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Research has shown that everyone has a role to play in preventing FASD and that positive messaging is most effective for promoting awareness and discussion of alcohol use during pregnancy. Understanding positive messaging can help avoid the unintended negative consequences we have seen from previous efforts. Prevention-positive principles include:
- Using non-exploitative imagery. Prevention campaigns are replacing lone naked-belly images with those that emphasize the mother-child dyad within a supportive network.
- Respectful messaging that encourages women to access help if they need it rather than fear-based or blaming messaging like “if you loved your baby, you wouldn’t drink.”
- Linking to where information and help is available.
- Not describing FASD as “100% preventable” as this may lead women to think that the system of care won’t welcome them if they have already consumed alcohol in pregnancy.
Here are some recent examples of prevention-positive efforts from across Canada.
Yukon
The Yukon FASD Interagency Advisory Committee is taking a prevention-positive approach with their “Alcohol-free is supportive” campaign. It consists of posters in English and French, ads in the local theatres, online ads, and a radio ad as featured on CKRW. Below is an example of one poster with plans for others in the coming months. Partners in this project are the Yukon Government, Fetal Alcohol Syndrome Society of the Yukon (FASSY), and Child Development Centre.
Alberta
Women can sign up to do a “Dry 9” and receive a t-shirt and emails of support during their pregnancy. The Dry 9 movement encourages others to support women who decide not to drink any alcohol during their pregnancy. Short videos on topics such as the “Persistent Friend”, “Co-Parent to Be”, and the “Previous Generation” can be shared with others. The Alberta Gaming and Liquor Commission launched the Dry 9 movement last December as part of DrinkSense.
Saskatchewan
The Saskatchewan Prevention Institute focused on positive partner support in their “This is why I supported her not to drink” campaign. The information card is available as a poster and there are also versions in Dene and Cree. Learn more about partner influence and support on their “How To Help” page http://skprevention.ca/how-to-help/
Saskatchewan Prevention Institute http://skprevention.ca/
Québec
Health professionals in Québec City will use printable pamphlets to have discussions with women and their partners about alcohol and pregnancy. Besides information on alcohol and FASD, the pamphlets, published with the help of Public Heath Agency of Canada, describe fetal development, and resources and support. Link to brochures and posters can be found on the Dispensaire Diététique de Montréal site.
Montreal Diet Dispensary and the Public Health Agency of Canada
Ontario
Having discussions about alcohol and birth control with all women of childbearing age and their partners has proven to be an effective FASD prevention strategy. This FASD ONE prevention poster aims to encourage health and social service providers to have discussions and to support a universal screening approach.
FASD ONE
For previous posts about other prevention campaigns, see:
ARE SHOCK TACTICS EFFECTIVE? March 22, 2011
SHOULD AWARENESS CAMPAIGNS BE FEAR-BASED OR SUPPORT-BASED? April 20, 2011
STRONG SPIRIT STRONG FUTURE CAMPAIGN IN WESTERN AUSTRALIA December 19, 2013
ALCOHOL AND PREGNANCY CAMPAIGN FROM NUNAVUT, CANADA September 23, 2014
ONTARIO ALCOHOL AND PREGNANCY AWARENESS CAMPAIGN DRAWS MIXED REACTIONS September 16, 2014
“SWAP THE PUB FOR YOUR BUB” – PREGNANT PAUSE CAMPAIGN LAUNCHES IN CANBERRA August 21, 2014
FASD AWARENESS CAMPAIGNS: CREATING EFFECTIVE MESSAGES July 14, 2014
“WOMEN WANT TO KNOW” CAMPAIGN FOR HEALTH PROFESSIONALS FROM AUSTRALIA July 9, 2014
RETHINK YOUR DRINKING CAMPAIGN FROM SOUTHWESTERN ONTARIO January 13, 2014
When you sign up for online alerts regarding new FASD research, a lot of research articles come your way. Some offer hope like the recent article on a possible future treatment for newborns diagnosed with FASD (see Common drugs reverse signs of fetal alcohol syndrome in rats). But most are headlines about newly identified risks associated with alcohol-exposed pregnancies.
