When Sara Messelt joined Proof Alliance 20 years ago as program coordinator, the little nonprofit had a big vision. Research has shown since 1974 that alcohol during pregnancy harms a developing fetus, but she learned most people "did not have the facts." So Proof Alliance (formerly Minnesota Organization on Fetal Alcohol Syndrome or MOFAS) has stuck to a consistent message: There is no safe kind of alcohol, no safe amount and no safe time to drink it during pregnancy. Messelt, now Proof Alliance's executive director, has seen huge strides in knowledge, but 1 in 9 pregnancies still is exposed to alcohol. Messelt shares how the organization is working to keep at-risk pregnant women healthy.

Q: I found this shocking: Research shows that alcohol is more dangerous to a pregnant woman than cocaine, opioids, meth or marijuana. Really?

A: Whether it is a high school health class or a room full of Rotarians, everyone is stunned when I share the fact that alcohol produces by far the most serious neurobehavioral effects on the fetus of any of these different substances. The Institute of Medicine states, "Of all the substances of abuse, including cocaine, heroin and marijuana, alcohol produces by far the most serious neurobehavioral effects in the fetus resulting in lifelong, permanent disorders." Of course, you don't want to use any of them and using a combination of substances increases the impact.

Q: Help us understand fetal alcohol spectrum disorders (FASD).

A: FASD refers to a spectrum of lifelong and irreversible disabilities. This form of organic brain injury causes inconsistency in behaviors and intellectual abilities on a daily basis. Unfortunately, there is not one medical test (like a blood test) to confirm a diagnosis. Instead, FASD is diagnosed by a team of professionals assessing four specific areas including prenatal alcohol history, brain function and structure, facial features, and growth issues.

Q: How did Proof Alliance begin?

A: In addition to being Minnesota's First Lady from 1991 to 1999, Susan Shepard Carlson is an attorney and retired Hennepin County District Court judicial officer. Through her work with kids and families in the juvenile court system, she began to note that many had issues with potential prenatal alcohol exposure and that this created special challenges in helping them be successful. When Susan looked for a statewide resource for information and support, she found that there was not one at that time. She launched an initiative to promote education and prevention about alcohol-related birth defects in March 1997 and soon after convened a governmental task force. Her efforts resulted in almost $7 million per year in funding for fetal alcohol initiatives. Minnesota has become a national leader on this issue.

Q: And unfortunately, a national leader in FASD cases. Why is that?

A: FASD is a big problem in Minnesota. We have some of the highest rates of binge drinking (close to our neighbors in Wisconsin) in the country. We also know that about 40% of pregnancies in our state are unplanned. That combination of stats alone can demonstrate why FASD is a big challenge in our state. On the flip side, because of the bipartisan support by our policymakers, we have the largest statewide response to preventing FASD and supporting all impacted. Still, with all that work we have so far to go. A recent study found that as many as 1 in 20 school-aged children have FASD. That's more common than autism.

Q: How comfortable are doctors when talking about FASD?

A: Progress is being made. In 2013, we conducted a study that found 1 in 5 pregnant women in Minnesota did not receive any message about alcohol use from their doctor or were told they could drink lightly or in moderation. Our hope is to repeat that study and see where we are. We work with an incredible team of prenatal care providers including OB/GYNs and primary care doctors who are deeply committed to making sure all of their pregnant patients get clear public health education. There is some information provided in medical school, but we know it needs to be expanded. We recently were awarded a federal grant in partnership with Boston Medical Center to help train 40 clinics in the Upper Midwest and New England on the best way to screen for alcohol use in pregnancy.

Q: Why the recent name change from MOFAS?

A: Many people still have skepticism that alcohol use during pregnancy really has an impact. When we worked with Minneapolis-based ad agency Colle McVoy on a pro-bono ad campaign, they challenged us to think about how our brand and our name helped us achieve our mission. We have proof that FASD is 100% preventable, and people living with an FASD can reach 100% of their potential. It's important to know that many pregnant women could be dealing with a substance use disorder and need appropriate treatment and support. We advocate for programs and services that offer women access to that support (proofalliance.org).

Q: What gives you hope?

A: More people know that there is no safe level of alcohol during pregnancy. People with FASD are beginning to have their human rights acknowledged. Proof Alliance is determined to keep pushing until we truly realize our vision, which is that we live in a world where alcohol is not consumed during pregnancy and all people living with FASD are living their best life.