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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

SOGC cover

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has just released clinical practice guidelines for health professionals working with First Nations, Inuit, and Métis patients.

The guidelines are intended to provide health professionals with the information and tools to provide culturally safe care. Chapter 6 focuses on maternal care, including prenatal care.

For more on this topic, see earlier posts:

(The image below from the cover is called “Skywoman” and is by Simon Brascoupé, Haudenosaunee/Anishinabeg).

SOGC guide

 

Research explores whether alcohol use prior to pregnancy awareness affects women’s decision-making

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Most women are aware that alcohol and other substance use can affect an unborn baby. Current medical advice supports abstaining from consuming alcohol during pregnancy as there is no known safe level of alcohol consumption.  However, we also know that approximately 1/3 to half of pregnancies are unplanned. And, in most Western countries, the majority of women drink alcohol. (According to the 2006 Canadian Maternity Experience Survey, 62% of women consumed alcohol in the three months prior to pregnancy. Other studies suggest that over 50% of women ages 18-24 drink at moderate to high risk levels).

As a result, some people have expressed concern or reported anecdotes about women who might seek an abortion due to fear or stress associated with drinking alcohol prior to becoming aware of their pregnancy and the harm they might have caused their baby.

A study published last year by Roberts et al called “Alcohol, Tobacco and Drug Use as Reasons for Abortion” examines some of these questions for the first time. The research team surveyed 956 women accessing abortion services in the USA to identify whether alcohol, tobacco or other drug use in the month prior to pregnancy awareness contributed to their decision to end their pregnancy. 25 women (2.6%) identified alcohol as a reason for seeking the abortion.

The majority (84%) of women who identified alcohol as a reason for seeking an abortion reported drinking at binge levels (5+ standard drinks per occasion) or having experienced alcohol-related problems such as blackouts. Around half of the women who reported binge drinking as a reason for seeking an abortion were binge drinking more than once a week and the median number of binge drinking sessions was five.

This study can be seen as reassuring in that a small number of women considered their alcohol use as a factor in ending an otherwise wanted pregnancy. It does raise questions about how we talk about FASD and the framing of messages about the potential harms of alcohol use during pregnancy.

Current guidelines by obstetrics and gynecology professional associations in Canada and the USA explicitly state that low levels of alcohol use in early pregnancy is not an indication to end a pregnancy.

For more on related topics, see earlier posts:

References

O’Leary, C. (2012). Alcohol and Pregnancy: Do Abstinence Policies Have Unintended Consequences? Alcohol and Alcoholism, 47(6):638-9. doi: 10.1093/alcalc/ags094

Roberts, S.C.M., Avalos, L.A., Sinkford, D., and Foster, D.G. (2012). Alcohol, Tobacco and Drug Use as Reasons for Abortion. Alcohol and Alcoholism, 47(6): 640–648. doi: 10.1093/alcalc/ags095. Download free full-text here.

Society of Obstetricians and Gynecologists of Canada. (2010). Alcohol Use and Pregnancy: Consensus Clinical Guidelines. Journal of Obstetrics and Gynaecology Canada, 32(8): S1-S32.

Walker, M., Al-Sahab, B., Islam, F., & Tamim, H. (2011). The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian Maternity Experiences Survey (MES). BMC Pregnancy and Childbirth, 11(1), 52. doi:10.1186/1471-2393-11-52. Download free full-text here.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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