FASD PREVENTION: AN ANNOTATED BIBLIOGRAPHY OF ARTICLES PUBLISHED IN 2016 Prepared by Rose Schmidt, Nancy Poole, Christina Talbot, Natalie Hemsing and Katy Flannigan Centre of Excellence for Women’s Health and CanFASD Research Network March 2017
FASDPREVENTION:ANANNOTATED
BIBLIOGRAPHYOFARTICLESPUBLISHEDIN
2016
Preparedby
RoseSchmidt,NancyPoole,Christina
Talbot,NatalieHemsingandKatyFlannigan
CentreofExcellenceforWomen’sHealth
andCanFASDResearchNetwork
March2017
1
FASDPreventionLiteratureSearch2016
ContentsIntroduction.................................................................................................................................................1SearchMethods..........................................................................................................................................2
SearchResults.............................................................................................................................................3Prevalenceofdrinkinginpregnancy...........................................................................................................4Influencesandfactorsassociatedwithdrinkinginpregnancy.....................................................14Level1Prevention............................................................................................................................................19Level2Prevention............................................................................................................................................23Preconceptioninterventions........................................................................................................................28Level3Prevention............................................................................................................................................30Level4Prevention............................................................................................................................................32Other.......................................................................................................................................................................33
Summaryofincludedstudiesbymethodandcountryofstudy.........................................36
Introduction
Annually,researchersassociatedwiththePreventionNetworkActionTeam(pNAT)oftheCanFASDResearchNetworksearchtheacademicliteratureforarticlesrelatedtofetalalcoholspectrumdisorder(FASD)prevention.Thefindingsareorganizedusingafour-levelpreventionframeworkusedbythepNATtodescribethewiderangeofworkthatcomprisesFASDprevention.TheannualliteraturesearchisintendedtoupdatethoseinvolvedinFASDpreventioninCanada,sotheycaninformtheirpracticeandpolicyworkwithcurrentevidence.ThemembersofthepNATalsohavetheopportunityinmonthlywebmeetingstodiscusstheimplicationsofthefindingsfortheirwork.
2
SearchMethods
ThefollowingdatabasesweresearchedusingEbscoHostforarticlespublishedbetweenJanuaryandDecember2016:
1. AcademicSearchComplete2. BibliographyofNativeNorthAmericans3. CINAHLComplete(CumulativeIndexofNursingandAlliedHealthLiterature)4. MEDLINEwithFullText5. PsycINFO6. SocialWorkAbstracts7. UrbanStudiesAbstracts8. Women'sStudiesInternational
Searchesofeachdatabasewereconductedusingthefollowingsearchterms:1)[fetalalcoholsyndromeORfetalalcoholspectrumdisorderORFASDORfeotalalcoholspectrumdisorderORalcoholrelatedfetaldamage](SU);2)[FASDORfetalalcoholORfeotalalcoholORalcoholexposedpregnancyORalcoholANDpregnancy](Any)+[preventionORpreventingORpreventative](Any);3)[FetalORfetusORfeotusORfoetal](any)+alcohol(SU);4)[AlcoholORdrink*](SU)+[pregnancyORpregnant](SU)+prevention(any);4)[Pregnan*ORconceptionORpreconceptionORpost-partum](SU)+[alcoholORdrink*](any);5)Alcohol(SU)+prevention(SU)+[womenORgirlsORyouthORteen*ORAboriginalORFirstNation*](any);6)[alcoholORdrink*](SU)+awareness(any);7)FASD(SU)+awareness(any);8)alcohol(SU)+intervention*(any)+women(SU);9)[AlcoholORdrink*](SU)+motivationalinterviewing(any)+[womenORgirlsORgenderORfemale](any);10)[AlcoholORdrink*](SU)+screening(any)+[womenORgirlsORgenderORfemale](any);11)[AlcoholORdrink*](SU)+briefintervention(any)+[womenORgirlsORgenderORfemale](any);12)[Alcoholordrink*](SU)+[homevisitsORhomevisiting](any);13)[ParentchildassistanceprogramORPCAP](any);13)[AlcoholORdrink*](SU)+[midwivesormidwifeormidwifery](any);14)[AlcoholORdrink*](SU)+communitybased;15)[AlcoholORdrink*](SU)+[NICUORneonatalintensivecareunit];16)[Pregnan*ORconceptionORpreconceptionORpost-partum](any)+substanceusetreatment(any);17)[Pregnan*ORconceptionORpreconceptionORpost-partum](any)+harmreduction(any).AllsearcheswerelimitedtoarticlespublishedintheEnglishlanguage.ArticleswerefurtherscreenedforrelevancetotheFASDNAT,andnon-relevantarticles(e.g.diagnosisofFASD)wereremovedfromthelist.Articleswerethencategorizedintooneormoretheme,aspresentedbelow.
LEVEL 2Discussion of alcohol use and
related risks with all women of childbearing years and their
support networks
LEVEL 3Specialized, holistic support
of pregnant women with alcohol and other
health/social problems
LEVEL 1 Broad awareness building and
health promotion effortsCommunity development
LEVEL 4Postpartum support for new
mothers and support for child assessment and development
SUPPORTIVE ALCOHOL POLICY
3
SearchResults
Seventy-two(n=72)articleswereincludedfromoursearches.Twenty-three(n=23)articleswereassignedtomorethanonecategory.Table1providesanoverviewofthenumberofarticlesfoundineachtopicareabycountry.ItcanbeseenthatresearchonFASDprevention,publishedinEnglishismostoftenbeinggeneratedintheUnitedStatesandCanadafollowedbyAustraliaandtheUnitedKingdoms.
Table1:Studiesidentifiedbytopicandcountry
NumberofStudies
Country Prevalence Influences Level1
Level2 Preconception Level
3Level4 Other Total
Australia 2 5 3 . 1 . . 1 12
Canada 3 1 2 1 1 2 1 5 16
Denmark 1 . 1 . . . . . 2
EU(Generally) . . . . . . . 1 1
Finland 1 . . . . . . . 1
Germany . . . 1 . . . . 1
Lithuania . . . 1 . . . . 1
Nepal 1 1 . . . . . . 2
Nigeria 1 1 . . . . . . 2
Norway . . . . . 1 . . 1
Russia 1 1 . . 1 . . . 3
SouthAfrica 4 4 . 1 . . . . 9
Spain . . . 1 . . . . 1
Sweden . 1 . 1 . . . . 2
TheNetherlands . 1 1 1 . . . . 3
UK(England,Irelandand/orScotland)
3 1 3 3 1 . . 112
USA 7 5 3 8 . 4 3 2 32
24 21 13 18 4 7 4 10 101
4
Prevalenceofdrinkinginpregnancy
1. Alshaarawy,O.,Breslau,N.,&Anthony,J.C.(2016).MonthlyEstimatesofAlcoholDrinkingDuringPregnancy:UnitedStates,2002-2011.JournalofStudiesonAlcohol&Drugs,77(2),272-276.
Theauthorshypothesizedthatamonth-by-monthviewofpregnancyanddrinking,insteadofthetraditionaltrimesterview,mightbetterrevealthat:1)womenreducetheirdrinkingwhentheyfindouttheyarepregnant,and;2)persistentdrinkinglevelsinpregnantwomenmayreflectalcoholdependency.UsingtheexistingNationalSurveyonDrugUseandHealth,investigatorsgatheredcross-sectionalsnapshotsofcurrentpregnancystatusanddrinkinglevelsfromUSwomenaged12-44yearsfrom2002-2011.Drinkinglevelswereassessedforheavyepisodicdrinkingandalcoholdependence.ResultsconfirmedthatdrinkinglevelsofpregnantwomendroppedinMonth2,andthathigherdrinkinglevelsinMonth4remainedconsistentandmayindicatealcoholdependency.Investigatorscontendthatmorestudiesthatusethemonthlyestimatesshouldbeconductedbecausetheyofferinformationonthetimingofalcoholuseandcessationduringpregnancythatwillassistwithresearchandpreventionefforts.
2. Balachova,T.,Bard,D.,Bonner,B.,Chaffin,M.,Isurina,G.,Tsvetkova,L.,&
Volkova,E.(2016).Doattitudesandknowledgepredictat-riskdrinkingamongRussianwomen?TheAmericanJournalofDrugandAlcoholAbuse,42(3),306-315.doi:10.3109/00952990.2016.1141914
TheauthorsusedacrosssectionalsurveytoidentifythebeliefsandknowledgeofFASDheldbyurbanandruralRussianwomenaged18-44(n=648),anddetermineifFASDknowledgeandattitudestowardsdrinkingduringpregnancycorrelatedwithriskydrinking.WomenwerescreenedforriskyalcoholconsumptionusingT-ACEandTWEAK.Only34%ofallwomenhadheardofFAS.Ofthatnumber46%reportedthatFASwasabirthdefect;42%reportedthatitwasalifetimecondition;and,75%reportedthatthecauseofFASwasmaternaldrinking.Oftheoverallsample,40%ofwomenthoughteitheralcoholconsumptionduringpregnancywasnotharmful,ordidnotknowifitwasharmful;and8%hadaccurateknowledgeofFAS.Pregnantwomen,anddrinkingpregnantwomeninparticular,hadlowerknowledgescoresthannon-pregnantwomen.Knowledgescore(F(1,7)=7.21,p<0.04)andattitudescore(F(1,7)=11.07,p<0.02)weresignificantforpredictingalcoholuseduringpregnancy.Unexpectedly,knowledgewasnotassociatedwithdecreasedalcoholuseduringthepreconceptionperiodevenifwomenweretryingtoconceive.ThesefindingsstronglysupporteducationandpublichealthcampaignsaboutalcoholandFASD.Theauthorsstresstheneedtotargetthepreconceptionperiodinordertoreduceat-riskdrinkingandalcohol-exposedpregnancies.
5
3. Brown,Q.L.,Hasin,D.S.,Keyes,K.M.,Fink,D.S.,Ravenell,O.,&Martins,S.S.(2016).Healthinsurance,alcoholandtobaccouseamongpregnantandnon-pregnantwomenofreproductiveage.DrugandAlcoholDependence,166,116-124.doi:10.1016/j.drugalcdep.2016.07.001
Theauthorspreformedacrosssectionalanalysistounderstandtherelationshipbetweenhealthinsurancecoverageandpreventionoftobaccoandalcoholuseamongwomenaged12-44participatingintheNationalSurveyofDrugUseandHealthduring2010-2013(n=97,788).Resultsfromlogisticregressionmodelsshowedthatamongpregnantwomen,havinghealthinsurancewasassociatedwithloweroddsofusingalcoholinthepastmonth(AOR=0.47;95%CI=0.27–0.82),butnotforusingtobacco(AOR=1.14;95%CI=0.73–1.76).Amongnon-pregnantwomenwithhealthinsurance,theoddswereopposite:higheroddsofalcoholuseinthepastmonth(AOR1.23;95%CI=1.15–1.32)andloweroddsoftobacco(AOR=0.67;95%CI=0.63,0.72).Theauthorsconcludethathealthinsuranceduringpregnancyispromisingforreducingalcoholuseduringpregnancy,butsuggestsmoreneedstobedonetoreducetobaccouseduringpregnancy.4. Cohen,K.,Capponi,S.,Nyamukapa,M.,Baxter,J.,Crawford,A.,&Worly,B.
