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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

Image credit: Eric Parker, via flickr (creative commons)

Delft, Cape Town, South Africa (Image credit: Eric Parker, via flickr)

The reasons why a woman may drink alcohol during pregnancy can vary enormously. That said, research has consistently shown two strong associations with alcohol use during pregnancy: (1) women’s alcohol use before pregnancy (especially for women who drink heavily before pregnancy) and (2) past or current experiences of violence, trauma, and abuse.

The relationship between alcohol use during pregnancy and women’s experiences of violence, trauma, and abuse was recognized in early research with women who have children with FASD. For example, in a study in 2000 with 80 mothers of children with FAS,  95% of the women had been seriously sexually, physically, or emotionally abused at some point in their lives and 72% of them reported that they felt unable to reduce their alcohol use because they were in an abusive relationship.

A recent longitudinal study looked at both of these factors, alcohol use before pregnancy and experiences of trauma, in a group of 66 pregnant women in Delft, Cape Town, South Africa. The researchers found that:

  • Similar to previous research, women’s drinking levels before pregnancy were generally predictive of drinking levels during pregnancy. Most women significantly decreased their drinking after pregnancy recognition.
  • Women who reported no trauma history seemed to drink proportionally to the levels that they did before pregnancy recognition, i.e., higher-risk drinkers continued to drink at high levels, while lower-risk drinkers maintained their low drinking levels.
  • However, women who reported a history of trauma tended to drink at higher levels, regardless of prior drinking levels and even if they were low risk drinkers beforehand

The study findings suggest that there are two groups of pregnant women that may benefit from special attention from an FASD prevention perspective: (1) women are already drinking at risky levels before pregnancy, and (2) women who report a history of trauma, regardless of how much they were drinking prior to pregnancy.

To learn more about trauma-informed approaches to FASD prevention, visit the Coalescing on Women and Substance use website and check out the section on Alcohol and Pregnancy.

To learn more about alcohol and pregnancy in South Africa, see earlier posts:

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 available here).

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.  doi:10.1186/1471-2393-14-97. (Open access – free full text available).

Skagerstrom J, Chang G, Nilsen P (2011).  Predictors of drinking during pregnancy: a systematic review. Journal of Women’s Health (Larchmt), 20(6): 901–913. (Open access – free full text available).

Study in South Africa shows that case management can be effective for women at highest risk of having a child with FASD

Stellenbosch University in South Africa was one of the institutions involved in this new study on case management. Image via http://www.sun.ac.za

Stellenbosch University in South Africa was one of the institutions involved in a new study on case management and FASD prevention. Image via http://www.sun.ac.za

The most recent issue of the International Journal of Alcohol and Drug Research is a collection on  articles that focuses on FASD. The articles include pieces by Canada FASD Research Network members Jacqueline Pei, Dorothy Badry, and Aileen Feske. (View the Table of Contents here; all articles are available for free download).

In this special issue, there is a very interesting study by Philip May and colleagues who looked at the use of case management to prevent FASD. Their research took place in a South African community with a subculture of heavy, regular, weekend, recreational drinking and high documented rates of FASD and with women who were at high risk of drinking heavily throughout their pregnancy (e.g., because they had previously given birth to a child diagnosed with FASD or had drunk heavily during a previous pregnancy).

They provided 41 women with 18 months of case management support by a social worker or nurse. Through case management, women received education, coaching, and support with accessing inner strengths and external resources to reduce their alcohol use and address a range of other life issues.

At the beginning of the study:

  • 87.8% of the women were pregnant
  • Most women had previous alcohol-exposed pregnancies
  • 67.5% reported that most or all of their friends drank alcohol, and
  • 50.0% reported stressful lives

The researchers used a number of different tools to track changes in drinking practices, including AUDIT scores, average alcohol consumption, and estimated peak BAC measures, at 6, 12, and 18 months after starting the study.

They found that case management was particularly effective with pregnant women in reducing alcohol consumption. And while alcohol levels remained at lower levels than when they started the study, many women resumed previous drinking practices after pregnancy. This suggests that case management can be effective during critical periods, but other initiatives (e.g., changing the culture of drinking) are likely required to support women in making lasting changes.

Overall, this study is part of a growing body of literature supporting the use of case-management approaches for women at highest risk of having a child with FASD.

For more on FASD prevention in South Africa, see previous posts:

References

Grant, T., Streissguth, A., & Ernst, C. (2002). Benefits and challenges of paraprofessional advocacy with mothers who abuse alcohol and drugs and their children. Zero to Three, 23, 14–20. Free full-text available here.

May, P.A., Marais, A., Gossage, J.P., Barnard, R., Joubert, et al. (2013). Case management reduces drinking during pregnancy among high-risk women. The International Journal of Alcohol and Drug Research. ISSN: 1925-7066. Free full-text available here.

May, P. A., Miller, J. H., Goodhart, K. A., Maestas, O. R., Buckley,  et al. (2008). Enhanced case management to prevent fetal alcohol spectrum disorders in northern plains communities. Maternal and Child Health Journal, 12, 747–759.

16days-poster-600x552

Thousands of organizations across the world are participating in the 2012 16 Days of Activism Against Gender Violence Campaign. The campaign, now in its 22nd year, is organized by the Center for Women’s Global Leadership at Rutgers University. The campaign began on International Day for the Elimination of Violence Against Women (November 25) and ends on International Human Rights Day (December 10).

While there are a huge number of events and activities being held across South Africa, I was interested to see that the Province of the Northern Cape was hosting an event related to FASD awareness in the community of Carnavon on one of the 16 days.

According to the government press release:

“The preliminary finds of the Balelapa survey indicates that of the 2,045 persons interviewed in Carnavon , 1,523 indicated that they are unemployed and 1,075 indicated that they have no income. Unemployment and poverty are of the contributing factors for substance abuse and the situational analysis indicates that Carnavon is a high risk area for substance abuse.”

I think it’s still exceedingly rare for individuals and governments to make the connections between violence, poverty, substance misuse, and FASD.

Check out this series of stories by Leonie Marinovich on All Africa called South Africa: 16 Stories for 16 Days of Activism.

For more on FASD in South Africa, see earlier posts:

 16 Days logo

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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