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Green CR, Harding KD, Unsworth K, Kaminsky K, Roberts N, Nagpal TS, Cook JL. Reporting on Health Care and Social Service Provider Approaches to Promoting Alcohol Abstinence During Pregnancy. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:422-433. [PMID: 38713493 DOI: 10.1080/19371918.2024.2323136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite the known detrimental health effects of alcohol use during pregnancy, there are still health care (HCP) and social service providers (SSP) who do not promote complete abstinence. The purpose of this study was to explore the current practices of HCPs and SSPs when discussing alcohol use during pregnancy, and to understand their rationale for their specific recommendations. An online survey was completed by 1123 HCPs (n = 588) and SSPs (n = 535) that asked them to identify their approach to discussing alcohol and pregnancy. Participants had the option to further explain their current recommendations regarding alcohol use during pregnancy in an open-ended format. Open-ended responses were analyzed using a content analysis approach (n = 156). The majority of respondents recommend abstinence (83.9% of HCPs, n = 493; 78.4% of SSPs, n = 419), while 9.8% of HCPs (n = 57) and 2.2% of SSPs (n = 12) responded that low levels of consumption may be acceptable. HCPs may recommend low levels of consumption based on other international guidelines, limited evidence to suggest that one unit of alcohol is harmful, and as a harm reduction strategy. SSPs stated that they refer clients to HCPs for recommendations related to alcohol consumption, and that they prefer to provide information based on public health guidelines. This exploratory work may inform the development of resources to support HCPs and SSPs to recommend abstinence from alcohol throughout gestation.
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Affiliation(s)
- Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | - Kelly D Harding
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- Psychology Department, Laurentian University, Sudbury, ON, Canada
| | - Kathy Unsworth
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
| | - Kyla Kaminsky
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- The University of Ottawa, Ottawa, ON, Canada
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Thela L, Paruk S, Bhengu B, Chiliza B. Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102478. [PMID: 38401484 DOI: 10.1016/j.bpobgyn.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.
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Affiliation(s)
- Lindokuhle Thela
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa.
| | - Saeeda Paruk
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Busisiwe Bhengu
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Bonginkosi Chiliza
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
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Minozzi S, Ambrosi L, Saulle R, Uhm SS, Terplan M, Sinclair JM, Agabio R. Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy. Cochrane Database Syst Rev 2024; 4:CD015042. [PMID: 38682758 PMCID: PMC11057221 DOI: 10.1002/14651858.cd015042.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Despite the known harms, alcohol consumption is common in pregnancy. Rates vary between countries, and are estimated to be 10% globally, with up to 25% in Europe. OBJECTIVES To assess the efficacy of psychosocial interventions and medications to reduce or stop alcohol consumption during pregnancy. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO, from inception to 8 January 2024. We also searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). All searches included non-English language literature. We handsearched references of topic-related systematic reviews and included studies. SELECTION CRITERIA We included randomised controlled trials that compared medications or psychosocial interventions, or both, to placebo, no intervention, usual care, or other medications or psychosocial interventions used to reduce or stop alcohol use during pregnancy. Our primary outcomes of interest were abstinence from alcohol, reduction in alcohol consumption, retention in treatment, and women with any adverse event. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included eight studies (1369 participants) in which pregnant women received an intervention to stop or reduce alcohol use during pregnancy. In one study, almost half of participants had a current diagnosis of alcohol use disorder (AUD); in another study, 40% of participants had a lifetime diagnosis of AUD. Six studies took place in the USA, one in Spain, and one in the Netherlands. All included studies evaluated the efficacy of psychosocial interventions; we did not find any study that evaluated the efficacy of medications for the treatment of AUD during pregnancy. Psychosocial interventions were mainly brief interventions ranging from a single session of 10 to 60 minutes to five sessions of 10 minutes each. Pregnant women received the psychosocial intervention approximately at the end of the first trimester of pregnancy, and the outcome of alcohol use was reassessed 8 to 24 weeks after the psychosocial intervention. Women in the control group received treatment as usual (TAU) or similar treatments such as comprehensive assessment of alcohol use and advice to stop drinking during pregnancy. Globally, we found that, compared to TAU, psychosocial interventions may increase the rate of continuously abstinent participants (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.14 to 1.57; I2 =0%; 3 studies; 378 women; low certainty evidence). Psychosocial interventions may have little to no effect on the number of drinks per day, but the evidence is very uncertain (mean difference -0.42, 95% CI -1.13 to 0.28; I2 = 86%; 2 studies; 157 women; very low certainty evidence). Psychosocial interventions probably have little to no effect on the number of women who completed treatment (RR 0.98, 95% CI 0.94 to 1.02; I2 = 0%; 7 studies; 1283 women; moderate