(2016).Partnerinvolvementduringpregnancyandmaternalhealthbehaviors.MaternalandChildHealthJournal,20(11),2291-2298.doi:10.1007/s10995-016-2048-3
UsingaconveniencesamplefromaprenatalclinicintheUS,pregnantwomenweresurveyedabout“support”anditseffectonalcoholandtobaccoconsumption.Womensurveyed(n=198)identifiedasupportperson(partner,family,other),completedtheNorbeckSocialSupportQuestionnaire(NSSQ),andsociodemographicinformation.Ofthe60partnerspresentatprenatalvisit,26participatedinthesurvey.Resultsshowthatpartneredversusnon-partneredwomenhadlowerratesofalcohol(26%versus42%),andtobaccoconsumption(3%versus12%).Women’sperceivedpartnersupportwasnotassociatedwithlowerlevelsofalcoholconsumption,butitwasassociatedwithlowerlevelsoftobaccoconsumption.Bothincreasedincome,beingmarriedandhighereducationwereassociatedwithpositivelyinfluencingNSSQscores.5. English,L.L.,Mugyenyi,G.,Nightingale,I.,Kiwanuka,G.,Ngonzi,J.,Grunau,B.E.,
MacLeod,S.,Koren,G.,Delano,K.,Kabakyenga,J.Wiens,M.O.(2016).PrevalenceofethanoluseamongpregnantwomeninSouthwesternUganda.MaternalandChildHealthJournal,20(10),2209-2215.doi:10.1007/s10995-016-2025-x
TodeterminetheprevalenceandpredictorsofalcoholconsumptionduringpregnancyinSouthwesternUganda,womenandchildrenenrolledasadyad(n=505),completedanquestionnaireonalcoholandtobaccousebeforeandduringpregnancy,demographicinformation,educationlevels,andattitudesandbeliefsaboutalcoholuseduringpregnancy.ThosereportingdrinkingalcoholatanytimealsocompletedtheTWEAK.Meconiumsampleswerecollectedfromallchildren.Eighty-onewomen(16%)reportedusingalcohol;53%scoredtwoormorepointsontheTWEAK,indicatingpossibleproblemdrinking.Fewmeconiumsampleswereethanol(EtG)positive,andbiologicaloutcomesdidnotalignwithreporteduse.Self-reportswerehigherthanEtGpositivemeconium,however,theTWEAKquestionnaireswereassociatedwithEtGpositivemeconium.Basedonthisstudy,theauthorsfound:1)highprevalenceofalcohol-exposedpregnanciesinSWUganda;2)pre-conceptionalcoholuseisthestrongestpredictorofusethroughoutpregnancy;3)alcoholusebyapartnerisassociatedwithmaternaldrinkingthroughoutpregnancy;4)maternaleducationisaprotectivefactor;5)secondaryeducationpredictedloweroddsofdrinkinginpregnancy;and,6)“low-riskperceptions”ofalcoholuseinpregnancyweresignificantlyassociatedwithconsumption.Recommendationsincludeimprovingeducationalprogramsonalcoholexposedpregnancy(AEP)andFASD,andscreeningforalcoholuseinpregnancytointerveneearlier.
6
6. Green,P.P.,McKnight-Eily,L.R.,Tan,C.H.,Mejia,R.,&Denny,C.H.(2016).Vital
Signs:Alcohol-ExposedPregnancies-UnitedStates,2011-2013.MMWR:Morbidity&MortalityWeeklyReport,65(4),91-97.doi:10.15585/mmwr.mm6504a6
TheCenterforDiseaseControlanalyzedresponsesfromfemaleparticipantsontheNationalSurveyonFamilyGrowth2011-2013todetermine:1)prevalenceofalcohol-exposedpregnancy(AEP)risk,and2)characteristicsofwomenatriskforanAEP.Womenwhometfourcriteria(n=4,303)wereconsideredtobeatriskforAEPif:1)theyhadsexualintercoursewithamaleinthelast4weeks;2)drankanyamountofalcoholinthelast30days;3)neitherpartnerusedanyformofcontraceptioninthemonthbeforetheinterview;and,4)neitherpartnerwassterile.Additionally,womenweregroupedaccordingtowhetherornottheywantedtobecomepregnant.ThecalculatedprevalenceestimateforAEPriskwas7%forwomenaged15-44yearsofage.RiskforAEPwashigheramongwomenwhowere:1)married(12%)orcohabitating(14%);2)whohadonelivebirth(14%comparedwith6%withnoneor6%with2ormore);3)currentsmokers(11%comparedwith6%non-smokers).Byage,theriskwashighestamongwomen25-29years(10%)andlowestamongwomen15-20years(2%).TherewasapositiveassociationbetweeneducationandAEPrisk,butnotforrace/ethnicityandAEPrisk.Alcoholusedidnotdifferbasedonwhetherornotawomandesiredtobecomepregnant.BasedonthisstudytheCDCrecommendsawide-rangedapproachtoincludebothprimarycare(screeningandbriefintervention,contraception)andpopulation-basedstrategies(electronicscreening/briefintervention,enforcementofalcoholagerestrictions).7. Kesmodel,U.S.,Petersen,G.L.,Henriksen,T.B.,&Strandberg-Larsen,K.(2016).
TimetrendsinalcoholintakeinearlypregnancyandofficialrecommendationsinDenmark,1998-2013.ActaObstetriciaetGynecologicaScandinavica,95(7),803-810.doi:10.1111/aogs.12890
FollowingachangeinDanishgovernmentrecommendationsregardingalcoholconsumptionduringpregnancy(in2007)fromcondoningsomeconsumptiontototalabstinence,theauthorsinvestigatedifthechangeimpactedaveragealcoholintakeandbingedrinkinginearlypregnancy.Overn=68,000pregnantwomenreceivinghospitalprenatalcarebetween1998and2013completedaself-reportquestionnaireassessingbingedrinking,averagenumberofdrinksconsumedperweek,andtimingofconsumption.Findingssuggestthatthenumberofwomenreportingabstinencesignificantlyincreasedfrom1998(31%)to2013(83%),andtherewasadeclineinboththenumberofwomenwhoreportedbingedrinkingandtheaveragenumberofdrinksconsumedperweek.Interestingly,thegreatestdeclineindrinkingoccurredbetween1998and2007,whichispriortowhenthegovernmentmodifiedtheirrecommendations.Theauthorsconcludethatgreaterawarenessaroundthedangersofalcoholconsumptionduringpregnancymaybetterexplaindrinkingtrendsthanofficialrecommendationsfromthegovernment.
7
8. Kreshak,A.,Villano,J.,Clark,A.,Deak,P.,Clark,R.,&Miller,C.(2016).Adescriptiveregionalstudyofdrugandalcoholuseinpregnantwomenusingresultsfromurinedrugtestingbyliquidchromatography-tandemmassspectrometry.TheAmericanJournalofDrugandAlcoholAbuse,42(2),178-186.doi:10.3109/00952990.2015.1116540
TheauthorsinvestigatedtheprevalenceofdrugandalcoholuseamongpregnantwomeninSouthernCalifornia.Liquidchromatography-tandemmassspectrometrywasconductedonurinesamplesfrom295womenatallstagesofpregnancywhowereattendingurbanandsuburbanobstetricclinicstoexaminethepresenceofdrugsandalcohol.Overall,14%ofurinesamplestestedpositiveforasubstance,andonlyonesamplewaspositiveformorethanone.Themostcommonsubstancedetectedwasalcohol(6%),followedbymarijuana(4%)andopioids(4%).Comparedwithpreviousresearch,theauthorsnotethatthesefindingssuggestincreasedratesofopioiduse,stableratesofalcoholuse,anddecreasedratesofmarijuanauseamongpregnantwomen.Theysuggestthaturineanalysismayusefulfortheaccurateidentificationofwomenat-riskforadverseoutcomes.9. Matusiewicz,A.K.,Ilgen,M.A.,&Bohnert,K.M.(2016).Changesinalcoholuse
followingthetransitiontomotherhood:FindingsfromtheNationalEpidemiologicSurveyonAlcoholandRelatedConditions.DrugandAlcoholDependence,168,204-210.doi:10.1016/j.drugalcdep.2016.08.635
Despiteasubstantialbodyofliteratureexaminingacutereductionsofalcoholconsumptionduringpregnancy,littleresearchhasbeenconductedtoexaminedrinkingtrendsfollowingthetransitiontomotherhood.Theauthorscompareddrinkingpatternsofwomenwhobecamemothersandwomenwhodidnot,overathree-yearperiod.DatawascollectedfromtheUSNationalEpidemiologicalSurveyonAlcoholandRelatedConditions(NESARC)from2,118womenaged18yearsandolderwhoreportedatleastonedrinkinthepreviousyear.Fifteenpercent(15%)ofthesewomenbecamefirst-timemothers(includingthosewithadopted,foster,orstep-children)betweenthestudybaselineandthree-yearfollow-up.Alcoholusewasmeasuredusingfrequencyofconsumption,heavydrinking(4+inoneoccasion),andtypicalnumberofdrinksconsumedinonesittingoverthelastyear.Atbaseline,womeninbothgroupsreportedsimilarlevelsofdrinkingacrossallindicators.Atfollowup,womenwhobecamemothersshowedsignificantlylowerlevelsofdrinkingacrossindicators,evenafteradjustingfordemographicfactorsandbaselinealcoholuse.Theauthorsconcludedbynotingthatfurtherresearchisneededtoexplore:theassociationbetweenmotherhoodandalcoholconsumption,interventionstoreduceheavydrinkingamongwomen,andtheimpactofdrinkingonlong-termwell-beingofbothmothersandtheirchildren.10. May,P.A.,Hasken,J.M.,Blankenship,J.,Marais,A.-S.,Joubert,B.,Cloete,M.,...
Seedat,S.(2016).Breastfeedingandmaternalalcoholuse:Prevalenceandeffectsonchildoutcomesandfetalalcoholspectrumdisorders.ReproductiveToxicology,63,13-21.doi:10.1016/j.reprotox.2016.05.002
Thisstudyexaminedtheprevalenceofmaternalalcoholconsumptionduringthebreastfeedingperiod,anditsimpactonchildoutcomesat7yearsold.Datawascollectedfrom1,047mothersinseveralcommunitiesinSouthAfrica.Almostall(90%)mothersbreastfedtheirchildren(foranaverageof20months),and70%ofallmothersconsumedalcoholwhilebreastfeeding.Significantlymorewomenwhodrankprenatallyalsodrankduringthebreastfeedingperiod,and42%ofwomenwhoreportedabstinenceduringpregnancydrankwhilebreastfeeding.Exposuretoalcoholthroughbreastmilkwasalsoassociatedwitha6.4timesgreaterlikelihoodoflaterbeingdiagnosedwithFASD.Thesegroupdifferencesremainedevenaftercontrollingforprenataldrinkingandothermaternalriskfactors.Inconclusion,theauthorsnotethatmaternalalcoholconsumptionduringthebreastfeedingperiodhasdetrimentaleffectsonchildgrowthanddevelopmentaloutcomes.
