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A lot of progress has been made on effective FASD awareness and prevention strategies. Early efforts often used disrespectful tactics like unsettling pictures of women slugging down alcohol from a bottle while pregnant with a caption such as “Baby or the Bottle.” Those approaches have largely been abandoned. But one overly simple statement still pops up. And that is, “FASD is 100% Preventable.”

That statement is misleading because it suggests that FASD prevention is unidimensional and linked only to alcohol consumption. But alcohol use during pregnancy is linked to the social determinants of health, and its effects can be exacerbated by food insecurity, trauma, poverty and multi-substance use. It also suggests that stopping drinking is a simple choice. It puts the onus on the individual woman to make that choice and contributes to shame if they do not stop before they become pregnant. But in reality, there are many influences on women’s alcohol use, and real challenges to quitting before you know you are pregnant. Indeed, almost half of pregnancies are unplanned, so it is very challenging to be alcohol free before a pregnancy is confirmed.

In the case of other substances like tobacco or prescription painkillers, the public discourse extends beyond the individual user to corporate responsibilities, physicians and health authorities to provide harm reduction and treatment programs, and of governments to provide regulation and enforcement and policies that work toward social equity.

If we extend this perspective to alcohol use during pregnancy, we must speak about the responsibilities of the alcohol industry for targeting girls and women of childbearing age, and of health providers for providing comprehensive education and brief support during the preconception and prenatal periods. We must also consider the responsibilities of health services for providing integrated treatment programs for pregnant and parenting women; and of governments for ensuring gender equity and preventing violence against women.

Theoretically, stopping alcohol use in pregnancy, or ideally, before, sounds simple – just do it. But it takes a lot of individuals and sectors to do their part to make it realizable.  Simplifying it to statements like “FASD is 100% preventable” is not the best approach.

These previous blogs illustrate the full context of FASD and prevention approaches.

HOUSING IS KEY COMPONENT TO WOMEN’S RECOVERY, August 19, 2017

TARGETING STIGMA AND FASD IN MANITOBA, June 26, 2017

HEAVY DRINKING AMONG WOMEN: NORMALISING, MORALISING AND THE FACTS, Jan 24, 2017

FASD IS A PUBLIC SAFETY AND JUSTICE PRIORITY FOR ABORIGINAL GROUPS, October 23, 2016

HOW DO PARTNERS AFFECT WOMEN’S ALCOHOL USE DURING PREGNANCY? August 11, 2014

 

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:

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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]

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).

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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