For instance, these four recent headlines:
Drinking alcohol during pregnancy could have transgenerational effects
Prenatal exposure to alcohol increases likelihood of addiction later in life
Any alcohol consumption during pregnancy affects craniofacial development
Foetus absorbs mother’s alcohol and nicotine intake in just 2 hours
From a scientific research standpoint, it’s important to fully understand effects of alcohol -exposed pregnancies. But, from a prevention point of view, does it add anything to our efforts to know one more reason drinking alcohol during pregnancy is risky? Does it lessen the stigma these women face? Would one more identified risk be the thing a woman needed to hear in order to stop drinking in her pregnancy or while trying to become pregnant?
Obviously, the full picture of effects is important, and this kind of medical and scientific research should continue. At the same itme, it would be helpful to see more headlines on what has been discovered around prevention – focusing on programs that support the mother child dyad, efforts to reduce stigma, and implementation of trauma-informed and FASD-informed practices and policies.
How about five headlines like these?
Relational treatment programs reduce risk of alcohol-exposed pregnancies and FASD
Connection to culture is key to prevention for many women
Changes in alcohol policy contribute to reduction of violence against women and incidence of alcohol-exposed pregnancies
Secure housing contributes to reduction in alcohol-exposed pregnancies
Women who can safely discuss alcohol with their health provider are more likely to stop risky drinking
This real headline deserves more coverage: “ If we want to save lives, control alcohol. ”
We have lots of information of the risks of alcohol-exposed pregnancies. The work now is about prevention and we will work to bring you those “headlines.”
For more information on these topics, see these previous posts:
REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017
THUNDER BAY’S FAMILY HEALTH PROGRAM PUBLISHES RESEARCH REPORT FOR PREVENTING ALCOHOL-EXPOSED PREGNANCY October 4, 2016
THE WORK OF THE NETWORK ACTION TEAM ON FASD PREVENTION FROM A WOMEN’S HEALTH DETERMINANTS PERSPECTIVE (CANFASD RESEARCH NETWORK) April 11, 2016
FASD ISSUE PAPERS FROM THE CANADA FASD RESEARCH NETWORK PROVIDE A QUICK OVERVIEW OF RECENT RESEARCH December 1, 2014
SUPPORTING PREGNANT WOMEN WHO USE ALCOHOL OR OTHER DRUGS: A GUIDE FOR PRIMARY HEALTH CARE PROFESSIONALS MAY 15, 2016
FREE WEBINAR: UPDATED RESOURCES ON WOMEN AND ALCOHOL: APPLYING RESEARCH TO PRACTICE – MAY 8, 2014 April 21, 2014
FASD PREVENTION RESEARCH AND KNOWLEDGE TRANSLATION: DEVELOPING A PAN-CANADIAN AGENDA WORKSHOP January 29, 2014
FASD INFORMED PRACTICE FOR COMMUNITY BASED PROGRAMS March 27, 2014
RESEARCH MAKES LINKS BETWEEN GENDER, ETHNICITY, CHILDHOOD ABUSE AND ALCOHOL USE April 2, 2013
TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES April 17, 2013
In 2016, the UK Chief Medical Officer with endorsement from the Royal College of Midwives updated advice on drinking alcohol during pregnancy, stating:
“I want pregnant women to be very clear that they should avoid alcohol as a precaution. Although the risk of harm to the baby is low if they have drunk small amounts of alcohol before becoming aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant.”
This month, the Centre for Pregnancy Culture Studies (CPCS) and others have been getting a lot of press for the claim that women are being unnecessarily frightened by this most recent advice and may be terminating pregnancies because of it (see post below for facts on this). They say that women who choose to drink at low levels during pregnancy are being stigmatized when the facts don’t support the guidelines. Further, they claim “the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign.” (The Guardian, May 17, 2017)
That they see alcohol as a normal activity that women should have a right to, does a disservice to both feminism and to alcohol education. There is definitely here a reluctance to examine alcohol as a substance that has the potential to negatively affect health in all situations, and is a teratogen in the context of pregnancy. More, rather than less, discussion of alcohol on men’s and women’s health, and not only in relation to preconception and pregnancy would be welcome. Canada’s Low Risk Drinking Guidelines could inspire more public consideration of what we know and don’t know about alcohol.