8
11. Muggli,E.,O'Leary,C.,Donath,S.,Orsini,F.,Forster,D.,Anderson,P.J.,...
Halliday,J.(2016)."Didyoueverdrinkmore?"Adetaileddescriptionofpregnantwomen'sdrinkingpatterns.BMCPublicHealth,16,1-13.doi:10.1186/s12889-016-3354-9
ResearchersinAustraliagathereddataondrinkingpatternsfromwomenearlyintheirpregnancies(n=1,500),retrospectivelyduringtheirfirsttrimester,andthenduringthesecondandthirdtrimesters.Thequestionnairefocusedon1)dose,includingapictorialdrinkguideacrossninetypesofalcoholicdrinks;and,2)timing,includingspecial-occasionanddifficult-timesdrinking.Fortypercent(41%)ofwomendidnotdrinkduringpregnancy;27%drankinthefirsttrimesteronly(87%stoppedwhentheyfoundouttheywerepregnant);and,27%drankatsomelevelthroughoutpregnancy.Pregnantwomenwhodrankweremorelikelytohaveanunplannedpregnancy,andtohavehadtheirfirstintoxicationbeforeage18.Special-occasionquestionrevealedimportantdataaboutbingedrinkingthatwouldnothavebeencapturedotherwise,whichsuggeststhatusingthistypeofquestionwouldimprovetheaccuracyofself-reportingassessments.Theauthorsunderscorethatasinotherstudies,theyfoundthatpre-pregnancydrinkingpredictsdrinkinginpregnancy.Theydiscussimplicationsfortargetinghealthpromotionandinterventionsandforimprovingresearchmethods.12. Niemelä,S.,Niemelä,O.,Ritvanen,A.,Gissler,M.,Bloigu,A.,Werler,M.,&Surcel,
H.-M.(2016).FetalAlcoholSyndromeandMaternalAlcoholBiomarkersinSera:ARegister-BasedCase-ControlStudy.Alcoholism:Clinical&ExperimentalResearch,40(7),1507-1514.doi:10.1111/acer.13101
UsingthreeseparatenationwideregistersinFinlandfrom1987to2005,researcherswereabletocompareinformationandbiomarkersofwomenwhogavebirthtoachildwithFoetalAlcoholSyndrome(FAS)(n=565)withacontrolgroupwomen.Dataonbackgroundcharacteristicsofthewomenwascomparedtobiomarkersofalcoholconsumptionavailablefromprenatalserumscreeningsusedtoidentifyinfectiousdisease.Eachcaseidentifiedthathadanavailableprenatalserumscreening(n=385)wasmatchedbyageandyearofbloodsamplingwithtwocasesfromthecontrolgroup(n=745).MothersofchildrenwithFASweremorelikelytosmoke(85%versus3%)andtohavelowersocio-economicstatus.BiomarkersofalcoholconsumptionweresignificantlyhigheramongmothersofchildrenwithFASandwereabletopredict46%ofthesemothers.Moreover,thecombinationgamma-glutamyltransferase(GGT)andcarbohydrate-deficienttransferrin(%CDT)wasthebestpredictor.Althoughtheauthorsdescribethelimitationsofusingbiomarkerstoidentifyalcoholexposedpregnancies,theycontendthatsystematicallyusingbiomarkersduringthefirsttrimesterofpregnancycanhelpwithidentificationandintervention.
9
13. Onah,M.N.,Field,S.,vanHeyningen,T.,&Honikman,S.(2016).Predictorsofalcoholandotherdruguseamongpregnantwomeninaperi-urbanSouthAfricansetting.InternationalJournalofMentalHealthSystems,10(38).doi:10.1186/s13033-016-0070-x
Researchersconductedacrosssectionalstudytolearntheassociationbetweenalcoholandotherdrug(AOD)useandthelifeeventsofpregnantwomeninlow-incomeareas.Theyenrolled376pregnantwomenfromamidwiferyprimaryobstetriccareclinicinahigh-density,rural-urbantransitionareainCapeTown,SouthAfrica.UsingadiagnosticinterviewwithTheExpandedMini-InternationalNeuropsychiatricInterview(MINIPlus)Version5.0.0,theyassessedtheparticipantsfordepression,anxiety,suicidalideation,andAODuse.Severalothermeasureswereincludedtoassesssocioeconomicstatus,foodinsecurity,perceivedsocialsupport,conflict,andriskforpsychologicaldistress.Ofthewomensampled,18%reportedcurrentAODuse.Withinthatgroup22%reportedsuicidalideations,19%hadananxietydiagnosis,and18%wereexperiencingamajordepressiveepisode.Womenaged24-29reportedhigherlevelsofAODusethananyothergroup.FoodinsufficiencywasastrongpredictorofAODuse,andwomendeemed“verypoor”andthe“poorest”weretwiceaslikelytouseAODthanthe“leastpoor”(OR2.33,95%CI1.74–2.71;OR1.75,95%CI1.53–2.78).Womenwithaplannedpregnancywerelesslikelytousethanthosewithanunplannedpregnancy(OR0.30,95%CI0.11–0.80).WomenwhoexperiencedmentalhealthissuesinthepastweretwiceaslikelytouseAODthanwomenwhodidnot(OR12.13,9%CI1.81–2.61).ResearchersconcludethattheassociationofAODandmentalhealthissueslikelyreflectshowadverselivingconditionssupportmultiplementalhealthproblems,andtheymakesuggestionsforpreventionandinterventionefforts.
14. Onwuka,C.I.,Ugwu,E.O.,Dim,C.C.,Menuba,I.E.,Iloghalu,E.I.,&Onwuka,C.I.
(2016).PrevalenceandPredictorsofAlcoholConsumptionduringPregnancyinSouth-EasternNigeria.JournalofClinical&DiagnosticResearch,10(9),10-13.doi:10.7860/JCDR/2016/21036.8449
Toexaminetheprevalenceof,andfactorsassociatedwith,alcoholuseduringpregnancy,theauthorsconductedacrosssectionalstudyof380womenusingantenatalcareservicesatahospitalinEnugu,South-EasternNigeria.Thequestionnairescollecteddataon:socio-demographics,knowledgeofthenegativeeffectsofalcoholuseduringpregnancyonthefetus,knowledgeofFASDandthesource/softheirknowledge,useofalcoholduringtheirpregnancy,amountandtypeofalcoholconsumed,theirreasonforconsumingalcohol,andinterestinstoppingalcoholuse.Therateofalcoholconsumptionduringpregnancywas23%,andthemostcommonbeveragewasstoutbeer(63%).Justoverone-third(36%)ofparticipantswereknowledgeableofthenegativeeffectsofalcoholforthefetus.Thefactorsassociatedwithalcoholuseduringpregnancyinthissamplewere:age<30years,beingnulliparous,nothavingapost-secondaryeducation,consumingalcoholpriortopregnancy,andalackofknowledgeregardingthenegativeeffectsofalcoholonthefetus(p<0.05).TheauthorsconcludethatalcoholuseduringpregnancyamongwomeninthisregionofNigeriaishigh,andgiventheassociationwithalackofknowledgeregardingtheharmfuleffectsonthefetus,publichealthcampaignstoincreaseawarenessarewarranted.
10
15. Pettigrew,S.,Jongenelis,M.,Chikritzhs,T.,Pratt,I.S.,Slevin,T.,&Glance,D.(2016).AComparisonofAlcoholConsumptionIntentionsAmongPregnantDrinkersandTheirNonpregnantPeersofChild-BearingAge.SubstanceUse&Misuse,51(11),1421-1427.doi:10.3109/10826084.2016.1172641
ToinvestigatealcoholconsumptionamongwomeninAustralia,theauthorsconductedthreenationalonlinesurveys.Datafromwomenofchildbearingagewascategorizedbypregnancystatus:pregnant(n=101),possiblypregnant,(n=178),andnotpregnant(n=1,957).Womenwhowerecurrentlypregnantweremostlikelytoreportthattheyshould(47%)andwill(53%)reducetheiralcoholuse.Theproportionofwomenreportingtheyintendedtoconsumefiveormoredrinksduringoneoccasioninthenexttwoweeksdidnotdiffersignificantlybypregnancystatus(33%pregnant,32%non-pregnant,and39%possiblypregnant).Olderpregnantwomenreportedhigherratesofheavydrinkingintentions,andfewerintentionstoreducetheirdrinking.Theauthorsconcludethatthesimilarratesofheavydrinkingintentionsbetweenpregnantandnon-pregnantwomenindicatethatcurrentpublichealthguidancetoabstainfromalcoholuseduringpregnancyhasnotyethadanimpactatapopulationlevel. 16. Popova,S.,Lange,S.,Probst,C.,Parunashvili,N.,&Rehm,J.(2017a).Prevalence
ofalcoholconsumptionduringpregnancyandFetalAlcoholSpectrumDisordersamongthegeneralandAboriginalpopulationsinCanadaandtheUnitedStates.EuropeanJournalofMedicalGenetics,60(1),32-48.
Twoindependentsystematicreviewsandmeta-analyseswereconductedtoexaminethepooledprevalenceof:1)alcoholuseandbingedrinkingduringpregnancy;and2)FASandFASDamongAboriginalpeopleandthegeneralpopulationinCanadaandtheUSA.Thepooledestimaterevealedthat10%ofwomeninCanadaand15%ofwomenintheUSAconsumealcoholduringpregnancy,andinbothcountries3%ofwomenbingedrinkduringpregnancy.TheprevalencerateofalcoholuseamongAboriginalwomenwasthreetimeshigherintheUSAandfourtimeshigherinCanadathanamongthegeneralpopulation.Further,approximately20%ofAboriginalwomenintheUSAandCanadabingedrinkduringpregnancy.InCanada,therateofFASwasapproximately1per1000,andtherateofFASDwas5per1000.AmongAboriginalpeopleinCanada,therateofFASwas38timeshigher,andrateofFASDwas16timeshigherthanthegeneralpopulation.IntheUSA,therateofFASwasapproximately2per1000,andtherateofFASDwas15per1000.AmongAboriginalpeopleintheUSA,therateofFASwas4per1000,andrateofFASDwas10per1000.TheauthorsnotethattheprevalenceestimatesofFASandFASDshouldbeinterpretedwithcaution,duetothelownumberofavailablestudiesandthepresenceofmethodologicalweaknesses.However,theauthorsconcludethattherewasaclearneedforpreventionandsurveillanceapproachestomeasureandreducetheuseofalcoholduringpregnancyandratesofFASD.
