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New Zealand has published an action plan on how best to address FASD. Described as a “whole of government action plan” by Associate Minister of Health, Peter Dunne, Taking Action on Fetal Alcohol Spectrum Disorder: 2016-1019 builds on the best practices being done across communities and service sectors including government policy and partnerships, as well as front line prevention and intervention. According to Fetal Alcohol Network NZ, the government is earmarking an initial 12 million for these efforts, which will increase support and services to women with alcohol and substance use issues.

New Zealand began the process of building the action plan with a discussion document of principles, priorities and action areas. They spent over a year seeking submissions and comments on the plan from professionals, communities, families and whānau (Maori extended family.)  Notable changes to the principles based on those submissions included issues of ethnic and services inequities, as well as stigmatization of women, families and individuals with FASD. The resulting principles defined the core priorities of the plan: prevention, early identification, support and evidence. These priorities framed its action building blocks and designated indications of success of plan outcomes. You can view an analysis of the Ministry of Health action plan submissions here.

By underscoring a collaborative and practical approach, the goal is to make sure that “FASD is prevented and people with FASD and their family/whānau live the best possible lives.”(1) Read more about New Zealand’s efforts:
http://www.health.govt.nz/publication/taking-action-fetal-alcohol-spectrum-disorder-2016-2019-action-plan

To read more about New Zealand’s prevention efforts see these previous posts:

First FEBFAST and Debates about Alcohol Labeling in New Zealand, February 1, 2011


References

  1. FASD Working Group. 2016. Taking Action on Fetal Alcohol Spectrum Disorder: 2016–2019: An action plan. Wellington, NZ: Ministry of Health.

 

 

 

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.

FASD Awareness Day Share with CanFASD

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

FASD Annotated Bibliography, Part 2

2015-12-Life-of-Pix-free-stock-photos-city-distributors-newspapers-AlexisDoyenIt 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

  1. Reducing the risk of alcohol-exposed pregnancies: A study of a motivational intervention in community settings. Pediatrics, 2003. 111(Supplement 1): p. 1131-1135.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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).
  8. 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.
  9. Mitra, M., et al., Disparities in adverse preconception risk factors between women with and without disabilities. Maternal and Child Health Journal, 2015.
  10. 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.
  11. McBride, N., Paternal involvement in alcohol exposure during pre-conception and pregnancy. Australian Nursing & Midwifery Journal, 2015. 22(10): p. 51-51.

man drinking with family

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:

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.

 

NDARC Guide

This new resource from the National Drug & Alcohol Research Centre, University of New South Wales, Australia, is designed for all primary health care professions who see women in a broad range of health care service settings during the course of their practice.

The best practices guide builds on the evidence for providing coordinated, supportive and comprehensive care to pregnant women who use substances by providing a model for reducing the harm from alcohol and substance for women and their babies. See page 12 of this guide for a clearly charted overview of how physicians and other health care practitioners can support withdrawal, do psycho-social and nutritional interventions, and address barriers to care for pregnant women.

The model acknowledges the interconnections that impact a woman’s use of substances during pregnancy – including domestic violence, mental health, smoking, and stigma – and provides a guide for identifying risk and next steps for further assessment, support and/or treatment. See page 9 for a view of how identification differs for women who are pregnant, planning a pregnancy, or not planning a pregnancy.

It also moves beyond normal referral and coordination practices by using a holistic assessment process and designating a case coordinator or clinical lead to ensure “assertive follow-up.” Assertive follow-up consists of: making sure women are supported during pregnancy and birth; keeping mothers and their babies in the hospital so that post-birth assessments for mother and child can be done and plans for support and services are in place; providing breastfeeding, safe sleeping, parenting skills and contraception support; as well as, interfacing with partners, family members, and community agencies in support of the woman and her child.  See page 16 for more discussion on assertive follow-up and pages 19-20 for “Addressing barriers to care”.

Although the extensive resources that are included in this guide are geared for practitioners in Australia, many of them provide topic-specific information that practitioners everywhere may find helpful. See pages 24-27 for website links.

For more on screening in primary care settings, see previous posts:

For more on FASD prevention in Australia, see previous posts:

 

 

 

 

PCAP quilt squareParent-Child Assistance Programs (PCAP) are one important approach to FASD prevention in a number of provinces in Canada and the U.S. These programs use a relational, women-centred, strengths-based approach, which is proven to be effective in FASD prevention [1, 2].