CPCS’s comments were in tandem with a larger Policing Pregnancy conference held last week. And on points of pregnancy policing, we agree. Facts show that policing pregnancy increases stigma and pushes women to the margins so that they don’t get the help they want [1]. Women should not be policed for their actions in pregnancy, rather they should have access to information and conversations that can support their decisions.
Preconception and prenatal health care with a caring and knowledgeable health care provider is critical to helping women have the best health and pregnancy possible. How many women have the kind of discussion of alcohol and the care they deserve?
As one opinion writer noted in response to the coverage, the tinkering with alcohol guidelines for pregnant women is not the harm here – it is the lack of services and care that pregnant women receive. https://www.theguardian.com/commentisfree/2017/may/20/i-can-cope-with-drinking-advice-but-not-bad-care
For more information, see these earlier posts:
Policing or Supportive? Why We Should Test Pregnant Women for Alcohol Use, July 7, 2015
Do Concerns about Alcohol Use during Pregnancy Lead Women to Consider having an Abortion? February 1, 2013
References
- Poole, N. and B. Isaac, Apprehensions: Barriers to Treatment for Substance-Using Mothers. 2001, British Columbia Centre of Excellence for Women’s Health: Vancouver, BC.
3rd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 2
“International Research on Discussing Alcohol with Women and Their Partners, and Empowering Professionals to Have These Conversations”: Tatiana Balachova, PhD, Associate Professor, University of Oklahoma Health Sciences Center & Prevent FAS Research Group; Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists; Lisa Schölin, Consultant at WHO Regional Office for Europe – Alcohol, Illicit Drugs and Prison Health; Leana Oliver, CEO of FARR; Cheryl Tan, Health Scientist CDC
Research shows that building awareness and offering brief interventions can help women reduce alcohol-exposed pregnancies. For a variety of reasons, not all providers feel comfortable or confident in giving information or asking about alcohol use, and they may not be sure it makes a difference in preventing alcohol-exposed pregnancies. Consequently, researchers from around the world presented their findings at the 7th International FASD Conference Prevention Plenary. They discussed whether or not brief interventions work, and if they do, then which strategies work best.
Russia – Positive Messaging Improves Knowledge and Action
Tatiana Balachova, PhD, and her research group conducted a 3-part study to develop, implement, and test a prevention program in Russia. They found that women in Russia most trusted their OB/GYN physicians, so they developed FASD educational materials and trained physicians to deliver prevention information in two face-to-face structured interventions. FASD brochures using positive messages and images improved women’s knowledge of FASD and reduced risk for alcohol-exposed pregnancies. As well, they found that women who received the intervention reduced their frequency of alcohol use – most quitting – during in pregnancy.
Canada – Care/Service Provider Education is key
Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists of Canada (SOGC) detailed the Vision 2020 strategies: advocacy, quality of care, education, and growing stronger. These strategies underpin their goals for care providers to focus on preconception as well as pregnancy, and deliver consistent messaging. In line with these goals. Alcohol Use and Pregnancy Consensus Clinical Guidelines that were first published by the SOGC in August 2010 were updated in 2016. The guidelines highlight the value of brief interventions and will be supported in the coming year with online education and training that recognizes “red flags” and provide best practices for supporting women’s health and engagement in discussions on potentially stigmatizing topics such as alcohol use.
World Health Organization – Prevalence Rates Inform Strategy
Lisa Schӧlin, consultant with the World Health Organization’s European office, described the data from Europe on alcohol consumption and drinking during pregnancy. The most recent prevalence data shows that Europe has the highest consumption rate of alcohol per capita of anywhere else in the world. As well, at 25.2%, it has the highest rate of alcohol consumption during pregnancy and the highest rate of FAS (37.4 per 10,000). These data were published in a review of the evidence and case studies illustrating good practices and areas of European action called “Prevention of harm caused by alcohol exposure in pregnancy” – you can view or download here.