11
17. Popova,S.,Lange,S.,Probst,C.,Shield,K.,Kraicer-Melamed,H.,Ferreira-Borges,C.,Rehm,J.(2016b).ActualandpredictedprevalenceofalcoholconsumptionduringpregnancyintheWHOAfricanRegion.TropicalMedicine&InternationalHealth,21(10),1209-1239.doi:10.1111/tmi.12755
Asystematicreviewandmultiplemeta-analyseswereconductedtoassesstheprevalenceofalcoholuseandbingedrinkingduringpregnancyintheWorldHealthOrganizationAfricanRegion,bycountry.Forcountrieswithfewerthantwoprevalencestudies,ornoavailabledata,predictionswerebasedonregressionmodelling.ThepooledprevalenceratesofalcoholuseinpregnancyinCentralAfricarangedfrom2.2%inEquatorialGuinea(95%CI1.6–2.8%)to12.6%inCameroon(95%CI9.9–15.4%).InEasternAfrica,ratesrangedfrom3.4%inSeychelles(95%CI2.6–4.3%)to20.5%inUganda(95%CI16.4–24.7%).InSouthAfrica,ratesrangedfrom5.7%inBotswana(95%CI4.4–7.1%)to14.2%inNamibia(95%CI11.1–17.3%).InWesternAfrica,ratesrangedfrom6.6%inMauritania(95%CI5.0–8.3%)to14.8%inSierraLeone(95%CI11.6–17.9%).InAlgeriainNorthAfricatheratewas4.3%(95%CI3.2–5.3%;Algeria).TheonlycountrywithtwostudiesontheprevalenceofbingedrinkingduringpregnancywasSouthAfrica(4.6%)(95%CI3.1–6.4%;I2=74.1%).Theauthorsconcludethateducation,surveillanceandinterventionsareneededinsomeAfricancountrieswhereratesofalcoholuseorbingedrinkingduringpregnancyarehigh.18. Singal,D.,Brownell,M.,Hanlon-Dearman,A.,Chateau,D.,Longstaffe,S.,&Roos,
L.L.(2016).Manitobamothersandfetalalcoholspectrumdisordersstudy(MBMomsFASD):protocolforapopulation-basedcohortstudyusinglinkedadministrativedata.BMJOpen,6(9),e013330-e013330.doi:10.1136/bmjopen-2016-013330
ThisarticledescribestheresearchplanforthestudyofalargeretrospectivecohortofmotherswhosechildrenwerediagnosedwithFASD,designedtoinvestigateriskfactorsassociatedwithgivingbirthtochildrenwithFASD;andmaternalphysicalandhealthoutcomes,anduseofhealthandsocialservicesinManitoba.TheresearcherswillbelinkingchildrendiagnosedwithFASDfromaprovinciallycentralisedFASDassessmentclinic(fromMarch1999toMarch2012)totheirbirthmothersusingde-identifiedadministrativehealthdatahousedattheManitobaCentreforHealthPolicy,andaregeneratingacomparisoncohortofwomenwithchildrenwhodidnothaveanFASDdiagnosis.Thelongitudinaldataonuseofservices,aswellasthedataonrisksassociatedwithhavingachildaffected,willprovideimportantinformationforFASDpreventiondesign.19. Symon,A.,Rankin,J.,Butcher,G.,Smith,L.,&Cochrane,L.(2016a).Evaluationof
aretrospectivediaryforperi-conceptualandmid-pregnancydrinkinginScotland:across-sectionalstudy.ActaObstetriciaetGynecologicaScandinavica.doi:10.1111/aogs.13050
Theauthorsassessedperi-conceptualandmid-pregnancyalcoholconsumptionusingaweek-longretrospectivediaryandstandardalcoholquestionnaires,theagreementbetweentheseinstruments.ThiscrosssectionalstudywasundertakenintwoScottishhealthboardareasinvolving510womenattendingmid-pregnancyultrasoundscanclinics.Face-to-faceadministrationofanalcoholretrospectivediary,AUDITorAUDIT-C,andtheDepression-Anxiety-StressScale(DASS-21)wasconducted.Asub-sample(n=30)providedhairforalcoholmetaboliteanalysis.TheretrospectivediarycorrelatedmoderatelywiththeAUDITtools,andfoundsignificantlyhigherperi-conceptualconsumption,(medianunitconsumptionon“drinkingdays”6.8;range0.4-63.8);andadditional“specialoccasions”consumptionrangedfrom1to125unitsperweek.Biomarkeranalysisidentifiedthreeinstancesofhazardousperi-conceptualdrinking.Theauthorsconcludethatwomenreporthigherconsumptionlevelswhencompletingtheretrospectivediary,especially“binge”drinking,andnotethebenefitsofittocapturepre-pregnancyandantenataldrinking.
12
20. Symon,A.,Rankin,J.,Sinclair,H.,Butcher,G.,Smith,L.,Gordon,R.,&Cochrane,L.
(2016b).Peri-ConceptualandMid-PregnancyAlcoholConsumption:AComparisonbetweenAreasofHighandLowDeprivationinScotland.Birth:IssuesinPerinatalCare,43(4),320-327.doi:10.1111/birt.12252
ThisstudyassessedifgeneralpopulationalcoholconsumptionpatternswerereflectedamongpregnantwomenintwoScottishareaswithdifferentdeprivationlevels.Womenintwohealthboards(HB1,lowerdeprivationlevels,n=274;HB2,higherdeprivationlevels,n=236)wereadministered(face-to-face)a7-dayRetrospectiveDiarytooltocaptureperi-conceptualandmid-pregnancyalcoholconsumption.Agreaterproportionofwomeninthehigherdeprivationarea(HB2)sometimesdrankperi-conceptually,butwomeninthelowerdeprivationarea(HB1)weremorelikelytodrinkeveryweek(50%comparedwith30%;p<0.001)andtoexceeddailylimits(6units)atleastonceeachweek(32%comparedwith15%;p<0.001).Afterpregnancyrecognition,consumptionlevelsfellsharply,butwomeninHB2weremorelikelytodrinkaboverecommendeddailylimits(2units)eachweek(3%comparedwith0%;p<0.05).However,womeninHB1weremorelikelytodrinkfrequently.Womenwiththehighestdeprivationscoresineachareadrankonaveragelessthanwomenwiththelowestdeprivationscores.Theauthorsconcludethatheavyepisodicandfrequentconsumptionwasmorecommoninthelowerdeprivationarea,incontrastwithgeneralpopulationdata.Theauthorsnotetheimportanceofelicitingadetailedalcoholhistoryattheantenatalbookingvisit,andofgivingclearmessagingabouttherisksofdrinkingwhenpregnant.21. Thapa,N.,Aryal,K.K.,Puri,R.,Shrestha,S.,Shrestha,S.,Thapa,P.,...Stray-
Pedersen,B.(2016).AlcoholconsumptionpracticesamongmarriedwomenofreproductiveageinNepal:Apopulationbasedhouseholdsurvey.PLoSONE,11(4).
ThisstudyassessedtheprevalenceofalcoholconsumptionamongmarriedwomenofreproductiveageinNepalusingahouseholdsurveyadministeredovera5-monthperiodin2013.Atotalof9000marriedwomenofreproductiveagewereinterviewedusingasemi-structuredquestionnaire.Theresultsshowedanationalprevalenceofeverhavingconsumedalcoholamongmarriedwomenofreproductiveageof25%(95%CI21.7-28.0),last12months18%(95%CI15.3-20.7)andlast30days(currentdrinking)12%(95%CI9.8-14.1).Therewassubstantialvariationamongthedistrictsrangingfrom2%to60%.Analysisfoundthatwomenwithnoeducationorwithformaleducation,dalitandjanajatisethnicity,whosehusbandsdrinkalcohol,whobrewalcoholathomeandwomenfrommountainsweresignificantlyathigherriskofconsumingalcohol.Amongthewomenwhodrankalcoholinlast12months,asubstantialproportionofthemdrankhomebrewedalcoholicbeverages(96%,95%CI94.3-97.4).
13
22. Urban,M.F.,Olivier,L.,Louw,J.G.,Lombard,C.,Viljoen,D.L.,Scorgie,F.,&Chersich,M.F.(2016).Changesindrinkingpatternsduringandafterpregnancyamongmothersofchildrenwithfetalalcoholsyndrome:AstudyinthreedistrictsofSouthAfrica.DrugandAlcoholDependence,168,13-21.doi:10.1016/j.drugalcdep.2016.08.629
ThisarticledescribesalcoholusepatternsbypregnantwomeninthreedistrictsofSouthAfrica(CapeWinelands,aninlandminingtownandcoastaltowns).Mothers(n=156)andproxyinformants(n=50)ofschool-entrychildrendiagnosedwithFASandpartial-FASwereinterviewed,andcomparedwith55controls.Studyparticipantswereoflowsocio-economicstatus(SES),andamajorityofchildrenwereeitherinfostercare(12%)orhadbeencaredforbyrelativesforlongperiods(44%).Seventy-sevenpercent(77%)ofcasesreportedcurrentdrinking,35%hadstoppeddrinkingduringpregnancy,and6%increaseddrinking.Manywomenwhostoppedinpregnancyresumedpostpartum,howevercessationinpregnancywasstronglyassociatedwithdiscontinuationinthelongrun(OR=3.3;95%CI1.2-8.9;p=0.005).Atinterview,36%ofcasesand18%ofcontrolswereatriskofanalcohol-exposedpregnancy(p=0.02).Akeyco-existingriskwasamedianmaternalmass22kglowerthancontrols,with20%beingunderweightand14%microcephalic.TheauthorsconcludethattheriseincessationofdrinkingduringpregnancyovertimesuggestsrisingawarenessofFAS.Becausecessationisassociatedwithrecidivismafterpregnancy,butalsowithreducedlong-termdrinking,interventionsneedtoreachpregnantwomenandextendintothepostpartumperiod.
23. Washio,Y.,Mericle,A.A.,Cassey,H.,Daubert,A.M.,&Kirby,K.C.(2016).
Characteristicsoflow-incomeracial/ethnicminoritypregnantwomenscreeningpositiveforalcoholrisk.JournalofImmigrantandMinorityHealth,18(4),850-855.doi:10.1007/s10903-015-0238-5
Thisstudyexaminedtheprevalenceandcharacteristicsassociatedwithalcoholriskamonglow-income,predominantlyracial/ethnicminoritypregnantwomeninanurbanareaintheUSA.Pregnantwomenreceivingnutritionalcare(n=225)wererecruitedtocompleteafive-minutesurveyinthewaitingroomofanutritionalsupportservicetheywereaccessing.Thesurveyquestionscovereddemographicinformation,homelessnessstatus,alcohol,cigaretteandotherdruguse,andwhethertheywerelivingwithapersonwhousedsubstances.ThequestionsaboutalcoholusewerethoseincludedintheTWEAKscreeningtool.Twenty-sixpercent(26%)screenedpositiveforalcoholrisk.Currentsmokingstatus(AOR2.9,95%CI1.2-7.0;p=0.018)andahistoryofmarijuanause(AOR3.1,95%CI1.6-6.2;p=0.001)werethestrongestpredictorsofalcoholriskstatus.Theauthorsnotetheimportanceofscreeningforalcoholrisk,smoking,andillicitdruguseamongpregnantwomenandnotetheusefulnessoftheTWEAKinidentifyingalcoholriskinsettingsservingwomenwhoareoflowincomeandareraciallyandculturallydiverse.24. Winter,G.F.(2016).Alcohol,pregnancyandtheprecautionaryprinciple.British
JournalofMidwifery,24(10),684-684.doi:10.12968/bjom.2016.24.10.684
Inthiscommentary,theauthordiscussesthe“precautionaryprinciple”,theapproachtoFASDpreventiontakenbyFinland,Norway,Sweden,andDenmark.Theprinciplepurportsthatgiventheabsenceofclearscientificdataonsafelevelsofalcoholconsumptionduringpregnancy,thereis“certainuncertainty,”regardingsafelevelsand,therefore,themessagetowomenis“whytakechances.”Theauthordescribeshowthisprinciplehasgainedendorsementeventhoughitdoesnotfollowalogicalprogressionofthefacts(orlackofthem),whichisthescientificapproachtomedicalrecommendations.Instead,theprecautionaryprinciplereflectstheinfluenceofsocio-culturalinterpretationsofthefacts.Moreover,forthesereasons,morefactsmaynotsolvetheissueofcertainty.
14
Influencesandfactorsassociatedwithdrinkinginpregnancy
1. Balachova,T.,Bard,D.,Bonner,B.,Chaffin,M.,Isurina,G.,Tsvetkova,L.,&Volkova,E.(2016).Doattitudesandknowledgepredictat-riskdrinkingamongRussianwomen?TheAmericanJournalofDrugandAlcoholAbuse,42(3),306-315.doi:10.3109/00952990.2016.1141914
(Seeabstractabove)2. Brown,Q.L.,Hasin,D.S.,Keyes,K.M.,Fink,D.S.,Ravenell,O.,&Martins,S.S.
(2016).Healthinsurance,alcoholandtobaccouseamongpregnantandnon-pregnantwomenofreproductiveage.DrugandAlcoholDependence,166,116-124.doi:10.1016/j.drugalcdep.2016.07.001
(Seeabstractabove)3. Cohen,K.,Capponi,S.,Nyamukapa,M.,Baxter,J.,Crawford,A.,&Worly,B.
(2016).Partnerinvolvementduringpregnancyandmaternalhealthbehaviors.MaternalandChildHealthJournal,20(11),2291-2298.doi:10.1007/s10995-016-2048-3
(Seeabstractabove)4. English,L.L.,Mugyenyi,G.,Nightingale,I.,Kiwanuka,G.,Ngonzi,J.,Grunau,B.E.,.
