TMA Testimony by Kimberly Carter, MD
House Public Health
House Bill 446 by Rep. Dawnna Dukes
March 6, 2013
Good morning, Chair Kolkhorst and the members of the committee. I am Kimberly Carter, MD, MPP. I want to thank Representative Dukes for bringing attention to the important problem of fetal alcohol syndrome (FAS) in our state. I’m an obstetrics-gynecology specialist here in Austin and a member of the Texas Medical Association, on behalf of whose 47,000 physicians and medical students I am speaking today. I’m also an assistant professor in obstetrics and gynecology in Austin for The University of Texas Southwestern, and I have spent my career caring for women facing high-risk pregnancies. Today I’m speaking in opposition to House Bill 446 by Representative Dukes as it is currently written.
Prevention of Fetal Alcohol Syndrome
Alcohol exposure during pregnancy can have serious, life-long consequences for babies. FAS is one of the most severe outcomes of a mother’s alcohol use during pregnancy. Babies with FAS can have facial malformations, growth deficits, and neurodevelopmental problems. FAS is diagnosed in as many as two out of every 1,000 live births in the United States. In addition, it is estimated there are three times as many cases of fetal alcohol syndrome disorders, which are alcohol-related effects among children such as physical, mental, behavioral, and/or learning disabilities with possible lifelong implications.
TMA supports efforts to reduce FAS. However, this measure won’t do what it’s trying to accomplish. HB 446 requires physicians and health care providers to give pregnant women information on FAS at the first prenatal visit. They also must counsel the women on the risks of drinking and provide an informational pamphlet on FAS.
The American College of Obstetrics and Gynecology (ACOG) already provides strong guidance to physicians addressing this important and preventable health issue. ACOG recommendations direct physicians to screen each woman seeking obstetric-gynecologic care for alcohol use at least yearly and within the first trimester of pregnancy. To prevent FAS, the critical time to provide this support is before a woman gets pregnant and certainly at the earliest possible time during the pregnancy — during the first eight weeks, when the fetus’s organs are at the earliest and critical stages of development.
For most women, however, the first prenatal visit typically does not take place until near the end of the first trimester. Many women go even longer before seeking prenatal care. The most recent information for Texas, from 2009, indicates one out of every four pregnant Texas women did not receive prenatal care until after the first trimester. In some regions of Texas, almost 50 percent of pregnant women did not receive prenatal care in their first trimester. With more than 400,000 births each year in Texas, that means more than 100,000 women never saw a physician until more than three months into their pregnancy.
Physicians are committed to preventing FAS in the women under our care. There is no question we can and should do more to inform women why avoiding alcohol during pregnancy is important. Unfortunately, HB 446 does not help reach woman when it is the most critical — at the very onset of pregnancy when alcohol is the most dangerous to the fetus.
While well intended, we do not believe HB 446 will result in universal education at an early enough juncture and will, in fact, prescribe specific actions for physicians not based on good research or evidence. We welcome the opportunity to work with this committee, Representative Dukes, the Texas Office for the Prevention of Developmental Disabilities, the Department of State Health Services, and the Health and Human Services Commission to increase public and professional awareness of FAS.
Thank you for your time today, and I am happy to answer questions if I can.
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