certainty evidence). None of the included studies assessed adverse events of treatments. We downgraded the certainty of the evidence due to risk of bias and imprecision of the estimates. AUTHORS' CONCLUSIONS Brief psychosocial interventions may increase the rate of continuous abstinence among pregnant women who report alcohol use during pregnancy. Further studies should be conducted to investigate the efficacy and safety of psychosocial interventions and other treatments (e.g. medications) for women with AUD. These studies should provide detailed information on alcohol use before and during pregnancy using consistent measures such as the number of drinks per drinking day. When heterogeneous populations are recruited, more detailed information on alcohol use during pregnancy should be provided to allow future systematic reviews to be conducted. Other important information that would enhance the usefulness of these studies would be the presence of other comorbid conditions such as anxiety, mood disorders, and the use of other psychoactive substances.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Ludovico Ambrosi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Seilin S Uhm
- School of Medicine, University of Southampton, Southampton, UK
| | - Mishka Terplan
- Friends Research Institute, Baltimore, USA
- Family and Community Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy Lacroix ME, Sharma S, Waterman E. Guideline No. 441: Antenatal Fetal Health Surveillance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:665-677.e3. [PMID: 37661122 DOI: 10.1016/j.jogc.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy-Lacroix MÈ, Sharma S, Waterman E. Directive clinique n o 441 : Surveillance prénatale du bien-être fœtal. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:678-693.e3. [PMID: 37661123 DOI: 10.1016/j.jogc.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIF Résumer les données probantes actuelles et formuler des recommandations pour la surveillance prénatale du bien-être fœtal afin de détecter les facteurs de risque périnatal et toute potentielle décompensation fœtale et de permettre une intervention rapide en prévention de la morbidité et la mortalité périnatales. POPULATION CIBLE Personnes enceintes avec ou sans facteurs maternels, fœtaux ou gravidiques associés à des risques périnataux et à la décompensation fœtale. OPTIONS Utiliser des examens prénataux par technologie de base et/ou avancée en fonction des facteurs de risque de décompensation fœtale. RéSULTATS: La reconnaissance précoce de toute décompensation fœtale potentielle permet d'intervenir de façon à favoriser l'adaptation fœtale pour maintenir le bien-être ou à accélérer l'accouchement. BéNéFICES, RISQUES ET COûTS: Chez les personnes enceintes ayant des facteurs de risque périnatal confirmés, la surveillance du bien-être fœtal contribue à réduire le risque d'issue défavorable. Compte tenu du taux élevé de faux positifs, la surveillance du bien-être fœtal peut augmenter le risque d'interventions inutiles, ce qui peut avoir des effets nuisibles, dont l'anxiété parentale, l'accouchement prématuré ou assisté et l'utilisation accrue des ressources de soins de santé. L'optimisation des protocoles de surveillance d'après des pratiques fondées sur des données probantes peut améliorer les issues périnatales et réduire les effets nuisibles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed, Embase et Cochrane Library, de leur création jusqu'à janvier 2022, à partir de termes MeSH et de mots clés liés à la grossesse, à la surveillance fœtale, aux mouvements fœtaux, à la mortinaissance, aux complications de grossesse et à l'échographie fœtale. Le présent document est un résumé des données probantes et non pas une revue méthodologique. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les membres de l'équipe de soins qui prodiguent des soins ou donnent de l'information aux patientes en obstétrique, notamment les spécialistes en médecine fœto-maternelle, les obstétriciens, les médecins de famille, les sages-femmes, les infirmières, les infirmières praticiennes et les radiologistes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Board A, D’Angelo DV, von Essen BS, Denny CH, Miele K, Dunkley J, Park Y, Bauman B, Kim SY. The Postpartum Period: An Opportunity for Alcohol Screening and Counseling to Reduce Adverse Health Impacts. J Addict Med 2023; 17:528-535. [PMID: 37788605 PMCID: PMC10585373 DOI: 10.1097/adm.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
OBJECTIVES The postpartum period presents an opportunity to engage in discussions about alcohol consumption and related health harms. This study examined the prevalence of alcohol consumption among a sample of postpartum persons with a recent live birth and screening and brief intervention (alcohol SBI) or counseling by their providers. METHODS We analyzed 2019 data from a telephone survey conducted 9 to 10 months postpartum among individuals who responded to the standard Pregnancy Risk Assessment Monitoring System survey in 6 states. Weighted prevalence estimates were calculated for alcohol consumption and alcohol SBI after birth through up to 10 months postpartum. RESULTS Among 1790 respondents, 53.1% reported consuming alcohol postpartum. Among those who drank postpartum, 70.8% reported being asked about alcohol use by a healthcare provider. Slightly more than half of respondents who drank postpartum and were trying to get pregnant (52.4%) or were not using birth control at the time of the survey (59.8%) reported being asked about alcohol use. Approximately 25% of respondents who drank alcohol postpartum were advised about risky alcohol levels by a healthcare provider. Small proportions of individuals who drank alcohol postpartum and were pregnant or trying to get pregnant at the time of the survey were advised to reduce or stop drinking alcohol (10.6% and 2.3%, respectively). CONCLUSIONS These findings suggest missed opportunities to promote health and prevent adverse alcohol-related health outcomes during the postpartum period through evidence-based tools such as alcohol SBI.