South Africa – Short Messages Can Build Awareness
Leana Oliver, CEO of Foundation for Alcohol Related Research (FARR), explained how FARR builds upon existing health services by providing prenatal support, pregnancy planning and teaching of coping strategies to women through their programmes. Their “Do you have 3 Minutes?” campaign has been successful in building awareness within communities and in supporting prevention programmes (learn more here). As well, the FARR Training Academy offers accredited trainings and continued professional development on FASD to professionals, providers and educators. Research projects and FARR publications detail what has been learned such as the benefits of motivational interviewing and the need for preconception care and planning.
U.S. – Promoting Universal Screening and Brief Intervention
Cheryl Tan, Health Scientist, Centers for Disease Control and Prevention reviewed FASD activities currently underway. Surveillance of alcohol consumption by women of reproductive age is ongoing alongside efforts by the CDC to promote universal screening and brief interventions (aSBI) of adults 18+ years. She noted the wide discrepancy between how often providers say they conduct SBI (85%) and how often patients say they receive it (25%). As well, as a partner of the Collaborative of Alcohol-free Pregnancy, the CDC is helping to change healthcare practice through high-impact projects: 1) implement interprofessional model for prevention of AEP; 2) provide evidence for aSBI to insurers in the US; and, 3) reduce stigma associated with drinking during pregnancy.
For more these topics see earlier posts:
First-ever FASD Prevention Plenary at the 7th International Conference on FASD, March 22, 2017
WHO Europe: Prevention of harm caused by alcohol exposure in pregnancy, December 22, 2016
“Supporting pregnant women who use alcohol or other drugs: A guide for primary health care professionals”, May 15, 2016
How do partners affect women’s alcohol use during pregnancy?, August 11, 2014
Empowering Conversations to Prevent Alcohol Exposed Pregnancies: Extended Learning Webinars, May 8, 2014
The Prevention Conversation Project – Free Webcast on January 21, 2015 (Alberta FASD Learning Series), December 15, 2014
Alcohol and Pregnancy campaign from Norway, December 12, 2011
FASD Prevention in Russia, February 15, 2012
The Washington Post recently featured an article on the normalisation of heavy drinking for women. Citing targeted advertising and multiple media, particularly to girls on social media, the article outlines the dangers in this trend of treating alcohol as a lifestyle rather than a drug. The obvious dangers are that normalising heavy drinking will increase the number of alcohol-exposed pregnancies and have a negative impact on girls’ and women’s health. Advertising exploits the positive connections women seek with each other, making it about drinking together and promoting it on t-shirts, cups, cards and even wine labels.
The liquor industry is attempting to link drinking with gender equality. But there is nothing equal or liberating about the risks women and girls face, or the distain that is heaped upon them for drunkenness. A recent article in the Daily Mail supported public shaming of binge drinking by young women in particular, and featured numerous denigrating photos of them on New Year’s Eve. Many pointed out the hypocrisy of moralising (Suzanne Moore, The Guardian). A different dialogue is needed: one that focuses on facts, health, education, and creates platforms of conversation and support.
It’s science not sexism that reveals the risks and consequences of heavy drinking for women and girls, and ways to reduce harm. We have learned why women may drink, the effectiveness of non-judgmental approaches to reducing harm, and best practices and policies for promoting health. The facts are not as confusing as some suggest and by focusing on them, we can counter normalising and moralising.
- Women’s bodies process alcohol differently, so woman’s alcohol level will be higher than a man drinking the same amount. Canada’s low-risk drinking guidelines reflect this sex difference.
- Men, in general, are riskier drinkers than women as evidenced by rates of alcohol-related injury and mortality, but women have more chronic health risks related to heavy drinking (Wilsnack & Wilsnack, 2013).
- Beyond the risk of addiction, Jennie Cook’s research found a causal link between drinking and at least 7 forms of cancer for both sexes (Connor, 2017).
- Claims of protective factors for cardiovascular disease are coming under scrutiny and skepticism even as these claims remain a core industry research topic and argument for drinking (Chikritzhs, Fillmore, & Stockwell, 2009)
- How and when we present the facts of drinking alcohol to women and their partners makes a difference to the health of women and their families (See 10 Fundamental components of FASD Prevention from a women’s health determinant perspective).
