 0.0001), but the 1994-1995 prevalences were still high (39.3% and 29.0%, respectively). Adjusted logistic models confirmed both the decrease in risk for the later birth years and the persistent heightened risk for births among recent and at-risk drinkers.Conclusions: In addition to ongoing universal prevention strategies that have helped reduce the prevalence of drinking during pregnancy, selective and indicated prevention approaches are needed to encourage abstinence during pregnancy among recent and at-risk drinkers. 1061

This model, with its underlying assumptions and data, suggests that early treatment with captopril provides modest benefit at reasonable cost effectiveness, from the US single-payer perspective, in the prevention of ESRD compared with delaying treatment until diagnosis of microalbuminuria. Early treatment with other ACE inhibitors will provide similar cost effectiveness if they have equivalent efficacy, compliance and price per dose. Treatment may be considered among patients at age 20 years with new onset of type 1 diabetes. This conclusion is sensitive to the extent that ACE inhibitors delay onset of microalbuminuria. Other factors such as the patient's age and glycaemic level must be considered when deciding to initiate early treatment.

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To prevent fetal alcohol syndrome, some social drinkers who may become pregnant need more than a brief caution, but they can be difficult to detect in clinical settings. National Longitudinal Survey of Youth data from 754 women who completed up to four alcohol history interviews during their college-age years (18-21), and semiparametric group-based models were used to identify groups more likely to drink during a future pregnancy. Two drinking trajectories were observed. About 87% of the women were occasional or nondrinkers during their college-age years; 13% were frequent drinkers. Among first-births to women 22 yr. and older, the adjusted odds ratio for alcohol use during that pregnancy for frequent drinkers versus occasional and nondrinkers was 2.29 (95% confidence interval: 1.25-4.17). This finding suggests women who report frequent drinking during their college-age years may require additional assistance to reduce their risk of drinking during subsequent pregnancies.

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