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Affiliation(s)
- Amy Board
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise V. D’Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Beatriz Salvesen von Essen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- CDC Foundation, Atlanta, GA
| | - Clark H. Denny
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kathryn Miele
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janae Dunkley
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Brenda Bauman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shin Y. Kim
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Frank O, Murphy MSQ, Talarico R, Denize KM, Boisvert C, Harvey ALJD, Rennicks White R, Corsi DJ, Sampsel K, Wen SW, Walker MC, El-Chaâr D, Muldoon KA. The COVID-19 pandemic and parental substance use: a cross-sectional survey of substance use among pregnant and post-partum individuals and their partners. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2183148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Olivia Frank
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Public Health, Columbia University Mailman, New York City, New York, USA
| | - Malia S. Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kathryn M. Denize
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Carlie Boisvert
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kari Sampsel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C. Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- International and Global Health Office, University of Ottawa, Ottawa, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine A. Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Schmidt RA, Wey TW, Harding KD, Fortier I, Atkinson S, Tough S, Letourneau N, Knight JA, Fraser WD, Bocking A. A harmonized analysis of five Canadian pregnancy cohort studies: exploring the characteristics and pregnancy outcomes associated with prenatal alcohol exposure. BMC Pregnancy Childbirth 2023; 23:128. [PMID: 36855094 PMCID: PMC9972615 DOI: 10.1186/s12884-023-05447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND As a teratogen, alcohol exposure during pregnancy can impact fetal development and result in adverse birth outcomes. Despite the clinical and social importance of prenatal alcohol use, limited routinely collected information or epidemiological data exists in Canada. The aim of this study was to pool data from multiple Canadian cohort studies to identify sociodemographic characteristics before and during pregnancy that were associated with alcohol consumption during pregnancy and to assess the impact of different patterns of alcohol use on birth outcomes. METHODS We harmonized information collected (e.g., pregnant women's alcohol intake, infants' gestational age and birth weight) from five Canadian pregnancy cohort studies to consolidate a large sample (n = 11,448). Risk factors for any alcohol use during pregnancy, including any alcohol use prior to pregnancy recognition, and binge drinking, were estimated using binomial regressions including fixed effects of pregnancy cohort membership and multiple maternal risk factors. Impacts of alcohol use during pregnancy on birth outcomes (preterm birth and low birth weight for gestational) were also estimated using binomial regression models. RESULTS In analyses adjusting for multiple risk factors, women's alcohol use during pregnancy, both any use and any binge drinking, was associated with drinking prior to pregnancy, smoking during pregnancy, and white ethnicity. Higher income level was associated with any drinking during pregnancy. Neither drinking during pregnancy nor binge drinking during pregnancy was significantly associated with preterm delivery or low birth weight for gestational age in our sample. CONCLUSIONS Pooling data across pregnancy cohort studies allowed us to create a large sample of Canadian women and investigate the risk factors for alcohol consumption during pregnancy. We suggest that future pregnancy and birth cohorts should always include questions related to the frequency and amount of alcohol consumed before and during pregnancy that are prospectively harmonized to support data reusability and collaborative research.