- Prevention of alcohol harms requires a tiered response in policy, practice, and messaging (See FASD Prevention: Canadian Perspectives)
- Comprehensive and integrated programs that build relationships work best for supporting women in making healthy choices for themselves and their families (See Mothercraft’s Mother-Child Study)
References
Chikritzhs, T., Fillmore, K., & Stockwell, T. I. M. (2009). A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug and Alcohol Review, 28(4), 441-444. doi:10.1111/j.1465-3362.2009.00052.x
Coalescing on Women and Substance Use. http://coalescing-vc.org/virtualLearning/section2/documents/GirlsAlcoholPregnancyinfographic7.pdf
Connor, J. (2017). Alcohol consumption as a cause of cancer. Addiction, 112(2), 222-228. doi:10.1111/add.13477
Wilsnack, R. W., & Wilsnack, S. C. (2013). Gender and alcohol: consumption and consequences. In P. B. Peter Boyle, Albert B. Lowenfels, Harry Burns, Otis Brawley, Witold Zatonski, Jürgen Rehm (Ed.), Alcohol: Science, policy and public health (pp. 153-160). Oxford, England: Oxford University Press.
Since 1999, FASD activists have held World FASD Awareness Day events on 09/09 to represent the nine months of pregnancy, often highlighted with a bell ringing ceremony at 9:09 am. September 9, 2016 is approaching, and this year activists want to use social media because it provides a unique and far-reaching means of building awareness.
You can help build FASD awareness by posting a message, reposting theirs, or bringing attention to their events on your own social media accounts.
Canada
This year Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) is providing an online forum for organizations to post their initiatives on the CanFASD website. Include a description and a picture or video and they will re-post and Tweet it out to all of their followers. You can post using #FASDAwarenessDay #CanFASD and win prizes.
The Executive Director of CanFASD , Audrey McFarlane says “ CanFASD is very pleased to be able to highlight the fantastic work that the local communities are doing to raise awareness of FASD on September 9 as the local FASD service providers and caregivers are the hardworking folks that manage this work everyday.”
United States
NOFAS US has developed a FASD Awareness Day Packet for 2016 to assist organizations with planning activities for the month of September – FASD Awareness Month.
Their social media campaign includes:
- A Twitter Chat using the hashtag #FASDMonth as well as offering tweets you can use to send out to others.
- A one-time message commemorating FASD Awareness Day can be posted to your social media accounts using ThunderClap – a crowd-speaking platform using social media. Learn more here.
- A campaign to create a video that will feature an inflatable globe being “passed” around the world. Click here to learn more about the campaign.
New Zealand
The University of Auckland is hosting a FASD Policy and Research Forum starting at 9 a.m. on FASD Awareness Day. Find out more here. To find more information, links, and downloads from New Zealand, visit the Fetal Alcohol Network NZ and the Ako Aotearoa learning website for the Pregnancy and Alcohol Cessation Toolkit for providers.
Australia
NOFAS Australia is encouraging people to take a pledge not drink on Sept 9 and to post it on social media as a way to spread the word about FASD.
Also on the Pregnancy Birth & Baby website, there is a call to join the Pregnant Pause Campaign for FASD Awareness Day.
United Kingdom
The FASD Trust is asking people to get involved in a number of ways – raising awareness in school using the Trust’s School Pack, writing their MP. Click here to see their efforts.
To learn more about the history of FASD Awareness Day and get more ideas for events, click on FASD Awareness Day website.
Is your group, organization, or country planning a FASD Awareness Day event? Please share them in the Comments section below.
Previous postings about FASD Awareness Day
Today is International FASD Awareness Day, September 9, 2015
Today is International FASD Awareness Day, September 9, 2014
The College of New Caledonia (CNC) has developed a FASD-informed training curriculum to support their FASD informed guide and in response to the expressed needs of three national programs supported by the Public Health Agency of Canada (PHAC) that focus on healthy birth outcomes and healthy outcomes for children.
“Facilitating a Collaborative, Strength-based Approach to FASD Informed Practice: Western Region BC” was developed following consultations with workers in The Community Action Program for Children (CAPC), the Canada Prenatal Nutrition Program (CPNP), and Aboriginal Head Start (AHS in BC). Workers and administrators wanted help in adjusting their practice of working with women, children and families to include FASD-informed approaches.
