Washington and Alaska statewide fetal alcohol spectrum disorder diagnostic clinical networks: Comparison of three decades of 4-Digit Code diagnostic outcomes and prenatal alcohol exposure histories.

Background: Fetal alcohol spectrum disorder (FASD) screening, diagnosis, intervention, research and prevention hinges on establishment of interdisciplinary FASD diagnostic clinics using an evidence-based method of diagnosis. In 1993 Washington State opened the first interdisciplinary FASD diagnostic clinic sponsored by the CDC as a FASD primary prevention study. Clinic data was used to develop the evidence-based FASD 4-Digit Diagnostic Code, paving the way for the clinic's expansion into a statewide network of FASD diagnostic clinics (Washington Fetal Alcohol Syndrome Diagnostic & Prevention Network), now in its 30^th year. Alaska adopted this Washington model in 1999. Both states have also participated in the CDC Pregnancy Risk Assessment Monitoring System and Behavioral Risk Factor Surveillance System since the 1990s. Study objectives were to describe the two statewide FASD diagnostic networks; graphically compare the 4-Digit-Code FASD diagnoses and prenatal alcohol exposure (PAE) over 2-3 decades and illustrate how network data helped guide FASD public health policies and track successful prevention efforts.

Methods: Retrospective descriptive study.

Results: FASD diagnostic outcomes were similar across 2,532 Washington and 2,469 Alaskan patients. PAE in each State followed similar annual trajectories from 1991-2020. Both States documented significant decreases in FAS and PAE in the 1990s. Clinic data helped guide public health policies.

Conclusions: Both States demonstrated the feasibility and value of establishing statewide interdisciplinary FASD diagnostic clinical networks using the FASD 4-Digit-Code. Legislative support, centralized data collection, and use of a single, evidence-based FASD diagnostic system have been key to the long-term, ongoing success of these two diagnostic networks.