Substance use and pregnancy: Updated info sheets for service providers

When addressing alcohol use during pregnancy and the prevention of FASD, it’s important to remember that alcohol use does not occur in isolation. While it remains crucial to share information about the risks of, and to ask about alcohol use during the perinatal period, service providers should also be prepared to talk about how use of other substances together with alcohol increases risk. To assist service providers in having informed conversations about substances with women, we developed five info sheets on alcohol, cannabis, nicotine and tobacco, and prescription opioids. Originally created in 2017, they were updated in 2024 to reflect the most recent research and practice wisdom. Each sheet includes:

• General information about the substance;
• Health information that considers sex and gender factors relevant to women; and,
• The latest research related to pregnancy, breastfeeding, and parenting.

Below, we outline key updates to each sheet.

Women and Alcohol

The updated version of this sheet incorporates key points from Canada’s Guidance on Alcohol and Health,  to think through the continuum of risk associated with alcohol consumption with women and how to reduce harms.

Find the info sheet here.

Women and Cannabis

Updates to this info sheet include key findings from a three-year study led by the Centre of Excellence for Women’s Health on sex, gender, and cannabis. The sheet includes information to contextualize why women may be using cannabis, such as for pain management, relief from pregnancy related symptoms and discomfort, and as an alternative to pharmaceuticals.

While the latest research on cannabis use during pregnancy and breastfeeding is presented, we also acknowledge that significant knowledge gaps remain at this time. For more information on this topic, visit the Reproductive Health page of our Sex, Gender & Cannabis Hub.

Find the info sheet here.

Women, Nicotine & Tobacco

Nicotine and/or tobacco are often used at the same time as alcohol and have significant health impacts on women, pregnancy, fetuses, and children. The updates to this sheet include the addition of nicotine use and vaping, and information on supporting women through withdrawal and cessation efforts from nicotine and tobacco.

As requested by many service providers, the updated sheet includes emerging research on the impact of vaping nicotine on women’s and perinatal health. For more information on this topic, check out our two resources on vaping during pregnancy and postpartum from a recently completed study on vaping cannabis and nicotine during the pregnancy and postpartum periods:

• Vaping During Pregnancy and Postpartum
• Why women vape during pregnancy and postpartum: Conversation starters for your practice

Find the info sheet here.

Women and Prescription Opioids

In the update to this sheet, we include information on the impact of prescription opioids on women’s health, including hormonal changes and other effects, in addition to risks of addiction. Additionally, recent research on pregnancy, breastfeeding and parenting are included, with updated information on Neonatal Opioid Withdrawal Syndrome.

Find the info sheet here.

As we updated Women and Prescription Opioid info sheet, we were also concluding a two-year project centred on women’s chronic pain and prescription opioid use, which prompted us to create a complementary info sheet with a special focus on chronic pain. It provides some reasons why women use prescription opioids for chronic pain, highlights women’s experiences of benefits and harms, and provides some guidance on comprehensive pain management. For more information on this topic, check out the project page on our website.

Find the sheet here.

Ideas for Action

Our hope is that service providers can use these sheets in their conversations with women, providing a tangible resource to ground discussions and for women to take home for further reflection. Designed to be user friendly, each sheet offers a concise yet comprehensive overview of the substance, accompanied by essential insights and information relevant to women’s general and perinatal health. Find all the sheets and explore more resources here.

Celebrating Leadership on FASD prevention – The work of Margaret Leslie

Click here to listen to the blog (2:49).

Margaret Leslie and Nancy Poole at her retirement event at Hart House, University of Toronto, January 24, 2024

In the lead-up to International Women’s Day, this blog celebrates the impressive contribution of Margaret Leslie to FASD prevention program development, delivery, evaluation and research. This year, the theme for International Women’s Day is about investing in women. Margaret recently retired after 3+ decades of embodying this theme in her leadership of the Breaking the Cycle program in Toronto. 

“Breaking the Cycle (BTC) is an early identification and prevention program designed to reduce risk and to enhance the development for substance-exposed children (prenatal – 6 years) by providing services which address maternal addiction problems and the mother-child relationship through a community based cross-systemic model. Families receive integrated addictions counselling, health/medical services, parenting support, development screening and assessment, early childhood interventions, child care, access to FASD Diagnostic Clinic, and basic needs support in a single access setting in downtown Toronto, with home visitation and street outreach components.” (mothercraft.ca)

An early BTC evaluation report

Since 1995, Margaret and her colleagues have been committed to research and evaluation to guide the multifaceted program development at BTC.  Their early and ongoing research and evaluation work has yielded rich practice-based lessons that have been shared with, and influenced, all of us at the national level.

