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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 World Health Organization’s regional office for Europe has published Prevention of harm caused by alcohol exposure in pregnancy: Rapid review and case studies from Member States.
In this report it is stated that Europe has the highest level of alcohol consumption in the world, and that the gender gap in drinking, and in binge drinking, among young people has narrowed.
Looking over the past decade, the report features a review of 29 research studies and details current FASD prevention efforts of Finland, Germany, Lithuania, Luxembourg, Norway, Poland, Slovenia and Sweden. Studies included in the report were based on Recommendation 2 of the WHO Guidelines for the identification and management of substance use and substance use disorder in pregnancy, which calls for prevention of alcohol consumption in the general population of pregnant women through brief interventions. Consequently, the review excluded studies of alcohol-dependent women.
For women who may become pregnant, interventions related to both risky drinking and contraception were reviewed, such as CHOICES, EARLY and BALANCE.
For pregnant women, interventions to abstain from or reduce alcohol use, or to raise awareness were reviewed. Two of the studies with pregnant women included their partners and showed positive results regarding women reducing their drinking and partners supporting non-drinking.
Case studies of prevention efforts from the 8 profiled countries describe national awareness campaigns; screening and specialized treatment in clinical practice guidelines; national strategy/policy planning and implementation; and post-partum support including for those affected by FASD. The report features a table that illustrates country-specific levels of FASD awareness, which can assist in developing focused strategies.
For more on related topics, see earlier blogs:
HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION, November 21, 2016
Most interventions and programs to prevent alcohol use during pregnancy focus on encouraging pregnant women to abstain from alcohol use. However, one of the most consistent predictors of alcohol use during pregnancy is women’s drinking patterns before pregnancy. As well, a large majority of women have been drinking alcohol for many years prior to getting pregnant.
A recent journal article published in the Maternal and Child Health Journal (April 2015) looks at data from the National Survey of Family Growth in the United States to estimate the number of women during a one month period who are at risk of having an alcohol-exposed pregnancy. (An “alcohol-exposed pregnancy” means that a woman is drinking alcohol, sexually active and not using contraception).
The study found that during a one-month period, nearly 2 million women in the United States were at risk of an alcohol-exposed pregnancy, including 600,000 who were binge drinking. This translates to 3.4%, or 1 in 30, non-pregnant women being at risk of an alcohol-exposed pregnancy.
Interestingly, being at risk for an alcohol-exposed pregnancy was not clearly associated with most demographic and behavioral characteristics (e.g., income level, tobacco use, ethnicity, education level, etc).
That said, women in this study who were planning to get pregnant were the ones who were at highest risk of an alcohol-exposed pregnancy – because they often continue to drink until they find our they are pregnant (and thus exposing the fetus to alcohol for several weeks or even months).
As a recent report on alcohol use in OECD countries describes how rates of alcohol use (including binge drinking) continue to rise in young women in many parts of the world. This suggests the importance of strategies to improve women’s overall health in relation to alcohol (e.g., emphasizing a culture of moderation with low risk drinking guidelines) and FASD prevention activities that target alcohol and contraception use prior to pregnancy and in the preconception period.
Cannon, M.J., Guo, J., Denny, C.H., Green, P.P., Miracle, H., Sniezek, J.E., Floyd, R.L. (2015). Prevalence and Characteristics of Women at Risk for an Alcohol-Exposed Pregnancy (AEP) in the United States: Estimates from the National Survey of Family Growth. Maternal and Child Health Journal, 19:776–782. DOI 10.1007/s10995-014-1563-3.