..Wiens,M.O.(2016).PrevalenceofethanoluseamongpregnantwomeninSouthwesternUganda.MaternalandChildHealthJournal,20(10),2209-2215.doi:10.1007/s10995-016-2025-x
(Seeabstractabove)5. Green,P.P.,McKnight-Eily,L.R.,Tan,C.H.,Mejia,R.,&Denny,C.H.(2016).Vital
Signs:Alcohol-ExposedPregnancies--UnitedStates,2011-2013.MMWR:Morbidity&MortalityWeeklyReport,65(4),91-97.doi:10.15585/mmwr.mm6504a6
(Seeabstractabove)
15
6. Haydon,H.M.,Obst,P.L.,&Lewis,I.(2016).BeliefsunderlyingWomen'sintentionstoconsumealcohol.BMCWomen'sHealth,16,1-12.doi:10.1186/s12905-016-0317-3
Theauthorsinvestigatedwomen’sunderlyingintentionsformakingdrinkingchoicesandtheiractualbehaviorsbasedonageandlevelsofdrinking.TwoquestionnaireswerecreatedbasedontheTheoryofPlannedBehaviour--atheoryusedtopredicthealthandsocialbehaviours.Womenaged18-37(mean=35)wereaskedtocompletetwoonlinequestionnaires:Questionnaire1(n=1039)abouttheirintentionstodrinkalcohol(low-risk,frequency,high-risk/binge),andtwoweekslater;andQuestionnaire2(n=845)abouttheiralcoholconsumption.Exceptforintentiontodrinkatlowrisklevels,women’sintentionstodrinkandtheirunderlyingchoiceswererelatedtoage.Forinstance,olderwomen(aged45+)weremorelikelytointendtodrinkfrequentlyandrelatedbeliefswererelaxationandstressrelief.Womenaged18-24weremorelikelytointendtobingedrinkandrelatedbeliefswerebirthdaycelebrations,highertolerance,accesstowineriesandwineclubs,andnothavingchildren.Theauthorscontendthatthestudyresultsunderscoretheimportanceoftargetinginterventionsandmessagingtospecificagesanddrinkingbehaviors,aswomen’sintentionsandchoicesmaychangeoverthelifespan.7. Högberg,H.,Skagerström,J.,Spak,F.,Nilsen,P.,&Larsson,M.(2016).Alcohol
consumptionamongpartnersofpregnantwomeninSweden:acrosssectionalstudy.BMCPublicHealth,16,1-10.doi:10.1186/s12889-016-3338-9
Inthisstudytheauthorsexamined:patternsofalcoholconsumptionamongpartnersofpregnantwomen(usingtheAUDIT-C),motivationsforpartnerstomodifytheirdrinkingbehaviourspre-andpostnatally,andperceptionsoftheadvicetheyreceivedfrommidwivesaboutalcoholconsumption.Aquestionnairewasadministeredthrough30antenatalclinicsinSwedenbetween2009and2010.Responseswerereceivedfromn=444partnersofwomenwhowere>17weekspregnant.Almostall(95%)oftherespondentsreportedsomelevelofdrinkingbeforepregnancy,with18%reportingbingedrinking(6+standarddrinksperoccasion)atleastoncepermonthinthelastyear.Overhalf(58%)reportedreducedconsumptionafterpregnancyrecognition,withahigherproportionofbingedrinkersreducingtheiralcoholusecomparedwithnot-frequentbingedrinkers(p=0.025).Menmostcommonlyreportedtheirreasonforreducingalcoholusewassupportforandsolidaritywiththeirpartner(49%),notwantingtodrinkalone(34%),andanincreasedsenseofresponsibility(34%).Thirty-sevenpercent(37%)ofpartnersreportedreceivingsocialsupportfortheirreducedalcoholconsumption,andpartnersgenerallyappreciatedcounsellingprovidedbymidwivesaboutdrinkingandpregnancy.Theauthorsconcludethatpregnancyisacrucialtimetopromoteinterventionstodecreasedrinkingduringpregnancyforbothmothersandtheirpartners.8. Holland,K.,McCallum,K.,&Walton,A.(2016).'I'mnotclearonwhattheriskis':
women'sreflexivenegotiationsofuncertaintyaboutalcoholduringpregnancy.Health,Risk&Society,18(1/2),38-58.doi:10.1080/13698575.2016.116618
ThisstudywasundertakeninAustraliatoexploretheperspectivesofwomen(n=20)regardingfactorsinfluencingtheirknowledgeandbehavioursaboutalcoholconsumptionduringpregnancy.Emphasiswasplacedonhealthadviceandmediareporting.Datawascollectedthroughsemi-structuredqualitativeinterviewsorfocusgroupswithwomenwhowereeitherpregnant,planningtobecomepregnant,orhadrecentlyhadachild.Allwomenreportedstoppingorreducingtheiralcoholuseuponpregnancyrecognition.Severalthemesemerged:guiltandreassuranceaboutdrinkingbeforerealizingtheywerepregnant,choosingabstinenceasthesafestoptiondespiteuncertaintyaroundlevelofrisk,andnotdenyingthemselvesofanoccasionaldrinkifit“feltright”forthem.Womenalsocalledforaclearandresponsiblepublicmessageaboutprenatalalcoholconsumption,andcautionaround“policing”pregnantwomenthroughguiltabouttheirdecisiontodrink.
16
9. McBride,N.,&Johnson,S.(2016).Fathers'RoleinAlcohol-ExposedPregnancies:SystematicReviewofHumanStudies.AmericanJournalofPreventiveMedicine,51(2),240-248.doi:10.1016/j.amepre.2016.02.009
Thissystematicliteraturereviewincludedstudiesontheimpactofpaternalalcoholconsumptiononmaternaldrinkingpatternsandchildhealthoutcomes.Elevenmedium-orlarge-scalestudieswereidentifiedbetween1990and2014,mostofwhichwereconductedintheUS.Themajority(7)ofstudiesinvestigatedtheimpactofpaternalpreconceptiondrinkingonfetalandinfanthealth;fourofthesestudiesalsofocusedonpaternalconsumptionduringpregnancy,andoneincludedinformationonpaternaldrinkingpost-pregnancy.Paternalpreconceptionconsumptionwasfoundtobeassociatedwithlowerratesoflivebirthandhigherratesofmiscarriageandspontaneousabortionamongcouplesundergoinginfertilitytreatments.Intwostudiesexaminingpaternalpreconceptiondrinkingandbirthweight,onereportednosignificantfindings,andanotherreportedhigherriskforlowbirthweightandgestationalage.Oneadditionalstudyexaminedtheeffectsofalcoholconsumptiononspermhealthandfoundsomeindicationoflowercountandunderdevelopment.Amongstudiesexamininginfanthealth,onestudyfoundnosignificanteffectofpaternalconsumption(pre-,during-,or6monthspost-pregnancy)onoffspringintellectualdisability,andtwostudiesfoundsignificantlygreaterriskforleukemia,ventriclemalformation,andabnormalsitus.Threestudiesexaminedtherelationshipbetweenpaternalandmaternaldrinkingduringpregnancy,andallfoundthatpaternalconsumptiontobeassociatedwithhigherratesofconsumptionamongpregnantpartners.Theauthorsconcludedthatpaternalalcoholconsumptionisanimportantfactorrelatedtomaternalprenataldrinking,spermhealth,andinfantandchilddevelopment,highlightingthathealthypregnanciesandoutcomesarenotonlytheresponsibilityofmothers,butalsotheirpartners.10. Muggli,E.,O'Leary,C.,Donath,S.,Orsini,F.,Forster,D.,Anderson,P.J.,...
Halliday,J.(2016)."Didyoueverdrinkmore?"Adetaileddescriptionofpregnantwomen'sdrinkingpatterns.BMCPublicHealth,16,1-13.doi:10.1186/s12889-016-3354-9
(Seeabstractabove)11. Onah,M.N.,Field,S.,vanHeyningen,T.,&Honikman,S.(2016).Predictorsof
alcoholandotherdruguseamongpregnantwomeninaperi-urbanSouthAfricansetting.InternationalJournalofMentalHealthSystems,10.
(Seeabstractabove)12. Onwuka,C.I.,Ugwu,E.O.,Dim,C.C.,Menuba,I.E.,Iloghalu,E.I.,&Onwuka,C.I.
(2016).PrevalenceandPredictorsofAlcoholConsumptionduringPregnancyinSouth-EasternNigeria.JournalofClinical&DiagnosticResearch,10(9),10-13.doi:10.7860/JCDR/2016/21036.8449
(Seeabstractabove)13. Pettigrew,S.,Jongenelis,M.,Chikritzhs,T.,Pratt,I.S.,Slevin,T.,&Glance,D.
(2016).AComparisonofAlcoholConsumptionIntentionsAmongPregnantDrinkersandTheirNonpregnantPeersofChild-BearingAge.SubstanceUse&Misuse,51(11),1421-1427.doi:10.3109/10826084.2016.1172641
(Seeabstractabove)
17
14. Roberts,S.C.M.,Subbaraman,M.S.,Delucchi,K.L.,Wilsnack,S.C.,&Foster,D.G.
(2016).Moderatorsandmediatorsoftherelationshipbetweenreceivingversusbeingdeniedapregnancyterminationandsubsequentbingedrinking.DrugandAlcoholDependence,159,117-124.doi:10.1016/j.drugalcdep.2015.11.033
ThisstudyuseddatafromtheTurnawayStudy,aprospectivecohortstudywhichinvolved956womenseekingterminationoftheirpregnancyat30facilitiesintheUS;someofthesewomenreceivedterminationsandsomewererefusedterminationsduetolategestation.Thisstudyanalyzesdatafromthe452womenwhoreceivedterminationsand231womenwhowererefusedterminations,toinvestigateifbaselinecharacteristics(includingstress,numberofsocialroles,andemotionsregardingthepregnancy)mediatetheassociationbetweenterminationandbingedrinking.Datacollectedatbaseline,6-month,12-month,18-month,24-month,and30-monthinterviewswasanalyzed.Theauthorsfoundthathavingapreviouslivebirthmediatedtheassociationbetweenterminationandbingedrinking;bingedrinkingwasloweramongwomenwithpreviouslivebirthswhocarriedtotermcomparedtowomenwhoterminatedthepregnancy.Fornulliparouswomenwhoweredeniedatermination,thereductioninbingedrinkingwasnotmaintained,andby2.5yearsfollowupbingedrinkingamongnulliparouswomenwhoterminatedandthosewhoweredeniedterminationweresimilar.Stress,negativeemotionsaboutthepregnancyandsocialroleswerenotfoundtomediatetheassociationwithbingedrinking.Whilepositiveemotionsregardingthepregnancyreportedatoneweekmediatedbingedrinkingat6-monthfollowup,thiswasnotsustainedat2.5yearfollow-up.15. Singal,D.,Brownell,M.,Hanlon-Dearman,A.,Chateau,D.,Longstaffe,S.,&Roos,
L.L.(2016).Manitobamothersandfetalalcoholspectrumdisordersstudy(MBMomsFASD):protocolforapopulation-basedcohortstudyusinglinkedadministrativedata.BMJOpen,6(9),e013330-e013330.doi:10.1136/bmjopen-2016-013330
(Seeabstractabove)16. Thapa,N.,Aryal,K.K.,Puri,R.,Shrestha,S.,Shrestha,S.,Thapa,P.,...Stray-
Pedersen,B.(2016).AlcoholconsumptionpracticesamongmarriedwomenofreproductiveageinNepal:Apopulationbasedhouseholdsurvey.PLoSONE,11(4).