These trainings were delivered on-site to approximately 350 people during 2014-2016. Developed by Anne Guarasci and Barb Durban with funding from PHAC, the curriculum, in the form of PowerPoint presentations, has been refined for distribution and consists of three separate presentations each with a particular focus, but all include a primer on FASD including current diagnostic terminology.
1. “Supporting Marginalized Parents who may have FASD” — This presentation focuses on what causes FASD, how it is diagnosed, and who is at risk; the complex nature of prevention and why a holistic, relational approach is required; behavioural and cognitive cues that may indicate FASD; and, the fundamentals of an FASD-informed practice.
2. “Strategies and Structures for Supporting Marginalized Women and Families who may have FASD” — Participants explore practices and communication skills that empower and support clients and build relationships; examine individual and agency perceptions, policies and structures in order to reduce barriers to relationship and services for clients; and, develop FASD-specific communication strategies. Client “compliance” issues are re-examined within the context of brain functioning. FASD diagnostic terminology and pathways to access assessment and diagnosis are reviewed.
3. “FASD Prevention” — Using a FASD-informed approach as described in CNC guides (1,2) and the work of Deb Rutman (3), this training builds on the 4 levels of prevention of FASD in Canada (4): awareness and health promotion; brief counseling with women and girls of childbearing age; specialized prenatal support; and postpartum support. How FASD-informed and trauma-informed approaches overlap is explored along with many strategies for working with women, including those who may have FASD, such as building relationships and reducing barriers through reflective practice, Motivational Interviewing, harm reduction, and individualized services.
The FASD-informed practice training curricula is intended for training of program coordinators and administrators, new frontline workers and seasoned workers who may benefit from a refresher. A year-long evaluation of the training was conducted by Deborah Rutman, and the results will be available for presentation in this blog space, in the next few months.
For more about FASD-informed work, see earlier posts:
- Women with FASD, Substance Use, and FASD Prevention (March 7, 2011)
- Supporting Women with FASD who are Pregnant or Parenting(January 17, 2012)
- FASD Informed Practice for Community Based Programs (March 27, 2014)
REFERENCES/SUGGESTED READING
- Guarasci, Anne (2013). FASD Informed Practice for Community Based Programs. Burns Lake, BC: College of New Caledonia – Lakes District Campus.
- Guarasci, Anne (2011). Empowering Front-Line Staff and Families Through a Collection of Lived Experiences: Supporting Women Who Have Fetal Alcohol Spectrum Disorder (FASD) Behaviours and Characteristics and/or Other Related Disabilities. Burns Lake, BC: College of New Caledonia – Lake District Campus.
- Rutman, D. (2011). Substance using women with FASD and FASD prevention: Voices of women with FASD: Promising approaches in substance use treatment and care for women with FASD. Victoria, BC: University of Victoria.
- Poole, Nancy A. (2008). Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives. Public Health Agency of Canada: Ottawa, ON.
FASD Annotated Bibliography, Part 2
It seems more attention is being brought to preconception health and its role in FASD prevention. We have known about the value of preconception intervention for many years. The Project CHOICES Research Group described positive intervention results using Motivational Interviewing in 2003 [1]. Yet now attention to the preconception period seems to be “trending.”
Preconception intervention has been discussed all along (we were asking about it in a landmark study in the ‘90s[2]), but the recent actions like U.S. CDC recommendations and Yukon’s placement of pregnancy tests in bars are certainly highlighting preconception alcohol use and health behaviours. The current Annotated Bibliography of articles published on FASD prevention seems to bear this recent focus out:., there were a total of five articles on preconception efforts in the 2013 list; and in articles published in 2015, that number has doubled.
In the latest annotated list, Landeen et al. says that the “fetal origin of disease theory” provides the rationale for providing preconception interventions[3]. Johnson et al. describe the development and dissemination of the CHOICES model[4] and its successful adaptation in a variety of settings. Hanson et al. have written three articles that expand on the work they did adapting and implementing a CHOICES program with the Oglala Sioux Tribe in the U.S.[5-7]. Analyses by Hussein et al.[8], Mitra et al.[9] and Oza-Frank et al.[10] suggest that preconception interventions must be tailored if they are to be successful. McBride stresses the need for preconception counseling for men, as substance use during pregnancy is not solely a decision made by women or under their control [11].