Margaret also led several strategies about trauma-informed and relational approaches, that have supported community based programs nationally and internationally, to assist women and their children who face intersecting issues of violence, trauma and substance use. That, and related work to advance comprehensive and intersectional approaches, caused BTC under her leadership to be recognized as offering best practice by the United Nations Office on Drugs and Crime.

Most recent fact sheets

Research and program evaluation continue to provide additional insights into the outcomes and underlying processes of the BTC approach. BTC recently published its fourth evaluation report and fact sheets about The Mother-Child Study: Evaluating Treatments for Substance-Using Women – A Focus on Relationships.  The study examined and validated BTC’s seminal 3-pronged relational approach designed to help mothers, their children and the mother-child unit. It also underlines the importance of harm reduction, trauma informed and integrated approaches.

Through all these avenues and resources, Margaret has made a profound contribution to the field of FASD prevention. Brava Margaret and happy International Women’s Day!

“Recovery is the resistance”

Click here to listen to the blog (3:53).

For some women, not drinking in pregnancy is about making a very profound change: it means finding recovery from a serious alcohol problem and all the health and social issues that accompany having a serious alcohol problem. No small task.

Books about recovery from women’s perspectives can be incredibly helpful to those embarking on this journey, as an adjunct or alternative to finding treatment and other supports.

Writing on women and recovery

Beginning in the 1970s, through writings, trailblazing women have helped us see recovery from the perspective of women, and to take a critical view of how addiction-related groups, programs and systems have failed to take women’s lived experience into account. In the New Life booklet and the Women for Sobriety program, Jean Kirkpatrick catalysed women to see themselves as capable and competent as women, connected to other women in collective recovery. Stephanie Covington, in the initial and subsequent A Woman’s Way through the 12 Steps books, has done the invaluable service of helping many women find within AA, what can work for them as women. Charlotte Kasl wrote the Many Roads One Journey book and designed the 16 Steps for Discovery and Empowerment program as an alternative recovery model for women that links the experience of trauma and substance use. In the book Drink: The Intimate Relationship Between Women and Alcohol, Canadian journalist Ann Dowsett Johnston provided both personal reflections on recovery, but also a solid critique of how alcohol is marketed to women, nesting the recovery journey within a soup of societal forces that make the journey uphill.

More recent empowering guidance on women’s recovery

There are recent writings from women in recovery which are inspiring in their descriptions of the complexities of the recovery process, their critique of the gendered challenges women face, and their very practical advice on self directed recovery practice for women. One such book is Dawn Nickel’s She Recovers Every Day book of meditations for women. Dawn and her daughter founded the SheRecovers movement “dedicated to redefining recovery, inspiring hope, ending stigma and empowering women in or seeking recovery to increase their recovery capital, heal themselves and help other women to do the same.”  This book, while small in size, packs powerful wisdom and critique in short daily readings that conclude with a daily affirmation statement. It is helpful to every woman on a recovery path, and as SheRecovers asserts:

“we are all recovering from something, and you don’t have to recover alone.”

-SheRecovers

Quit Like a Woman!

Another fine example of the new wave of writings on women and stopping drinking is Holly Whitaker’s book entitled Quit Like a Woman. She picks up on Johnston’s thesis about the challenges of not drinking, within a culture obsessed with alcohol. The book is funny, clever, fearless, insightful and candid. See for example “seven things I wish I’d known about relationships before I got sober” – the “act like a log” advice alone, is worth reading the book for. It is a great, readable guide for women who want to take steps to quit drinking, providing solid analysis of what women face in recovery, what her own trial and error process involved, and what might work as other women put together a recovery journey. In the final chapter Whitaker says “If recovery is anything, it’s the first step on the path to radical self awareness.” She sums up by taking up the points of the pioneering women mentioned above, about seeing sexism and other forms of oppression that we need to shed and resist, discovering our power, and finding collective growth in recovery. She ends with the statement:

“Recovery is the resistance. Here is where you start”

-Holly Whitaker

Awareness raising as foundational to FASD prevention

Click here to listen to the blog (4:48).