(Seeabstractabove)17. Urban,M.F.,Olivier,L.,Louw,J.G.,Lombard,C.,Viljoen,D.L.,Scorgie,F.,&
Chersich,M.F.(2016).Changesindrinkingpatternsduringandafterpregnancyamongmothersofchildrenwithfetalalcoholsyndrome:AstudyinthreedistrictsofSouthAfrica.DrugandAlcoholDependence,168,13-21.doi:10.1016/j.drugalcdep.2016.08.629
(Seeabstractabove)
18
18. Washio,Y.,Mericle,A.A.,Cassey,H.,Daubert,A.M.,&Kirby,K.C.(2016).Characteristicsoflow-incomeracial/ethnicminoritypregnantwomenscreeningpositiveforalcoholrisk.JournalofImmigrantandMinorityHealth,18(4),850-855.doi:10.1007/s10903-015-0238-5
(Seeabstractabove)19. Watt,M.H.,Eaton,L.A.,Dennis,A.C.,Choi,K.W.,Kalichman,S.C.,Skinner,D.,&
Sikkema,K.J.(2016).AlcoholuseduringpregnancyinaSouthAfricancommunity:Reconcilingknowledge,norms,andpersonalexperience.MaternalandChildHealthJournal,20(1),48-55.doi:10.1007/s10995-015-1800-4
TheaimofthisstudywastoqualitativelyexploreknowledgeandattitudesaboutmaternalalcoholconsumptionamongSouthAfricanwomenwhoreportedalcoholuseduringpregnancy.In-depthinterviewswithwomeninCapeTownwhowerepregnantorwithinoneyearpostpartumandself-reportedalcoholuseduringpregnancywereusedtoexplorepersonalexperienceswithdrinkingduringpregnancy,communitynormsandattitudestowardsmaternaldrinking,andknowledgeaboutFASD.Women’sknowledgeoftheimpactsoffetalalcoholexposurewasofteninaccurate,basedonreceivinginformationfromcompetingsources,andtheinternalizingofmisinformation.Womenexpressedfeelingjudged,ambivalent,ordefensiveabouttheirbehaviors,andultimatelyuncertainabouttheiralcoholuse.Theauthorsseetheneedtodeliveraccurateinformationabouttheharmsoffetalalcoholexposurethroughsourcesperceivedastrustedandreliable.Inaddition,attheIndividualinterventionlevelwomenwouldbenefitfromassistancewithreconcilingcompetingattitudesandidentifyingmotivationsforreducingalcoholuseduringpregnancy.20. Winter,G.F.(2016).Alcohol,pregnancyandtheprecautionaryprinciple.British
JournalofMidwifery,24(10),684-684.doi:10.12968/bjom.2016.24.10.684(Seeabstractabove)21. Wulp,N.Y.,Hoving,C.,&Vries,H.(2016).Correlatesofpartnersupportto
abstainfromprenatalalcoholuse:across-sectionalsurveyamongDutchpartnersofpregnantwomen.Health&SocialCareintheCommunity,24(5),614-622.doi:10.1111/hsc.12235
Thisstudyidentifiedcorrelatesofpartnersupport,throughanonlinecross-sectionalstudyofDutchpartnersofpregnantwomen(n=237).RespondentswererecruitedthroughDutchmidwiferypracticesinSeptember-October2009.QuestionnaireswerebasedontheI-ChangeModel.Partnersreportinghighsupport,comparedwiththosereportinglowsupport,weremorelikelyto:desiretheirpartnertoabstainfromalcoholuse;havereceivedadvicefromtheirpregnantspouseormidwifethatabstinencewasdesirable;seemoreadvantagestoprovidingsupport;havestrongerperceptionsthatthebabywouldexperienceharmfromprenatalalcoholuse;havemoreinfluencesfromtheirsocialenvironmentencouragingtheirsupport,havegreaterself-efficacy;andastrongerintentiontosupporttheirpartnerduringtheremainderofthepregnancy.Theauthorsconcludethathealthprofessionalsmayimprovetheiralcoholadvicebydiscussingtheadvantagesanddisadvantagesofsupportwiththepartnerandbyencouragingcouplestodiscussandproposesolutionsforthesituationsinwhichpartnersfinditdifficultnottosupportalcoholabstinence.
19
Level1Prevention
1. Avery,M.R.,Droste,N.,Giorgi,C.,Ferguson,A.,Martino,F.,Coomber,K.,&Miller,P.(2016).Mechanismsofinfluence:Alcoholindustrysubmissionstotheinquiryintofetalalcoholspectrumdisorders.Drug&AlcoholReview,35(6),665-672.doi:10.1111/dar.12399
Industrygroupsseektoinfluencegovernmentpoliciestoprotecttheirvestedinterestinanumberofwaysincludinglobbying,industry-fundedresearch,andtargetedmedia.Aspartofits‘InquiryintoFASD’theAustralianHousecommitteereceived92submissionsfromhealth,academic,governmentgroupsandindividualsfromaroundthecountry.In2012,thecommitteetableditsfinalreportentitledFASD:TheHiddenHarm.TheinvestigatorsexaminedindustrysubmissionstotheInquiryanddeterminedthatfourstrategieswereusedtominimizeorrefuteconcernsrelatedtoalcoholandFASD.Strategicaimsincludedunderminingcommunityconcern,disputingtheevidence,campaigningforineffectiveindustrymeasures,andattackingresearchersandhealthprofessionals.Theauthorsconcludethatthealcoholindustryusesthesamestrategiesasdidthetobaccoindustrytopromotetheirfinancialinterestsabovepublichealth,andthatthegovernmentismoreboundtotheinterestsofthealcoholindustrythantotheinterestsofthepublic.2. Bell,E.,Andrew,G.,DiPietro,N.,Chudley,A.E.,Reynolds,J.N.,&Racine,E.
(2016).It'saShame!StigmaAgainstFetalAlcoholSpectrumDisorder:ExaminingtheEthicalImplicationsforPublicHealthPracticesandPolicies.PublicHealthEthics,9(1),65-77.doi:10.1093/phe/phv012
TheauthorsreviewedsocialandbiomedicalliteratureaswellasqualitativeresearchonexperiencesofthosewithFASDandputforwardamodelforunderstandingstigmabasedon:1)attitudestowardwomenwhodrinkduringpregnancy;2)beliefsaboutthosewhohaveFASDandtheirfamilies;and,3)theexperiencesofthoseaffectedbyFASDascomparedtothoseofotherswhohaveotherneurodevelopmentalormentalhealthconditions.Resultsshowthatstigmamaydirectresearcheffortsandpromoteknowledgegaps;anddignityandconsequencesareimpactedbystigmaandtherebyraiseethicalissues.ConsequencesofinadvertentanddeliberateuseofstigmainpublichealthFASDeffortsaredescribed.AuthorscallforthedevelopmentofanethicalframeworkforsystematicallyanalysingstigmainpublichealthFASDefforts,sothatpositiveoutcomesareviewedalongsidepossibleharmsrelatedtostigma.3. Charness,M.E.,Riley,E.P.,&Sowell,E.R.(2016).Drinkingduringpregnancy
andthedevelopingbrain:Isanyamountsafe?TrendsinCognitiveSciences,20(2),80-82.doi:10.1016/j.tics.2015.09.011
Theauthorsreviewtheevidenceandexplainwhyitmaynotbepossibletoprovewhetherornotlowtomoderatedrinkingduringpregnancycausesnofetalharm.Theresultingambiguityhasplayedoutinpopularmediaandcausedconfusionforwomen.Consequently,wehavetoconsiderwhatcanbeproved--thatthereisnoknownsafeamountofalcoholduringpregnancy.Theauthorssuggestthatcurrentuncertaintycanservebothtoreassurewomenwhomayhaveconsumedalcoholbeforeknowingtheywerepregnant,andtoencouragewomentonotdrinkduringpregnancy.Theyrecommendthatpregnantwomenbeencouragedintheireffortstoreduceharmsratherthanbestigmatizedfordrinking.
20
4. Eguiagaray,I.,Scholz,B.,&Giorgi,C.(2016).Sympathy,shame,andfewsolutions:Newsmediaportrayalsoffetalalcoholspectrumdisorders.Midwifery,40,49-54.doi:10.1016/j.midw.2016.06.002
ThereexistsagenerallackofunderstandingofFASDamongthepublic,andmanycountrieshavenopoliciestoaddressit.Becauseawiderangeofhealthinformationisnowdisseminatedthroughthemedia,theauthorslookatthewaytheAustralianmediaframestheissueandhowtheirmessagesaffecttheiraudience.Theidentify1)sympathyand2)shameasthetwodominant,butoftencontradictory,framesusedindiscussingFASD.GroupsdescribedasdeservingofsympathywerechildrenandadultswithFASD,andinsomecasesmotherswhoconsumedalcoholinpregnancy.Groupsdescribedasdeservingofblameincludedbiologicalmothers(1/5ofarticlesreviewed),healthcareproviders,andgovernment.Notably,twogroupswerenotincludedincallstoaccountfortheirroleinamelioratingFASD:partnersofpregnantwomen,andthealcoholindustryandadvertising.Theauthorsmakerecommendationsforallgroupsandsuggestfurtherresearchofotherformsofmedia,andsocialmedia,inparticular.
5. Fitzgerald,N.,Angus,K.,Emslie,C.,Shipton,D.,&Bauld,L.(2016).Gender
differencesintheimpactofpopulation-levelalcoholpolicyinterventions:evidencesynthesisofsystematicreviews.Addiction,111(10),1735-1747.doi:10.1111/add.13452
Inthisreviewofsystematicreviewsofalcoholpolicyinterventionsatthepopulationlevel,theauthorsexaminedgender-specificdataandanalysesconsideredinpopulationlevelalcoholpolicyinterventions.Theythenconductednarrativesynthesesoftherelevantdataasto“whomtheevidencedoesanddoesnotapply.”Inclusioncriteriafollowedaprescribedframeworkwith63reviewsbeingincludedandthencategorizedinto10broadalcoholpolicyareas.Findingsshowedthatfewsystematicreviewsreportedresultsbygenderandmanystatedthatgender-specificinformationwasunavailableintheprimarystudy.Theauthorsdiscussthe10policyareasanddescribehowthelackofgender-specificdatasignificantlyimpactsalcoholpolicy.Theyconcludethatdataongenderdifferencesshouldbeincludedinresearchinordertoincreaseeffectivenessofalcoholpolicy,particularlyregardingmassmediaandadvertising.
6. Haydon,H.M.,Obst,P.L.,&Lewis,I.(2016).BeliefsunderlyingWomen's
intentionstoconsumealcohol.BMCWomen'sHealth,16,1-12.doi:10.1186/s12905-016-0317-3
(Seeabstractabove)
7. Kalinowski,A.,&Humphreys,K.(2016).Governmentalstandarddrink
definitionsandlow-riskalcoholconsumptionguidelinesin37countries.Addiction,111(7),1293-1298.doi:10.1111/add.13341
Theauthorsexploredvariabilityinthedefinitionofastandarddrinksize,andguidelinesaboutlow-riskdrinking.InformationwasgatheredthroughstructuredInternetsearches,directcontactwithgovernmentagencies,and/orconsultationwithexpertsin37countries.Ofthe75countriesincludedinthestudy,themajorityofgovernmentshadnotadoptedastandarddrinkdefinition;informationwasincludedfrom37countries.Themodalstandarddrinkwasreportedtobe10gofpureethanol(range8gto20g).Substantialvariabilityintherecommendationsforlow-riskdrinkingwerealsonoted,withdailylimitsrangingfrom10g-42gforwomenand10g-56gformen,andweeklylimitsrangingfrom98g-140gforwomenand150g-280gformen.Inadditiontonationaldifferences,therewereinconsistenciesanddiscrepanciesintheinformationpresentedbyseveralcountries.To
21
conclude,theauthorsnotethatmanycountriesdonotdefinestandarddrinksizesorlow-riskdrinking,andthatcautionshouldbetakenwhencomparingdrinkingguidelinesacrosstheglobe.