Members of the pNAT are currently undertaking a review of the literature on preconception interventions and formulating recommendations for a national research agenda. They will present some of these recommendations at the research meeting in August at the University of Regina (See www.canfasd.ca for more info on this meeting).
In keeping with our understanding of multiple forms of evidence, we are interested in knowing what you are seeing and hearing about preconception interventions on alcohol. Has preconception intervention been a part of your practice for a while? Who is funded to provide it in your location? What has worked, and how has it worked, in your experience?
For further reading on preconception interventions, see earlier postings:
Alcohol and FASD: It’s not just about women, June 6, 2016
FASD Prevention needs to begin before pregnancy: Findings from the US National Survey on Family Growth, May 20, 2015
Global Trends in Unintended Pregnancy: Implications for FASD Prevention, October 13, 2014
Impact Evaluation of the Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta, February 7, 2014
FASD Prevention in Nova Scotia, April 25, 2013
The Sacred Journey – new resource for service providers who work with First Nations families, August 1, 2012
FASD Prevention in Russia, February 15, 2012
New book: Fetal Alcohol Spectrum Disorder: Management and Policy Perspectives of FASD, Jan 6, 2011
REFERENCES/SUGGESTED READING
- Reducing the risk of alcohol-exposed pregnancies: A study of a motivational intervention in community settings. Pediatrics, 2003. 111(Supplement 1): p. 1131-1135.
- Astley, S.J., et al., Fetal Alcohol Syndrome primary prevention through FAS Diagnosis II, A comprehensive profile of 80 birth mothers of children with FAS Alcohol and Alcoholism, 2000. 35(5): p. 509-519.
- Landeen, L.B., R. Bogue, and M. Schuneman, Preconception and prenatal care–useful tools for providers of women’s health. South Dakota Medicine: The Journal Of The South Dakota State Medical Association, 2015. Spec No: p. 36-43.
- Johnson, S.K., M.M. Velasquez, and K. von Sternberg, CHOICES: An empirically supported intervention for preventing alcohol-exposed pregnancy in community settings. Research on Social Work Practice, 2015. 25(4): p. 488-492.
- Hanson, J.D., K. Ingersoll, and S. Pourier, Development and implementation of choices group to reduce drinking, improve contraception, and prevent alcohol-exposed pregnancies in American Indian women. Journal of Substance Abuse Treatment, 2015.
- Hanson, J. and J. Jensen, Importance of Social Support in Preventing Alcohol-Exposed Pregnancies with American Indian Communities. Journal of Community Health, 2015. 40(1): p. 138-146 9p.
- Hanson, J.D. and S. Pourier, The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community. International Journal Of Environmental Research And Public Health, 2015. 13(1).
- Hussein, N., J. Kai, and N. Qureshi, The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. The European Journal Of General Practice, 2015: p. 1-11.
- Mitra, M., et al., Disparities in adverse preconception risk factors between women with and without disabilities. Maternal and Child Health Journal, 2015.
- Oza-Frank, R., et al., Provision of specific preconception care messages and associated maternal health behaviors before and during pregnancy. American Journal of Obstetrics & Gynecology, 2015. 212(3): p. 372.e1-372.e8.
- McBride, N., Paternal involvement in alcohol exposure during pre-conception and pregnancy. Australian Nursing & Midwifery Journal, 2015. 22(10): p. 51-51.
For over 25 years, there have been studies seeking to understand if paternal drinking affects fetal and infant health and FASD in particular. Finding that 75% of children born with FASD had fathers who were alcoholics, Abel et al. conducted a number of animal studies that described negative effects from paternal alcohol consumption but without clear or satisfactory links to humans [1]. Consequently, FASD prevention programs have primarily focused on pregnant women, where the evidence was certain, and treated paternal drinking as largely a risk factor for maternal drinking rather than a risk factor for FASD itself.