Since 2015 we have been discussing awareness raising as one of the 4 levels of FASD prevention via this blog. This month we share selected examples of posters developed in Canada to promote awareness of the risks of alcohol use during pregnancy, as a reminder of best practice in awareness raising.

What can we achieve with awareness raising posters?

CanFASD has created Tips for creating effective alcohol and pregnancy awareness campaigns to promote understanding of effective approaches. These tips highlight how posters and other awareness raising products can:

• Influence knowledge and levels of awareness, and shift unhelpful attitudes and beliefs
• Encourage information seeking
• Convey info about how to make positive changes and identify where to receive support and services
• Remind people who already know the facts of the issue and reinforce this knowledge
• Show how we all play a part in FASD prevention, that FASD prevention is not only the responsibility of pregnant women & gender diverse individuals

Included in the resource, four components for effective posters are named:

1. Comprehension – posters contain simple, clear information
2. Noticeability – posters are easy to read and are placed in an easy to see location
3. Recall – posters are memorable
4. Integrated – posters connect us to more learning and resources

Evidence-informed awareness raising using posters

Drawing upon these 4 components and integrating a women’s health determinants perspective, awareness raising posters can be supportive of healthy pregnancies, contribute to FASD prevention and be non-stigmatizing. Here are a few Canadian examples of posters that use components of evidence-based approaches:

Noticeability and use of non-stigmatizing images and messaging

The Saskatchewan Prevention Institute offers many helpful images which can be used in poster development for prevention efforts.

The images are positive and inclusive – avoiding images that are unnecessarily threatening or stigmatizing. Unnecessarily graphic images can be off-putting, can prompt a fear-based response, that in turn can cause women who have consumed alcohol while pregnant to feel helpless, ashamed, and hesitant to seek healthcare.

In this poster from the Yukon, a catchy image is shown with two coffee cups side-by-side. The poster considers a prominent reason for alcohol use – social connection – and suggests places and ways in which people can gather and have an alcohol-free pregnancy.

Finding the balance between naming the risk and connecting to supports

It is important to clearly state the risk of alcohol use in pregnancy without disempowering or stigmatizing pregnant women and gender diverse individuals. This is key to their acting on the information, and reaching out for support as needed.

The Piruqatigiit Resource Centre in Nunavut offer a poster about Tamatta/Circles of Support which includes clear information and is informed by culture-based principles. They support information seeking with the statement “it’s never too late to reach out” and provide an address in Iqaluit, and website and phone number to access for additional information and support.

Promotes collective responsibility for FASD prevention

As with the Circle of Support poster, it is important to advance collective responsibility for FASD prevention.  Support for reducing/stopping alcohol use in pregnancy needs to be placed with partners, friends, health care providers, communities, liquor distribution branches, policy makers, etc.

This poster (and accompanying pamphlet) is part of BC Liquor Stores’ social responsibility commitment. They place posters and distribute pamphlets about the risks of alcohol use during pregnancy in government stores.

And this poster from the Saskatchewan Prevention Institute promotes awareness of the responsibility of partners, specifically.

Canada FASD Conference

The Canadian FASD conference took place in Saskatoon in November, sponsored by the CanFASD Research Network in partnership with the governments of Alberta, Saskatchewan, and the Canada Northwest FASD Partnership.

Like no other FASD conference to date, the attention to prevention was phenomenal.  And the warmth, respect and solidarity among researchers, families, service providers, government representatives and individuals with the disability was wonderful to experience.

Some highlights from presentations related to our 4 levels of prevention:

See Developing an Innu FASD Prevention Strategy and Giving Birth to a New Area of FASD Research

See Healthy Care Pregnancy Program

See the Prevention Conversation and Project Choices

See Alberta PCAP Council

See Global Alcohol Policy Alliance

Across the four levels, there was:

• A workshop on the 4 levels of FASD prevention that was offered in a world café style. We were heartened by how many people came to learn and offer ideas about prevention.
• Finally, at a plenary panel on day two of the conference we reflected on our pNAT work from research, practice, policy and lived experience perspectives. Dr Mary Motz reflected on the foundations of her longstanding practice at the Breaking the Cycle program, Melanie Muehling highlighted the cross-disciplinary approach of the Government of Manitoba in partnership with community programs, researchers and people with lived experience, Lisa Lawley from Terrace, BC spoke compellingly on how we can continue to support women with lived and living experience, and Dr Nancy Poole commented on the future of FASD prevention work at all the 4 levels.  We thank Myles Himmelreich as emcee for making the panel intro and closure so much fun.