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Affiliation(s)
- Rose A. Schmidt
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON Canada
| | - Tina W. Wey
- grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Centre, Montreal, QC Canada
| | - Kelly D. Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada ,grid.258970.10000 0004 0469 5874Department of Psychology, Laurentian University, Sudbury, ON Canada
| | - Isabel Fortier
- grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Centre, Montreal, QC Canada
| | - Stephanie Atkinson
- grid.25073.330000 0004 1936 8227Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - Suzanne Tough
- grid.22072.350000 0004 1936 7697Owerko Centre at the Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Cumming School of Medecine, University of Calgary, Calgary, AB Canada
| | - Nicole Letourneau
- grid.22072.350000 0004 1936 7697Owerko Centre at the Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB Canada
| | - Julia A. Knight
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON Canada
| | - William D. Fraser
- grid.86715.3d0000 0000 9064 6198Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, QC Canada
| | - Alan Bocking
- grid.17063.330000 0001 2157 2938Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON Canada
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Popova S, Charness ME, Burd L, Crawford A, Hoyme HE, Mukherjee RAS, Riley EP, Elliott EJ. Fetal alcohol spectrum disorders. Nat Rev Dis Primers 2023; 9:11. [PMID: 36823161 DOI: 10.1038/s41572-023-00420-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Michael E Charness
- VA Boston Healthcare System, West Roxbury, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND, USA
| | - Andi Crawford
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Raja A S Mukherjee
- National UK FASD Clinic, Surrey and Borders Partnership NHS Foundation Trust, Redhill, Surrey, UK
| | - Edward P Riley
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales FASD Assessment Service, CICADA Centre for Care and Intervention for Children and Adolescents affected by Drugs and Alcohol, Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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Wolfson L, Poole N. Supportive alcohol policy as a key element of fetal alcohol spectrum disorder prevention. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231151838. [PMID: 36718116 PMCID: PMC9893348 DOI: 10.1177/17455057231151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In Canada, a Four-Part Model of Fetal Alcohol Spectrum Disorder (FASD) Prevention has been developed that describes a continuum of multi-sectoral efforts, including broad awareness campaigns, safe and respectful conversations around pregnancy and alcohol use, and holistic and wraparound support services for pregnant and postpartum women with alcohol, and other health and social concerns. Supportive alcohol policy is at the centre of the four mutually reinforcing levels of prevention. The purpose of this narrative review is to describe alcohol policies related to specific levels of FASD prevention, and to consider the implications of alcohol policies on FASD prevention and women's and fetal health. The majority of the evidence focused on alcohol in pregnancy guidelines, alcohol warning labels, and knowledge and uptake of national or regional alcohol and pregnancy guidelines. Several US studies described shifts in alcohol and pregnancy policy over the 7-year period, including moves to punitive approaches that criminalize women's substance use or prompt child apprehension. This review indicates that more attention could be paid to the role of alcohol policy in FASD prevention and in promoting women's and fetal health, and that policy actions and advocacy could be important catalysts for both FASD prevention and women's health promotion. Moving forward, it is essential that alcohol policies are rooted in evidence; attend to and promote women's health including health during pregnancy; and are collaborative in order to prompt a higher standard of care, and more holistically respond to the factors that contribute to women's alcohol use during pregnancy.
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Affiliation(s)
- Lindsay Wolfson
- Centre of Excellence for Women’s Health, Vancouver, BC, Canada,Canada FASD Research Network, Vancouver, BC, Canada,Lindsay Wolfson, Centre of Excellence for Women’s Health, E209-4500 Oak Street Box 48, Vancouver, BC V6H 3N1, Canada.