8. Kesmodel,U.S.,Petersen,G.L.,Henriksen,T.B.,&Strandberg-Larsen,K.(2016).
TimetrendsinalcoholintakeinearlypregnancyandofficialrecommendationsinDenmark,1998-2013.ActaObstetriciaetGynecologicaScandinavica,95(7),803-810.doi:10.1111/aogs.12890
(Seeabstractabove)9. Lee,E.,Sutton,R.M.,&Hartley,B.L.(2016).Fromscientificarticletopress
releasetomediacoverage:advocatingalcoholabstinenceanddemocratisingriskinastoryaboutalcoholandpregnancy.Health,Risk&Society,18(5/6),247-269.doi:10.1080/13698575.2016.1229758
Theauthorsusecontentandthematicanalysistodescribethe“riskstory”thatwasassociatedwiththe2012article“FetalAlcoholExposureandIQatAge8:EvidencefromaPopulation-BasedBirth-CohortStudy”(whichexaminedtheroleofgenes,prenatalalcoholmetabolism,andchildoutcomesinwhichtheauthorsconcludedtherewasnosafeamountofalcoholtoconsumeduringpregnancy),aswellasthepresscommunicationsandmediacoveragethatfollowed.Theauthorsprovideanoverviewofthedebatearoundtheriskofalcoholconsumptionduringpregnancy,anddescribe“democratization”asreferringtothemessagethatriskappliestoanydrinkingandeverywomanequally.Theauthorsnotethatthereportingofthekeyfindingsfromthe2012studywasnotcompletelyinlinewiththearticle’sfindings,duetothewaythemediareleaseframedthefindings,aswellastheselectivereportingofdataandfactualinaccuraciesintroducedbyjournalists(particularlyinhowtheyreportedthelinkbetweendrinkingandchildIQ)inthesubsequentpubliccommunications.Theauthorsnotehowthemediatendstosensationalizeindividualrisk,overtheinfluenceofbroaderdeterminantsofhealth–andthatresearchershaveanimportantresponsibilitytoinfluencehowthestoriesoftheirfindingsaretold.
1. O'Connor,M.J.,Quattlebaum,J.,Castañeda,M.,&Dipple,K.M.(2016).Alcohol
InterventionforAdolescentswithFetalAlcoholSpectrumDisorders:ProjectStepUp,aTreatmentDevelopmentStudy.Alcoholism:Clinical&ExperimentalResearch,40(8),1744-1751.doi:10.1111/acer.13111
Adolescentswithneurocognitiveeffectsofprenatalalcoholexposure(PAE)haveincreasedvulnerabilityforalcoholmisuseandforrelatedalcoholusedisordersinadulthood.TheauthorsdescriberesultsfromtheProjectStep-Up,adevelopmentallysensitive,harm-reductiongroupinterventiondesignedforadolescentparticipantswithFASDandtheircaregivers.Adolescentparticipants(n=54;30females;24males)attendedweekly,60-minuteinterventionsessionsovera6-weekperiod.Theircaregiversconcurrently,butseparately,attendedsessionsonPAEeffectsonthebrain,adolescentalcoholuse,andtherelatedparentingchallenges.Whenteenswereclassifiedbasedonlife-timedrinkinghistoriesresearchersfoundthat33%werelight/moderatedrinkers(n=18),and67%wereabstinent/infrequentdrinkers(n=36),consequentlythesegroupswereevaluatedseparately.Assessmentspre-intervention,during,and3-monthspostinterventionshowed:1)nodifferencepre-andpost-interventionforabstinent/infrequentdrinkers;and,2)significantdecreaseinalcoholriskandnegativebehavioursrelatedtoalcoholusefortheProjectStep-upgrouppost-interventionwhencomparedtoControlgroup(Cohen’sd=1.08and0.99).Thisstudysuggeststhatamanualizedinterventiondeliveredbytrainedtherapistsdidnotfosterdrinkinginteens,showedpositiveresultsinriskandbehaviours,andshouldbeconsideredwithinthecontextoftheinterventionlimitationsdescribed.
22
10. Petticrew,M.,Douglas,N.,Knai,C.,Durand,M.A.,Eastmure,E.,&Mays,N.(2016).Healthinformationonalcoholicbeveragecontainers:hasthealcoholindustry'spledgeinEnglandtoimprovelabellingbeenmet?Addiction,111(1),51-55.doi:10.1111/add.13094
IntheUnitedKingdom,warninglabelsonalcoholproductsarebasedonavoluntaryagreementbetweenthegovernmentandalcoholindustry,andin2011,theindustrycommittedtolabel80%ofproducts.Theauthorsassessedthe100best-sellingalcoholbrands(n=156totalalcoholproducts)intheUKfor:presenceofhealthwarninglabelling,andtheclarityofthemessageandplacementofthelabel.Specifically,themessageswereassessedforinformationon:1)thenumberofalcoholunits,2)governmentguidelinesonalcoholconsumption,3)warningsregardingalcoholuseduringpregnancy,4)mentionoftheDrinkawarewebsite,5)andastatementregardingresponsibleuse.Thesizeandcolouroftextandwarninginformationwasalsoassessed.Theyfoundthatguidelinesonalcoholconsumption,informationonalcoholunitsandpregnancywarningswereincludedon78%oftheproductsanalyzed.Whilethemeanfontsizeoftheunitguidelineswas8.17-point,pregnancywarningswere5.95mmandwasoftensmalleronwinebottles.Inconclusion,theauthorsnotethatmoreconsistentlabelling,withlargerfontandlogosarerequired.11. Poole,N.,Schmidt,R.A.,Green,C.,&Hemsing,N.(2016).PreventionofFetal
AlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps.SubstanceAbuse:ResearchandTreatment,2016(Suppl.1),1-11.doi:10.4137/SART.S34545
CanadianFASDexpertshaveclassifiedthepreventionoffetalalcoholspectrumdisorder(FASD)infourlevels:Level1)publicawarenessandhealthpromotion;Level2)conversationswithwomenofreproductiveageandtheirpartnersregardingalcoholuse;Level3)specializedsupportforwomenwhoarepregnant;andLevel4)supportfornewmothersinthepostpartumperiod.ToidentifyanddescribethecurrentlevelsofservicesinCanada,anonlineDelphisurveywascompletedbyasampleof50serviceproviders,civilservantsandresearchersinvolvedinFASDprevention.TheauthorsfoundthatCanadianpracticesreflectedthefourlevelsofprevention,althoughthesewerenotevenlydistributedacrossthecountry.Theynotetheneedto:improvetheavailability,scope,andintegrationofservices,educationandsupport,andtolinkFASDpreventioneffortswiththewiderhealthpromotionandsubstanceusepreventionfields.12. Roozen,S.,Black,D.,Peters,G.J.Y.,Kok,G.,Townend,D.,Nijhuis,J.G.,...Curfs,L.
M.G.(2016).FetalAlcoholSpectrumDisorders(FASD):anApproachtoEffectivePrevention.CurrentDevelopmentalDisordersReports,3(4),229-234.
DespitewidespreadcampaignstopreventAEP,currentstrategiesmaybeineffectiveorcounterproductive.Preventioncampaignsareoftenbasedonthebeliefthatincreasedawarenesswillleadtoachangeinbehavior.However,theauthorsarguethatpreventioncampaignsshouldbebasedonevidencebasedhealthpromotionprinciplestoincreasetheireffectiveness,anddescribeInterventionMapping(IM).IMoffersaprocesstodevelop,implementandevaluatehealthpromotionactivities.EachofthesixstepsofIMinformthenextstep,althoughthestepsareiterative,notlinear.Thestepsareasfollows:1.Createalogicmodeloftheproblembasedonaneedsassessment;2.Statetheoutcomesandobjectives;3.Developtheprogramplan,includingscope,sequence,changemethods,andpracticalapplications;4.Producetheintervention,includingprogrammaterialsandmessages;5.Planprogramuse,includingadoption,implementation,andmaintenance;6.Developanevaluationplan.TheauthordescribeseachofthesixstepsusingFASDpreventionasanexample.
23
Level2Prevention
1. Charness,M.E.,Riley,E.P.,&Sowell,E.R.(2016).Drinkingduringpregnancyandthedevelopingbrain:Isanyamountsafe?TrendsinCognitiveSciences,20(2),80-82.doi:10.1016/j.tics.2015.09.011
(Seeabstractabove)2. Eichler,A.,Grunitz,J.,Grimm,J.,Walz,L.,Raabe,E.,Goecke,T.W.,...Kornhuber,
J.(2016).Didyoudrinkalcoholduringpregnancy?Inaccuracyanddiscontinuityofwomen'sself-reports:Onthewaytoestablishmeconiumethylglucuronide(EtG)asabiomarkerforalcoholconsumptionduringpregnancy.Alcohol,54,39-44.doi:10.1016/j.alcohol.2016.07.002
Theauthorssupportdetermininglowtomoderatelevelsofalcoholconsumptionduringpregnancyinordertoimplementearlyinterventionsforchildrenbeforedevelopmentalconsequencescanbeobserved.Theyfollowed180womencomparingEtGresultsatbirthwithself-reportsofalcoholuseduringthethirdtrimester(gestational)andwhentheirchildrenwere6-8years(retrospective).UsingtwothresholdsforpositiveEtGcomparedforsignificance(≥10ng/g(n=42)and≥120ng/g(n=26))theylookedatvariablesof1)Inaccuracyofself-reportand,2)Inconsistencyofself-reportgestationallyandretrospectively.Regardinginaccuracy:womendidnotdiffersignificantlyintheirself-reportswhethertheirchildrenwereEtG-positiveorEtG-negative.Bothgroupsofwomendenyalcoholconsumption.Ofthosewomenreportingalcoholconsumptionduringpregnancy,thereisasignificantdifferencebetweenEtG-positiveandEtG-negativegroupsinthereportedamountofalcoholconsumed.Specifically,forwomenretrospectivelyreporting5ormoredrinkspermonth,anEtGoverthethresholdismoreprobable.Regardinginconsistency:Womenwhodeniedalcoholconsumptioninthegestationalreport,alsodenieditintheretrospectivereport(95%)showingconsistencybetweenthe2reportingperiods.However,ofwomenwhoreportedalcoholconsumptioningestationalreport,only28%reporteditinretrospectivereport,showingthatself-reportmaybemorebiasedretrospectively.TheauthorssupportusingEtGmarkersasawaytoidentifychildrenneedingearlydevelopmentinterventions.Theyconcludethatalthoughself-reportsarenotreliable,neithergestationalnorretrospectivemeasurescorrespondtoEtGmarkers,andthatfurtherresearchshouldfocusoncorrelatingEtGvalueswithchilddevelopmentinsteadofwomen’sself-reports.3. Jensen,J.,Kenyon,D.B.,&Hanson,J.D.(2016).Preventingalcohol-exposed
pregnancyamongAmerican-Indianyouth.SexEducation,16(4),368-378.doi:10.1080/14681811.2015.108207
ThisarticlepresentsthefindingsofacommunityneedsassessmentoftheCHOICESProgrammeintheOglalaSiouxTribe(OST)inSouthDakota,USA.Theprogrammeisdesignedtoreducealcohol-exposedpregnancies(AEP),andhasshownsomepromiseinAmericanIndian(AI)adultwomenatriskforhavinganAEP.ThegoalofthestudywastoexplorethepossibilityofexpandingtheCHOICESprogrammeintheOSTcommunity.Keyinformantinterviewswereconductedwithn=25serviceproviders,and8focusgroupswerefacilitatedwithn=58adultAIwomen(aged18-44)andmen(aged18+),aswellaselderwomen(aged45+).Severalthemesemerged,includingtheimportanceofinvolvingyouthintheprogramme,emphasisoneducationinthepreventionofAEPs(especiallythroughschool-basedprogramming),considerationoffamilyasintegraltothepreventionofAEPs,andinclusionofastrongculturalcomponentinpreventionefforts.TheauthorsconcludethatthesefindingsprovideevidencefortheexpansionofAEPpreventioninitiativesintheOSTcommunityandidentifiedseveralkeyelementstosupportsuchexpansion.