We are also thankful to the CanFASD Research Network for all these opportunities to show how FASD prevention work is being advanced in Canada.

Global Alcohol Policy Conference

Click here to listen to the blog (3:39).

We recently posted about the role of supportive alcohol policy as a key component in supporting women and children’s health and FASD prevention efforts. In October, Lindsay Wolfson, a researcher at the Centre of Excellence for Women’s Health and Canada FASD Research Network, attended the 7^th Global Alcohol Policy Conference in Cape Town, where she presented the findings of this work. You can find the paper she led on alcohol policy and FASD prevention here.

Considering gender, pregnancy, and FASD Prevention: Highlights from the conference

The bi-annual conference brought together constituents from across the globe. The conference addressed alcohol marketing and advertising controls; pricing and taxation; liquor law enforcement; and health and safety messaging. Linked to these policy domains was an emphasis on alcohols relationship to gender-based violence and community-based alcohol strategies.

The conference opened with a powerful plenary where Bongiwe Ndono of South Africa Alcohol Policy Alliance, emphasized the role of alcohol in gender justice and how, without appropriate laws and regulations and a shift in society’s relationship with alcohol, we will not be able to address the links between alcohol and violence.

The conference also featured leading researchers from South Africa, Australia, the United Kingdom, and the United States. Drs. Rachel Jewkes, Anne-Marie Laslett, and Natalie Blackburn described the complex relationship between alcohol and violence, including how alcohol is a contributor, cause, and trigger for abuse; gender transformative programs that focus on reducing alcohol use and gender-based violence; and how alcohol policies can be paired with other strategies to reduce intimate partner violence and alcohol use most effectively.

In another plenary presentation, Dr. Antonia Lyons from the University of Auckland, discussed the influential and addictive nature of digital alcohol marketing compared to previous marketing media. Her presentation emphasized how, by creating devices, products, and social media platforms all with addictive qualities and that allow for personalization, the alcohol and tech industries stand to maximize profits without regard for the harms they are causing. This is important, given the increasingly gendered nature of alcohol advertising and the impact that this marketing may have on alcohol use and alcohol use during pregnancy.

FASD prevention was often mentioned as a goal or an unanticipated outcome of policy efforts. For instance, in one presentation from Northeast England about developing a childhood alcohol-free strategy, the authors described how an estimated 47% of adults drank above the low risk drinking guidelines and 41% of women used alcohol during pregnancy. The strategy has been effective in reducing children’s exposure to parental alcohol use and has led to a reduction in alcohol use during pregnancy.

Canada on the global stage

Where FASD was highlighted, it often was done with Canada’s leadership at the forefront. For example, in the extensive discussions on alcohol warning labels, researchers and policymakers often cited the evidenced and successful nature of pregnancy and alcohol warning labels in the Yukon. And, there was global recognition of Canada’s efforts to amend warning labels on alcohol containers and to bring forth a National Framework on FASD. These discussions highlight the importance of continued investment in FASD prevention in Canada. Further, they offer an opportunity for us to continue to reflect, discuss, and promote supportive alcohol policy as a key FASD prevention strategy.

Working with the Media: Creating Resources for Journalists

Click here to listen to the blog (2:02).

Translating knowledge about alcohol, alcohol use in pregnancy, and FASD remains a tricky task. In 2013, at the International Conference on FASD in Vancouver, a panel addressed how the science of alcohol use during pregnancy is translated into messages by the public health and media, and provided tips for media advocacy. In 2023, the need for consistent and de-stigmatizing information has never been more urgent.

Research in the last decade has found that media coverage of FASD most often frames the actions of mothers who use alcohol during pregnancy without compassion, and individuals with FASD as deserving of sympathy. Coverage is often stigmatizing and isolating and is often interspersed with conflicting information about the safety of alcohol use during pregnancy.

In recent years, the Canada FASD Research Network has released common messaging guides (updated annually) with the most up-to-date language advice for speaking and writing about FASD, as well as a media guide. Their most recent resource, Reporting on Alcohol Use During Pregnancy and Fetal Alcohol Spectrum Disorder, further supports understanding and reporting by those working in the Canadian media.