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC, Canada,Canada FASD Research Network, Vancouver, BC, Canada
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11
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Chang G. Reducing Prenatal Alcohol Exposure and the Incidence of FASD: Is the Past Prologue? Alcohol Res 2023; 43:02. [PMID: 37114249 PMCID: PMC10127686 DOI: 10.35946/arcr.v43.1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
PURPOSE This narrative review summarizes and synthesizes the clinical trials and randomized clinical trials that evaluated selected and targeted approaches to reducing preconception and prenatal alcohol exposure (PAE) and alcohol-exposed pregnancy (AEP) since 2011. SEARCH METHODS A professional hospital librarian completed the primary search using strategies specified within this review, resulting in 94 records returned in PubMed, Ovid MEDLINE, Clinical Key, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The author completed two supplementary literature searches. SEARCH RESULTS From the total of 238 records returned from the three searches, 217 records were eliminated. Elimination reasons included other medical problem (119); duplicate entry (34); no content/results (23); secondary analysis (16); focus on effects of PAE (9); treatment of childhood fetal alcohol spectrum disorders (FASD) (6); maternal risk factors (3); and other (7). The remaining 21 studies were included with four overarching themes: (1) case management efforts (n = 4); (2) preconception efforts to reduce AEP (n = 5); (3) motivational interviewing and screening, brief intervention, and referral to treatment (n = 2); and (4) use of technology to deliver the intervention (n = 10). DISCUSSION AND CONCLUSIONS Case management and home visits did not appear to have strong current empirical support. Study limitations included small sample sizes and no comparison groups, whereas larger efforts did not demonstrate definitive advantages to justify this intensive approach. The studies of preconception efforts, all based on the Project CHOICES approach, had similar outcomes, with the reduction in AEP risk largely due to improved contraception in women of childbearing age who were sexually active and drank alcohol but were not pregnant. It is unknown whether these women refrained from alcohol use when they became pregnant. Two studies of motivational interviewing to reduce prenatal alcohol use did not demonstrate the efficacy of the intervention. Both were small, with less than 200 pregnant women combined; moreover, the study samples had low baseline levels of alcohol use, allowing little opportunity for improvement. Finally, studies evaluating the impact of technological approaches to reducing AEP were reviewed. These exploratory investigations had small sample sizes and provided preliminary evaluations of techniques such as text messages, telephone contact, computer-based screening, and motivational interviewing. The potentially promising findings may inform future research and clinical efforts. Future directions may include research to address the limitations of the evidence to date and should reflect the complexities of FASD that include the biological and social context associated with prenatal alcohol use.
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Affiliation(s)
- Grace Chang
- Department of Mental Health, Veterans Administration Boston Healthcare System, Boston, Massachusetts, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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12
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Binder A, Preiser C, Hanke S, Banabak M, Huber C, Petersen KU, Batra A. Researching Alcohol Consumption During Pregnancy. Opportunities and Challenges With Two Methods of Data Acquisition. QUALITATIVE HEALTH RESEARCH 2022; 32:1809-1827. [PMID: 36017584 PMCID: PMC9511243 DOI: 10.1177/10497323221119005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Qualitative research methods, primarily interviews, have become more common in the field of addiction research. Other data sources were often neglected, although sources such as social media can offer insights into the realities of people, since social media also plays a relevant role in today's living environments. This article examines the use of online forums as an underutilized data source in contrast to telephone interviews, to identify methodological opportunities and challenges. We analyzed nine discussion threads and seven interviews about 'alcohol consumption during pregnancy'. Discursive comparison of the results was performed with a focus on sampling issues, comparability and risks for participants and researchers. Key issues were present in both data sources. People with different opinions were openly hostile in forums, while tolerance was more often expressed in interviews. The interviews showed a rather mild communication style, which could be attributed to social desirability. In the forum discussions, the participants often expressed themselves very directly. To comprehensively grasp the subject matter of the research, it is important to recognize the types of communication promoted by different data sources. These results have implications for research about female substance use. Knowledge of the issues will bestow a valuable contribution to researchers working in the field of substance use to help develop appropriate research approaches, as they engage in research into this highly stigmatized and controversial area.
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Affiliation(s)
- Annette Binder
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Christine Preiser
- Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara Hanke
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Meryem Banabak
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Clara Huber
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Kay Uwe Petersen
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
| | - Anil Batra
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, Tuebingen, Germany
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13
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Jung J, Karwal EK, McDonald S, Turner T, Chou D, Vogel JP. Prevention and control of non-communicable diseases in antenatal, intrapartum, and postnatal care: a systematic scoping review of clinical practice guidelines since 2011. BMC Med 2022; 20:305. [PMID: 36123668 PMCID: PMC9487084 DOI: 10.1186/s12916-022-02508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are a leading cause of maternal mortality and morbidity worldwide. The World Health Organization is developing new recommendations focusing on the management of NCDs for pregnant, intrapartum, and postnatal women. Thus, to support the development of new guidelines and recommendations, we aimed to determine the availability, focus, and scope of recommendations of current guidelines for the management of NCDs during pregnancy, intrapartum, and postnatal period. METHODS PubMed, Global Index Medicus, TRIP, and Guideline International Network databases were searched on 31 May 2021, to identify any NCD-related guidelines published between 2011 and 2021 with no language or country restrictions. Websites of 165 professional organizations were also searched. Characteristics of included guidelines were analyzed, and recommendations were extracted from guidelines of five high-priority NCD conditions (diabetes, chronic hypertension, respiratory conditions, hemoglobinopathies and sickle cell disease, and mental and substance use disorders). RESULTS From 6026 citations and 165 websites, 405 guidelines were included of which 132 (33%) were pregnancy-specific and 285 (88%) were developed in high-income countries. Among pregnancy-specific guidelines, the most common conditions for which recommendations were provided were gestational diabetes, circulatory diseases, thyroid disorders, and hypertensive disorders of pregnancy. For the five high-priority conditions, 47 guidelines were identified which provided 1834 recommendations, largely focused on antenatal care interventions (62%) such as early detection, screening tools, pharmacological treatment, and lifestyle education. Postnatal recommendations largely covered postnatal clinical assessments, lifestyle education, and breastfeeding. Health system recommendations largely covered multidisciplinary care teams and strengthening referral pathways. CONCLUSIONS This study provides a robust assessment of currently available guidelines and mapping of recommendations on NCD management within maternal health services, which will inform the scope of the World Health Organization's future guideline development activities. This study identified a need to develop guidelines that consider NCDs holistically, with an integrated approach to antenatal, intrapartum, and postnatal care, and that are relevant for resource-limited contexts. Any such guidelines should consider what interventions are most essential to improving outcomes for women with NCDs and their newborns, and how variations in quality of NCD-related care can be addressed.