As a visual way to express their experiences of mentorship within Alberta’s PCAP program, women came together in workshops across the province to create individual quilt squares for a larger quilt.

The finished quilt, pictured below, captures the hope, resilience, acceptance and connection that participation in the PCAP program has brought them and their children.

revisedapril4 quilt photoIMG_7064

Described as lively, creative, interactive and dynamic, the workshops were held in Calgary, Edmonton and several rural communities; women were supported by their mentors in getting to them. The workshops built connection between women as well as long-term relationships with their children and their mentors.

Developed and researched by Dorothy Badry, Kristin Bonot and Rhonda Delorme, a full description of the project is here.This is the second quilt project from Alberta’s PCAP program; the first quilt was made by mentors (read more about that project here).

To read earlier blogs about FASD primary prevention projects in Canada follow the links below:

The Mother-Child Study

H.E.R. Pregnancy Program

The Mothering Project

HerWay Home Program

FASD Prevention in Saskatchewan

Harm Reduction and Pregnancy

1. Thanh, N.X., et al., An economic evaluation of the parent-child assistance program for preventing fetal alcohol spectrum disorder in Alberta, Canada. Adm Policy Ment Health, 2015. 42(1): p. 10-8. View article link
2. Grant, T.M., et al., Preventing alcohol and drug exposed births in Washington state: Intervention findings from three parent-child assistance program sites. The American Journal of Drug and Alcohol Abuse, 2005. 31(3): p. 471-490. View PDF

ACEs_Original

Adverse childhood experiences (ACEs) is a term that describes potentially traumatic events that can have lasting negative effects on health and well-being. Research has shown a clear connection between ACEs on alcohol use and misuse in adults.

An emerging area of research also suggests that a history of childhood stressors, such as physical, sexual, and emotional abuse, may influence alcohol use among pregnant women.

In a recent study, researchers used data from the 2010 Nevada Behavioral Risk Factor Surveillance System to learn more about this relationship. They found a dose–response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for pre-pregnancy drinking and other known factors that influence drinking during pregnancy.

This study contributes to a growing body of research demonstrating that factors affecting alcohol use during pregnancy begin long before pregnancy.

It also suggests the importance of initiatives and movements such as ‘trauma-informed’ practice and their application to FASD prevention. Learn more about trauma-informed practice, alcohol, and pregnancy use on the Coalescing on Women and Substance use website.

For more on this topic, see earlier blog posts:

5_preganancy

References

Astley, S.J., et al. (2000). Fetal Alcohol Syndrome (FAS) primary prevention through FAS Diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and Alcoholism,  35(5): p. 509-519. [Free full text]

Choi, K.W., Abler, L.A., Watt, M.H., Eaton, L.A., Kalichman, S.C., Skinner, D., Pieterse, D., and Sikkema, K.J. (2014) Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences. BMC Pregnancy and Childbirth, 14: 97. [Free full text]

Chung, E. K., Nurmohamed, L., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2010). Risky health behaviors among mothers-to-be: The impact of adverse childhood experiences. Academic Pediatrics, 10(4): 245–251. [Free full text]

Frankenberger, D.J., Clements-Nolle, K., Yang, W. (2015). The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues (epub ahead of print). [Abstract]

Nelson, D. B., Uscher-Pines, L., Staples, S. R., & Ann Grisso, J. (2010). Childhood violence and behavioral effects among urban pregnant women. Journal of Women’s Health, 19(6): 1177–1183. [Abstract]

Skagerstrom, J., Chang, G., & Nilsen, P. (2011). Predictors of drinking during pregnancy: A systematic review. Journal of Women’s Health, 20(6):901–913. [Free full text]

telegraph screen shot

Recent research from the UK is sparking discussion about whether routinely testing pregnant women for alcohol use would be helpful.

While the researchers are insisting that binge drinking is ‘prevalent and socially pervasive’ and stronger measures are required, others argue that biological testing is a form of policing women and one that is counteractive in long-run

Sally Peck in her article in The Telegraph says:

“But here’s why we shouldn’t test pregnant women on their alcohol consumption: policing rather than supporting pregnant women fails to prepare them for motherhood.

