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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.

Russian study picRussia – 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.

JOGC picCanada – 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.

who-coverWorld 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.

FARR picSouth 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.

CDC picU.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

Making the link between unintended pregnancies and FASD prevention

The Centers for Disease Control and Prevention (CDC) in the United States released two reports this month with new data on alcohol consumption during pregnancy and unintended pregnancies. It’s interesting to take a look at these reports side-by-side as they suggest completely different target groups for FASD prevention activities.

The first report looked at alcohol use and binge drinking among women of childbearing age. The researchers found that approximately 7.6% (or 1 in 13) of pregnant women consume alcohol during pregnancy and that 1.4% of pregnant women binge drink. Interestingly, non-pregnant women and pregnant women had similar patterns of binge drinking: about three times per month and approximately six drinks on an occasion.

Among pregnant women, the highest prevalence estimates of reported alcohol use were among those who were aged 35–44 years (14.3%), “white” (8.3%), college graduates (10.0%), or employed (9.6%).

In 2005, the Surgeon General issued an advisory urging women who are pregnant or who might become pregnant to abstain from alcohol use. Currently, the CDC advises: “Because no safe level of alcohol during pregnancy has been established and alcohol is known to cause birth defects, developmental disabilities, and other adverse pregnancy outcomes, women who are pregnant or who might become pregnant should refrain from drinking alcohol.”

It’s the last part of this advisory targeted at “women who might become pregnant” that leads us to the second report.

Generally speaking, it is believed that 1/3 to 1/2 of pregnancies are unintended. This report found that about 37% of births in the United States were unintended at the time of conception. While this statistic hasn’t changed much since the early 1980s, the groups with the highest rates of unintended pregnancies have changed (you can take a closer look at the report for more – see the link below).

Unintended pregnancies include both pregnancies that are unwanted, and those are mistimed, meaning the woman said she wanted to become pregnant at some point, but not at the time she did.

There’s a lot of reasons why a women becomes pregnant unintentionally and contraception use is one of them. The researchers found that 40% of women were using contraception and 60% were not. The researchers asked women who were not using contraception at the time they conceived about their reasons. They found that:

  • 35.9 percent said they did not think they could get pregnant
  • 23.1 percent said they would not mind if they became pregnant
  • 17.3 percent said they had not expected to have sex
  • 14.3 percent said they were worried about the side effects of using birth control

In terms of men, 8% said their male partner did not want to use birth control himself, and 5.3 percent said their male partner did not want them to use birth control.

So, it’s interesting to think about, right?

  • 52% of women of childbearing age consume alcohol
  • 37% of pregnancies are unintended (which means these women were unlikely to change their alcohol consumption)
  • Of women who become pregnant unintentionally, 60% were not using contraception.

These data suggest that we need to be looking at alcohol use, especially risky alcohol use like binge drinking, way before conception. It also suggests that many women need additional support around their fertility and finding contraception that works for them (and that perhaps their male partners might want to get involved in some of these issues??)

References

Marchetta, C.M., Denny, C.H., Floyd, L., Cheal, N.E., Sniezek, J.E., McKnight-Eily, L.R. (2012). Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR), 61(28): 534-538.

Mosher, W.D., Jones, J. and Abma, J.C. (2012). Intended and Unintended Births in the United States: 1982–2010. National Health Statistics Reports, No. 55. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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