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Affiliation(s)
- Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Eshreena K Karwal
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Steve McDonald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Doris Chou
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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14
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Gimenez PV, Lichtenberger A, Cremonte M, Cherpitel CJ, Peltzer RI, Conde K. Efficacy of Brief Intervention for Alcohol Consumption during Pregnancy in Argentinean Women: A Randomized Controlled Trial. Subst Use Misuse 2022; 57:674-683. [PMID: 35258400 PMCID: PMC8967783 DOI: 10.1080/10826084.2022.2026967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although Brief Intervention (BI) has proven to reduce alcohol consumption during pregnancy in high income countries, there is no evidence from the Southern Cone of America. Thus, we conducted a study to assess BI efficacy among Argentinean pregnant women. METHOD AND MATERIALS We collected data on pregnant women receiving prenatal care at the public health system in Mar del Plata, Argentina. Women with less than 26 weeks of gestation (n = 486) were randomized to brief advice (BA) or BI. Three months later they were re-assessed; women with more than 26 weeks of gestation constituted a screening only control group (SC) (n = 154). Self-reported quantity and frequency of alcohol consumption, frequency of binge drinking, and related problems after three months were used as outcomes. We performed generalized estimating equations and clinical significance analyses. Also, we obtained newborn health indicators from the city's health system database to use as objective outcomes. Women who did not participate in any of the three former conditions were randomly selected to constitute a non-screening control group (NSC) (n = 150). We compared objective outcomes among BI, BA, and NSC groups using the Wilcoxon rank test. RESULTS In comparison with SC, BI and BA reduced alcohol consumption, without differences between the latter two. Newborns of women who received BI and BA had better health indicators compared with the NSC group. CONCLUSIONS performing either a BI or BA reduces alcohol consumption among Argentinean pregnant women and might lead to healthier newborns.
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Affiliation(s)
- Paula Victoria Gimenez
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | - Aldana Lichtenberger
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | - Mariana Cremonte
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | | | - Raquel Inés Peltzer
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
| | - Karina Conde
- Institute of Basic, Applied Psychology and Technology (IPSIBAT), National Scientific and Technical Research Council (CONICET), National University of Mar del Plata (UNMdP), Mar del Plata, Argentina
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15
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Popova S, Dozet D, Akhand Laboni S, Brower K, Temple V. Why do women consume alcohol during pregnancy or while breastfeeding? Drug Alcohol Rev 2021; 41:759-777. [PMID: 34963039 PMCID: PMC9305227 DOI: 10.1111/dar.13425] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Issue Alcohol consumption during pregnancy and breastfeeding cause adverse health outcomes to the mother and child, including Fetal Alcohol Spectrum Disorder (FASD). Approach Systematic literature review and thematic synthesis. Original studies that contained reasons for alcohol consumption in pregnancy and while breastfeeding were included. The Mixed Methods Appraisal Tool (MMAT) and the Confidence in the Evidence of Reviews of Qualitative Research (CerQUAL) approach were utilised. The review protocol is available on PROSPERO (registration number: CRD42018116998). Key Findings Forty‐two eligible studies comprising women from 16 countries were included. Most commonly reported reasons of alcohol use in pregnancy were societal pressure and the belief that only “strong” alcohol and alcohol in large quantities is harmful. Other reasons were: a lack of awareness of adverse effects on the fetus; coping with adverse life experiences; consumption based on intuitive decision‐making and influenced by personal/peer experiences; belief in the beneficial properties of alcohol; advice from medical practitioners; unwanted or unplanned pregnancy; alcohol dependence; and consumption as a cultural/traditional custom. Reasons for alcohol use during breastfeeding included the belief that alcohol stimulates breast milk production, unclear advice from medical practitioners, unawareness of the risks of infant exposure and to improve mood and celebrate events. Implications Understanding the context of reasons for alcohol use in pregnancy is crucial for implementing prenatal health education, and preventing FASD and other adverse maternal and child health outcomes. Conclusion Individual beliefs, knowledge/advice, culture and personal circumstances influence alcohol use in pregnancy. Data are limited for reasons surrounding alcohol use while breastfeeding.