The resource follows the release of Canada’s Guidance on Alcohol and Health and reinforces the messaging that drinking less is better for everyone’s health, and that no alcohol is safest during pregnancy. It then answers common questions about alcohol use in pregnancy such as: 1) What are the risks of alcohol use during pregnancy? 2) Why might alcohol be consumed during pregnancy? and 3) What supports can benefit people who use alcohol during pregnancy? Among others.

In this era of misinformation, it has never been more important to adopt an evidence-informed approach and consistent messaging around alcohol use, alcohol use during pregnancy, and FASD.

Read the resource in full here or visit the CanFASD website for more information.

FASD Awareness Month 2023

Click here to listen to the blog (3:24).

September is recognized as FASD Awareness Month in Canada, with International FASD Day on September 9^th. Throughout the month, there are events, campaigns, and activities that aim to raise awareness of the disability and its prevention in order to improve diagnosis, and support for individuals with FASD and their caregivers, as well as women at risk of having an alcohol exposed pregnancy.

Inspiring awareness-raising events and activities are happening across the country. The Canada FASD Research Network (CanFASD) is Canada’s go-to resource for more information, offering a social media toolkit, as well as a list of buildings and monuments that will light up red on FASD Day in connection with the Red Shoes Rock movement. Find it all here.

Uniting Our Strengths: Finding Solutions Together

This year’s theme for FASD Awareness Month is Uniting Our Strengths: Finding Solutions Together. In connection with that theme, we want to highlight some of the great prevention campaigns, activities, and partnerships happening across Canada for FASD month.

Posters, coasters, brochures & more!

Researchers at the Centre of Excellence for Women’s Health and CanFASD co-developed a brochure called Action on FASD Prevention in Canada that provides a brief overview of key principles that guide FASD prevention work in Canada, as well as examples of what prevention can look like at multiple levels. It is available to be printed and can be used as a quick explainer for those new to prevention.

In Alberta, the Prevention Conversation, Alberta Gaming, Liquor, and Cannabis, and the Alberta FASD Networks are distributing lawn signs, posters, and coasters with information about the risks of alcohol use in pregnancy and FASD.

The Saskatchewan Prevention Institute is including FASD awareness messaging on various items, including pop-sockets, t-shirts, and USB hubs. And keep your eyes peeled for their media release and social media posts online!

Community-based events

In addition to distributing posters, the Lakeland Centre for FASD is hosting a number of events for their community, including a community BBQ and a mocktail challenge. Check out CanFASD’s mocktail challenge from last year for inspiration!

In Yukon, the FASD Interagency Advisory Committee’s FASD Awareness & Prevention Working Group is running a Facebook quiz and interactive educational display. Healthy Child Manitoba is organizing take-home pregnancy kits with FASD prevention messaging attached.

New research

The Public Health Association of Quebec (ASPQ) is highlighting new research on attitudes around drinking, pregnancy, and FASD.

And CanFASD has information about recent and emerging research on FASD and its prevention. Learn more here and here.

These are just a taste of all the great activities and events happening to raise awareness of FASD prevention across the country! Each campaign, event, and activity contributes to raising awareness of the risks of alcohol use during pregnancy and FASD, allowing us to unite our strengths and find solutions together that are trauma-informed, culturally grounded, and non-stigmatizing.

Supportive Alcohol Policy as a Key Component in FASD Prevention

Click here to listen to the blog (3:56).

In Canada, the Four-Part Model of FASD Prevention is used to describe the continuum of multi-sectoral prevention efforts, including broad awareness campaigns, safe and respectful conversations around pregnancy and alcohol use, and holistic wraparound support services for pregnant and postpartum women with alcohol and other health and social concerns. Supportive alcohol policy is at the centre of these four mutually reinforcing levels of prevention, yet there has been little attention paid to the role of alcohol policy in FASD prevention and in promoting women’s and fetal health.

Alcohol policies are important because they determine the availability of alcohol and aspects of the environment in which decisions about drinking are made, such as the geographic density of alcohol serving establishments, health and safety messaging, and alcohol use guidelines (including Canada’s new Guidance on Alcohol and Health).

In 2023, researchers from the Centre of Excellence for Women’s Health wrote a review describing the state of the literature on alcohol and pregnancy policies and their impact across the four-part model of prevention. The findings primarily centered around alcohol warning labels, pregnancy guidelines and their national and regional uptake.