Now, with advances in epigenetic research, two recent analyses of studies are showing that paternal factors, and alcohol use, in particular, play a larger role in fetal/child health than just passing along genes. Each study analysis systematically reviewed findings about the role of paternal alcohol consumption on conception, pregnancy, and fetal and infant health. One analysis used a paternal-alcohol consumption lens, while the other used a birth-defect lens. These results provide evidence to expand prevention efforts to men, especially in the preconception period, and to continue research in the field of epigenetics and alcohol-exposed pregnancy. (To learn about epigenetics click here.)
The first review by McBride and Johnson looked at 150 research studies and distilled them down to 11 good-quality studies. The associated effects of paternal drinking fell into three themes: impact on maternal drinking, sperm health, and fetal/infant health. Two studies showed an association between low levels of paternal drinking with lowered sperm count, as well as underdeveloped sperm leading to conception problems and miscarriage. Seven studies showed an increased risk of miscarriage when men drank 10 drinks or more per week in the preconception period, and one study found an association of all cases of ventricle malformation (heart defect) with daily paternal alcohol consumption during the preconception period [2].
The second study review by Day and Savani et al. focused on birth defects and links to paternal alcohol consumption, age and environmental factors. The authors explore the evidence for how these factors impact sperm DNA and, therefore, how the developing cells of an embryo “read” and “express” genetic instructions. For example, genes that are normally “silenced” may be “activated”. Paternal alcohol consumption epigenetically impacts the “gene expression governing individual organ development” that can adversely affect fetal development, in the immediate instance and in future generations [3]. Deficiencies in brain size, heart formation, and cognitive and motor abilities (noted as being symptoms of FASD) were linked to paternal alcohol use even when there was no maternal alcohol consumption.
Both of these study analyses contend that more research is needed in order to understand the full impact of alcohol and epigenetics, and the interplay between maternal and paternal factors. Still, this latest research supports the need for health promotion policies and practices that address men’s alcohol use, not only as an influence on women’s alcohol use, and to benefit men’s health, but also for its potential adverse effect on fetal/child health.
For more on men and FASD prevention, see earlier posts:
- How Do Partners Affect Women’s Alcohol Use During Pregnancy?, August 11, 2014
- How Men Can Help Prevent FASD, March 11, 2014
- Pregnant Pause Campaign for Aussie Dads, October 1, 2013
- FASD Prevention in Australia’s Ord Valley, October 13, 2011
- Getting Fathers Involved, January 4, 2011
REFERENCES/SUGGESTED READING
Abel, E., Paternal contribution to fetal alcohol syndrome. Addiction Biology, 2004. 9(2): p. 127-133. (Link here)
McBride, N. and S. Johnson, Fathers’ role in alcohol-exposed pregnancies: Systematic review of human studies. American Journal of Preventive Medicine, Article in Press.
Day, J., et al., Influence of paternal preconception exposures on their offspring: Through epigentics to phenotype. American Journal of Stem Cells, 2016. 5(1): p. 11-18.
From the FASDay website:
“The first FAS Day began on September 9, 1999 in Auckland, New Zealand, where “Minute of Reflection” bells rang at 9:09 a.m., at Mt Albert Methodist church. Then it moved to Adelaide, Australia, and then to South Africa, where at 9:09 a.m., Cape Town volunteers gathered to hear the War Memorial Carillon that rang when Nelson Mandela was released from prison.
Volunteers in Italy, Germany and Sweden held events – and then FASDay crossed the Atlantic. There were events in every time zone across Canada and the U.S., including ringing of carillons in Toronto, Niagara Falls, Hastings, NE, and Austin & San Antonio, Texas. The westernmost activity was the community breakfast on the tiny island of Kitkatla, B.C., near the Queen Charlotte Islands, where the village bell rang at 9:09 a.m. followed by prayers in the native tongue by village elders.”
Events to increase awareness about FASD are happening all over the world today and throughout September. Find out what’s happening in your community.
The image above is from a poster and brochure developed by the British Columbia Liquor Distribution Branch. (Each of Canada’s 13 provinces and territories has a liquor board or commission that oversees the control, distribution and sale of beverage alcohol in its jurisdiction. Many boards run FASD Awareness campaigns in the month of September as part of their social responsibility initiatives).
Here are a few other resources on FASD developed by members of the Canada FASD Research Network that you might want to share with others.