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Affiliation(s)
- Svetlana Popova
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Danijela Dozet
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shahela Akhand Laboni
- Center for Clinical and Translational Science, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Krista Brower
- Edmonton Oliver Primary Care Network, Edmonton, Alberta, Canada.,Department of Educational Research, Lancaster University, Lancaster, UK
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16
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Abstract
Importance Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern. Objective The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use. Evidence Acquisition A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term "substance use," the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used. Results All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed. Conclusions The diversity of guidelines' recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.
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17
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Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives. Int J Ment Health Addict 2021; 21:1220-1239. [PMID: 34580577 PMCID: PMC8457028 DOI: 10.1007/s11469-021-00655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/27/2022] Open
Abstract
Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women's alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.
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18
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Cook JL. Alcohol use during pregnancy and fetal alcohol spectrum disorder in Canada: who, what, where? Health Promot Chronic Dis Prev Can 2021; 41:264-266. [PMID: 34549917 PMCID: PMC8565492 DOI: 10.24095/hpcdp.41.9.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jocelynn L Cook
- Chief Scientific Officer, The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
- National Database Lead, Canada FASD Research Network, Vancouver, British Columbia, Canada
- Adjunct Professor, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
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19
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Grubb M, Golden A, Withers A, Vellone D, Young A, McLachlan K. Screening approaches for identifying fetal alcohol spectrum disorder in children, adolescents, and adults: A systematic review. Alcohol Clin Exp Res 2021; 45:1527-1547. [PMID: 34453340 DOI: 10.1111/acer.14657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/30/2021] [Accepted: 06/08/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental disorder that is caused by prenatal alcohol exposure (PAE) and associated with a range of cognitive, affective, and health concerns. Although the identification of FASD can facilitate the provision of interventions and support, and plays a protective role against adverse outcomes, there are high rates of missed detection. The identification of FASD via screening may improve its recognition across settings. The current systematic review examined the available evidence on FASD screening tools and approaches across age groups and settings. METHODS A systematic search was carried out for both peer-reviewed studies and gray literature sources published between January 1990 and May 2020 and was preregistered with PROSPERO (#CRD42019122077). Studies included in the review focused on human applications of FASD screening in children, adolescents, and adults. The quality of the studies was assessed using the QUADAS-2 and GRADE frameworks. RESULTS The search yielded 20 screening tools and approaches across 45 studies, broadly characterized in 2 groups. The first group included approaches currently in use that aim to identify individuals at risk of FASD using a range of markers (n = 19) or associated sentinel dysmorphic facial features (n = 6). Another group of studies, characterized as emerging, focused on identifying promising biomarkers of PAE/FASD (n = 20). Overall, we identified limited research supporting the psychometric properties of most screening approaches. The quality review provided evidence of bias due to the common use of case-control designs and lack of adequate reference standards. CONCLUSIONS Although several FASD screening tools and approaches are available for use across a range of age groups and settings, the overall evidence base supporting their psychometric properties is weak, with most studies demonstrating significant risk of bias. Service providers should exercise caution in selecting and implementing FASD screening tools given these limitations. It is critically important to accurately identify individuals with FASD across ages and settings to support healthy outcomes. Thus, there is a pressing need for additional research in this area, particularly validation studies in large and representative samples using robust methodological approaches.