Alcohol Warning Labels

The findings emphasized that while the efficacy of alcohol warning labels as a single strategy is unclear, they are an important part of a comprehensive FASD prevention strategy. Further, in Canada, researchers have found that alcohol warning labels can contribute to a reduction of alcohol sales.

Pregnancy Guidelines

While there was an emphasis on the knowledge and uptake of guidelines on alcohol use in pregnancy and lower-risk drinking, the research findings demonstrated wide variability internationally, including inconsistent messaging around alcohol use. Despite this, knowledge of the risks of alcohol use during pregnancy and a belief that women are motivated to reduce their alcohol use if pregnant or planning a pregnancy were identified as facilitators to guideline adherence.

Legislative Policy

In the research, there was an increasing focus on alcohol and pregnancy legislative policy, particularly in the US. These ranged from punitive approaches that reported women’s behaviour and prompted child removal to supportive policies that improve women’s health and support the provision of early intervention and treatment services. In examining the evolution of such policies, US researchers found that the number of alcohol policies have increased and in an increasingly punitive policy environment, are often associated with restricting women’s reproductive autonomy.

Supporting FASD Prevention, Women’s Health, and Cross-System Collaboration

Shifting policies to be more supportive of FASD prevention requires the development of evidence-based policies that attend to, and proactively promote, women’s health. Moving forward, it is particularly important that alcohol policies – and supportive alcohol policies at that – are linked to child welfare policies that support mothering.  They are depicted together and central in the four part model diagram. This cross-system collaboration can help create a higher standard of care and address the barriers that prohibit women from seeking care in the first place. Through this collaboration, women will be supported to have healthy pregnancies, linked to treatment and diagnosis as necessary, and have access to services that prioritize their needs and goals.

To learn more, read the article here. 

FASD Prevention: An Annotated Bibliography of Articles Published in 2022

Click here to listen to the blog (3:53).

This year’s Annotated Bibliography of Articles Published in 2022 was just released and includes 113 articles from 33 countries.

Each year, researchers associated with the Prevention Network Action Team (pNAT) of the Canada FASD Research Network search the academic literature for articles related to alcohol use in pregnancy and Fetal Alcohol Spectrum Disorder (FASD) prevention. Articles are reviewed for relevancy, identified by topic and country, and the findings are summarized.

Countries with the highest number of articles published were the US (44 articles), Australia (25 articles), Canada (16 articles), and the UK (13 articles). The findings were organized using a four-part prevention model (below) used by the pNAT to describe the wide range of work that comprises FASD prevention. This year, 48 articles described the prevalence, influences, and factors associated with alcohol use in pregnancy, 12 articles described Level 1 prevention efforts, 32 articles described Level 2 prevention efforts, 13 articles described Level 3 prevention efforts, 13 articles described Level 4 prevention efforts, and 13 articles described stigma, ethical issues, and systemic approaches.

Canada’s 4-part prevention model

This year we created a category that includes articles describing supportive alcohol and child welfare policy, in which 11 articles were included. An article in this section described the benefits of the Plans of Safe Care initiative (covered in a previous blog), where nearly 90% of participant families were found to avoid out-of-home-placement, illustrating how this program fosters support and creates protective linkages to community-based programs for infants prenatally exposed to substances and their families.

This year, we also saw a shift in how technology was described. In previous years, articles largely spoke to how technology can be used in Level 1 and Level 2 prevention efforts. However, this year, we saw technology also being described in Level 3 and 4 efforts. One study described a virtual peer support program where participants found the virtual space to be a comfortable and safe space where they were able to develop community.

A number of articles considered issues and practices related to screening for alcohol use in the perinatal period. One study captured women’s preferences for specific screening tools (such as the 4P’s Plus), and another explored barriers to disclosure of alcohol use and how health professionals can mitigate these through relational practice.

Consistent with previous years, several studies reported the efficacy of brief interventions. Brief interventions developed by/with Indigenous communities were described, including a mobile health one. And in this year’s bibliography, there was more research on the use, barriers and benefits of brief interventions delivered by a range of providers including physicians, nurses, midwives, pharmacists, and nutritionists. 

The annual literature search is intended to update those involved in FASD prevention in Canada, so that their practice and policy work may be informed by current evidence. The members of the pNAT also have the opportunity in monthly web meetings to discuss the implications of the findings for their work. You can access the annotated bibliography here, and view previous annotated bibliographies here.