Instead of imposing prison-style booze tests, let’s talk more about how to help women and men navigate the early years of parenthood, and how to get help when they need it. And let’s make sure that the help we promise – or say that they should have – is actually available to them.”

Research has shown that testing women for alcohol and drug use during pregnancy fails to support women and their babies in the long-run. Women with substance misuse concerns are less likely to seek help from health care providers and avoid prenatal care. And while women in all socio-economic brackets use substances, certain groups of women are unfairly targeted and subject to more invasion of their privacy and are likely to experience adverse outcomes from testing (e.g., child protection reports, custody hearings). As well, routine testing raises ethical issues around consent (e.g., what happens if a mother says she doesn’t want to be tested? Should a health care provider do the test anyway?), women’s autonomy and self-determination, and patient-doctor confidentiality.

Read early posts on the politics and ethics of testing pregnant women for alcohol use:

cigarette-666937_640

Overall, alcohol and tobacco are the most commonly used drugs during pregnancy in Canada. They are also the two drugs that can be the most harmful to a fetus during pregnancy and in the long-term for babies that are exposed.

New research, using data from the Canadian Community Health Survey (2003-2012), takes a closer look at this relationship. Internationally, research has shown that women who smoke are also more likely to drink and vice versa. (One study by Cannon et al showed that 74% of mothers who had a child with FASD also smoked during their pregnancy).

The researchers looked at a national sample of 22,962 women who had given birth in the previous five years. They found that the overall prevalence of smoking during pregnancy in this group of women was 14.3% (of the women who smoked, 52.5% smoked daily and 47.5% smoked occasionally). The prevalence was the lowest in British Columbia at 9.0% and the highest in the territories (Yukon, Northwest Territories, and Nunavut combined) at 39.9%.

They found that:

  • Women who smoked during pregnancy were more likely to be younger, single, white/non-immigrants, and have a lower income.
  • Women who smoked during pregnancy were more likely to drink while pregnant. Women who were daily or occasional smokers during pregnancy were 2.54 and 2.71, respectively, times more likely to have consumed alcohol during pregnancy as compared to non-smokers.
  • Women who had a lifetime history of smoking, but who did not smoke during pregnancy, were also more likely to have consumed alcohol during pregnancy.
  • Binge drinking was the only factor that had a relationship to whether women used alcohol, smoked or used both during pregnancy.

These findings suggest the importance of public health interventions that address alcohol use and smoking together both before and during pregnancy.

References

Bailey, B.A., McCook, JG., Hodge, A. and McGrady, L. (2012). Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting harder drugs. Matern Child Health J, 16:414–422.

Cannon, M.J., Dominique, Y., O’Leary, L.A., Sniezek, J.E., & Floyd, R.L. (2012). Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome. Neurotoxicology and Teratology, 34: 90–95.

Janisse, J.J., Bailey, B.A., Ager, J., and Sokol, R.J. (2014). Alcohol, Tobacco, Cocaine, and Marijuana Use: Relative Contributions to Preterm Delivery and Fetal Growth Restriction. Substance Abuse, 35(1): 60-67, DOI: 10.1080/08897077.2013.804483

Lange, S., Probst, C., Quere, M., Rehm, J., Popova, S. (2015). Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011/12. Addictive Behaviors, 50: 102–109.

projectchoices_infographic_en

Project CHOICES is a program in Winnipeg, Manitoba, that works with girls and women of any age who are not currently pregnant, drink alcohol, and are sexually active. The goal of the program is to reduce the risk of an alcohol-exposed pregnancy through choosing healthy behaviours around alcohol and birth control use.

This infographic summarizes changes for participants three months after completing the program.

Project CHOICES is based on motivational interviewing which is a counseling approach that is respectful, non-judgmental and client-centred. Motivational interviewing allows health care providers and clients to explore possible areas of change, discuss strategies that make sense for the client and their life circumstances, and provides encouragement and support.

The program considers three different routes to reducing the risk of an alcohol-exposed pregnancy: (1) reducing alcohol use (2) using effective contraception (3) reducing alcohol use and using effective contraception.

Learn more about the evaluation from Healthy Child Manitoba. Check out the program website to learn more about the program, how to make a referral, and for resources on alcohol, pregnancy and birth control.

word on the street

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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