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Affiliation(s)
- Melissa Grubb
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Ariella Golden
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Abigail Withers
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Daniella Vellone
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Arlene Young
- Department of Psychology, University of Guelph, Guelph, ON, Canada
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20
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Graves L. Approaching Substance Use in Pregnancy: Giving Brief Intervention a Chance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1069-1070. [PMID: 32900453 DOI: 10.1016/j.jogc.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lisa Graves
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
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21
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Green CR, Kaminsky KJ, Tough S, Roberts N, Nagpal TS, Cook JL. Perspectives of Canadian Health Care Providers on Fetal Alcohol Spectrum Disorder: Has Anything Changed in 15 years? A Brief Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1086-1089. [PMID: 33581349 DOI: 10.1016/j.jogc.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
Initiatives have been implemented to provide training to health care providers (HCPs) on the adverse health outcomes associated with alcohol use during pregnancy, including the risk of fetal alcohol spectrum disorder (FASD). The purpose of this exploratory study was to compare two cross-sectional data sets of HCP perspectives over 15 years. In 2002 and 2017, two samples of HCPs received a survey on FASD. The findings from these surveys may inform the development of ongoing educational initiatives to help HCPs with screening for alcohol use during pregnancy and early diagnosis and prevention of FASD.
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Affiliation(s)
- Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Kyla J Kaminsky
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Suzanne Tough
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Nicole Roberts
- Better Outcomes Registry & Network (BORN) Ontario, Centre for Practice-Changing Research, Ottawa, ON
| | - Taniya S Nagpal
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON.
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22
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Popova S, Dozet D, O'Hanlon G, Temple V, Rehm J. Maternal alcohol use, adverse neonatal outcomes and pregnancy complications in British Columbia, Canada: a population-based study. BMC Pregnancy Childbirth 2021; 21:74. [PMID: 33482764 PMCID: PMC7821646 DOI: 10.1186/s12884-021-03545-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/06/2021] [Indexed: 11/15/2022] Open
Abstract
Background The current study aimed to estimate the prevalence of alcohol use identified as a risk factor during pregnancies by the antenatal care providers, resulting in live births in British Columbia (BC) and to examine associations between alcohol use, adverse neonatal outcomes, and pregnancy complications. Methods This population-based cross-sectional study utilized linked obstetrical and neonatal records within the BC Perinatal Data Registry (BCPDR), for deliveries that were discharged between January 1, 2015 and March 31, 2018. The main outcome measures were alcohol use identified as a risk factor during pregnancy, associated maternal characteristics, pregnancy complications, and adverse neonatal outcomes. Estimates for the period and fiscal year prevalence were calculated. Chi-square tests were used to compare adverse neonatal outcomes and pregnancy complications by alcohol use during pregnancy identified as a risk factor. Logistic regression was used to examine the association between alcohol use identified as a risk factor during pregnancy and adverse neonatal outcomes and pregnancy complications, after adjusting for identified risk factors. Results A total of 144,779 linked records within the BCPDR were examined. The period prevalence of alcohol use during pregnancy identified as a risk factor was estimated to be 1.1% and yearly prevalence was 1.1, 1.1, 1.3 and 0.9% from the 2014/2015 to 2017/2018 fiscal years, respectively. Alcohol use identified as a risk factor was associated with younger maternal age, fewer antenatal visits, being primiparous, a history of mental illness, substance use and smoking. Neonates with alcohol use during pregnancy identified as a risk factor had greater odds of being diagnosed with: “low birth weight (1000-2499g)” (ICD-10: P07.1; aOR = 1.25; 95% CI: 1.01, 1.53), “other respiration distress of newborn” (ICD-10: P22.8; aOR = 2.57; 95% CI: 1.52, 4.07), “neonatal difficulty in breastfeeding” (ICD-10: P92.5; aOR = 1.97; 95% CI: 1.27, 2.92) and “feeding problems, unspecified” (ICD-10: P92.9; aOR = 2.06; 95% CI: 1.31, 3.09). Conclusions The prevalence of alcohol use during pregnancy identified as a risk factor was comparable to previous estimates within the BCPDR. Identified prenatal alcohol exposure was associated with notable differences in maternal and neonatal characteristics and adverse neonatal outcomes. More consistent, thorough screening and prevention efforts targeting alcohol use in pregnancy are urgently needed in Canada. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03545-7.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada. .,Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Danijela Dozet
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Graham O'Hanlon
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Valerie Temple
- Surrey Place, 2 Surrey Place, Toronto, ON, M5S 2C2, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
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23
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Graves DL. Aborder la consommation de substances psychoactives pendant la grossesse : adopter l'intervention brève. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1071-1072. [DOI: 10.1016/j.jogc.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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