24
4. Joya,X.,Mazarico,E.,Ramis,J.,Pacifici,R.,Salat-Batlle,J.,Mortali,C.,García-Algar,
O.,&Pichini,S.(2016).Segmentalhairanalysistoassesseffectivenessofsingle-sessionmotivationalinterventiontostopethanoluseduringpregnancy.Drug&AlcoholDependence,158,45-51.doi:10.1016/j.drugalcdep.2015.10.028
Theauthorsinvestigatedtheeffectivenessofasingle-sessionmotivationalinterview(MI)forreducingalcoholconsumptionduringpregnancy,usingsegmentalhairanalysisasanindicatorofdrinking.Pregnantwomenoflowsocio-economicstatusandhighrateofimmigrationwhowereattendingaprenatalclinicinBarcelona,Spain(n=168)wererandomlyassignedtoeithertheMIgrouporeducationalcontrolcondition(ECC).WomenansweredtheAUDIT,andprovidedhairsamplesforanalysisafterthebirthoftheirchild.Analysisofhairsamplesrevealedthat41%ofparticipantsabstainedfromalcoholentirelythroughoutpregnancy,while59%showedsomeevidenceofalcoholconsumption,24%ofwhomexceededthecut-offforchronicethanolconsumption.Theresultsofthehairanalysisshowedlowcorrespondencewithself-reportsofdrinking,whichtheauthorsattributetowomen’smisreportingorunder-reportingofalcoholuse.Therewerenotstatisticaldifferencesbetweentheinterventionandcontrol,althoughtheinterventiongrouphadatrendtowardmaintainedabstinence.Theinterventiondidnoteffectivelysupportreduceddrinkingamongwomenwhomoderatelyorexcessivelyconsumedalcoholbeforetheintervention.Theauthorsconcludethatsingle-sessionMIisnotaneffectiveinterventionforreducingalcoholconsumptionduringpregnancyinthispopulation;howevermulti-sessionMImaybemorepromising.Furthermore,theauthorsnotethatsegmentalhairanalysismaybeusedtoimprovetheaccuracyofdetectingandmonitoringalcoholuseduringpregnancy.
5. Lacey,J.O.(2016).Reducingalcoholharm:earlyinterventionandprevention.
CommunityPractitioner,89(2),26-29. Inthisnarrativereview,theauthorshighlighttheimportanceofbriefsupportiveinterventionsbycommunitypractitionersinreducingalcoholconsumption.TheauthorreviewedrecentchangestotheUKalcoholconsumptionguidelines,includinglow-riskguidelinesanddefinitionsofstandarddrinksize,aswellasbinge,harmful,anddependentdrinking;andarecommendationofabstinenceforpregnantwomen.Briefalcoholinterventionswerethendiscussed,includingtheiressentialcomponentsandareviewoftheevidenceofsupportforsuchinterventions.ThearticleconcludedwithabriefoverviewofFASandFASD,andprovidedsuggestionsforhowcommunityhealthpractitionersmayhelpinpreventingnewcases.6. McQuire,C.,etal.(2016)."ObjectiveMeasuresofPrenatalAlcoholExposure:A
SystematicReview."Pediatrics138(3):1-17. Thissystematicreviewexaminedthevalidityofobjectivemeasurementsofprenatalalcoholexposure.Literaturepublishedbetween1990and2015wassearchedinthirteenacademicdatabases.Atotalof12studieswereidentifiedthatmetinclusioncriteria.Theauthorsreportvariationsintestperformancesacrossthesestudies:maternalblood(sensitivity0%-100%,specificity79%-100%,basedon4studies),maternalhair(sensitivity19%-87%,specificity56%-86%,basedon2studies)maternalurine(sensitivity5%-15%,specificity97%-100%,basedon2studies),andcombinationsofbiomarkers(sensitivity22%-50%,specificity56%-97%,basedon3studies).Highsensitivity(82%to100%)wasdemonstratedfortestsoftheconcentrationoffattyacidethylesters(inmeconiumandplacentaltissues),althoughspecificityvaried(13%to98%).Theauthorsnoteahighriskofbiasduetotheselectivereportingofoutcomesandtheuseofself-reportforreferencestandards.Theauthorsconcludethatevidenceisinsufficienttosupporttheuptakeinpracticeofobjectivemeasuresofprenatalalcoholexposure,andthatfurtherlarge-scalestudiesarerequiredtoexaminethepotentialapplicationofbiomarkersinmeconiumandplacentaltissues.
25
7. Montag,A.C.(2016).Fetalalcohol-spectrumdisorders:identifyingat-riskmothers.InternationalJournalofWomen'sHealth,8,311-323.doi:10.2147/IJWH.S85403
Inthisnarrativereview,theauthorsoverviewscreeningtoolsandbiomarkers.Theymakeacaseforincorporatingscreeningandregularuseofbiomarkersintoroutineobstetricandgynecologiccare.Theauthorsdiscussthereasonsearlyidentificationisbeneficialtobothwomenandtheirchildrenandjustifythemethodsusedtoidentifythemalongwithassociatedbioethicalimplications.Currently,womenareidentifiedbasedonmaternalcharacteristics,self-reportassessments,andbiomarkertestsofalcohol-exposedpregnancies,butnoneofthesemethodsaresufficientbythemselves.Theauthorssupportincludingpreconceptiondrinkinginself-reportsandfurtheringbiomarkertechnologyresearch.Theyrecommendimplementationofuniversalandroutinescreeningforalcoholconsumptiontoinclude:1)self-report;2)biomarkertechnologieswherenecessary;3)briefinterventions;and,4)referralandtreatment.8. Palm,A.,Olofsson,N.,Danielsson,I.,Skalkidou,A.,Wennberg,P.,&Högberg,U.
(2016).Motivationalinterviewingdoesnotaffectriskdrinkingamongyoungwomen:Arandomised,controlledinterventionstudyinSwedishyouthhealthcentres.ScandinavianJournalofPublicHealth,44(6),611-618.doi:10.1177/1403494816654047
Totesttheeffectsofamotivationalinterviewingintervention,theauthorsrandomizedyoungSwedishwomen(n=1051,age15-22)withriskydrinking,definedasanAUDIT-Cscoreof5orgreatertoeitherreceiveamotivationalinterviewinginterventionaspartoftheirhealthcarevisitatayouthhealthcentre,ortoreceiveregularcare.Aquestionnairewasadministeredtoallthewomenaftertheirvisit,andagainat12monthsfollow-up.Significantdecreasesinriskyandbingedrinkingwereidentifiedinbothgroups,with30%ofthewomenwhoreportedhighriskdrinkingatbaselinenolongerbeinghighriskat12monthfollowup.Generalisedestimatingequationanalysesdidnotfindanysignificantdifferencesineffectbetweenthegroups,whichdidnotchangewhenadjustingforeducationallevel,foreignbackground,violencevictimisationorsexualidentity.Ofthewomenwhodidnotreportriskydrinkingatbaseline,20%reportednewriskydrinkingpatternsatfollowup.Theauthorconcludesthepaperbydiscussingtheissueswithusingscreeninginstrumentsinyouthpopulationto“capturethelargemobilityindrinkingbehaviourinyoungpeople.”
26
9. Parrish,D.E.,vonSternberg,K.,Castro,Y.,&Velasquez,M.M.(2016).Processesofchangeinpreventingalcoholexposedpregnancy:Amediationanalysis.JournalofConsultingandClinicalPsychology,84(9),803-812.doi:10.1037/ccp0000111
Arandomizedcontroltrial(RCT)wasconductedtoexaminethemechanismsofchangeofprojectCHOICES,aninterventionbasedonmotivationalinterviewingandthetrans-theoreticalmodel,aimedatdecreasingtheriskofAEP.Theinterventionaddressesriskydrinking(4drinksormoreperday,or7ormoredrinksperweek)andcontraceptionuse.Bothbehaviouralandexperientialprocessesofchange(POC),asidentifiedinthetrans-theoreticalmodelofchange,werestudied.TheauthorshypothesizedthattheCHOICEStreatmentwouldincreasetheexperientialPOC,whichwouldthenincreasethebehaviouralPOCwhichwouldimpactthetreatmentoutcomes(riskydrinking,contraceptionuse)andriskofAEP.Atotalof830womenidentifiedasat-riskforAEPwererandomizedto:CHOICESinformationpluscounselling(IPC)(n=416)orinformationonly(IO)conditions(n=414).Apathanalyseswasused,withthetreatmentoutcomesandPOCmediatorvariablesmeasuredat3-monthsand9-monthsforeachbehavior(riskydrinkingandcontraceptionuse).Theoverallmodelsdemonstratedgoodfit,andtheindirecteffectofthetreatmentgrouponoutcomeviaPOCvariableswassignificantforthosemodelspredictingriskyalcoholuse(standardizedestimate0.02,95%CI0.034-0.002)andinadequatecontraception(standardizedestimate0.05,95%CI0.08-0.02).WhiletheindirecteffectoftreatmentgrouponAEPriskviaPOCforinadequatecontraceptionwassignificant(standardizedestimate0.03,95%CI0.05-0.01),theindirecteffectofPOCvariablesforriskyalcoholusewasnotsignificant(standardizedestimate0.01,95%CI0.017-0.002).TheauthorsconcludethataddressingexperientialPOCvariablesearlyintreatmentandbehaviouralPOClaterintreatmentmayimprovetheeffectivenessofmotivationbasedinterventions.
10. Poole,N.,Schmidt,R.A.,Green,C.,&Hemsing,N.(2016).PreventionofFetal
AlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps.SubstanceAbuse:ResearchandTreatment,2016(Suppl.1),1-11.doi:10.4137/SART.S34545
(Seeabstractabove)11. Roberts,S.(2016a).Conclusionoverreachinalcoholandpregnancyarticle.
JournalofStudiesonAlcoholandDrugs,77(4),667-668.doi:10.15288/jsad.2016.77.667
Inthislettertotheeditor,Robertsrespondstothearticle:Alshaarawy,O.,Breslau,N.,&Anthony,J.C.(2016).Monthlyestimatesofalcoholdrinkingduringpregnancy:UnitedStates,2002–2011.JournalofStudiesonAlcoholandDrugs,77,272–276.Shecritiquestheirconclusionthatwomenwhodrinkbeadvisedtousepregnancytestkitsaftereverysexualencounterthatmightgiverisetoaconception.Shenotesthattheymake“broad—andworrisome—recommendationabouthowsexuallyactivewomenofreproductiveageshouldbehave.”ThisconclusionisviewedasproblematicbyRobertsbecause:itdoesnotaccountforchanceofbecomingpregnantinanymonth,doesnotaccountforthetimelagbetweenfertilizationandimplantation,andisbasedonamisunderstandingoftheabilityofpregnancyteststoconfirmpregnancy(theearliestdetectioninhomepregnancytestsbeing5daysbeforeamissedperiod).Robertsarguesthatconclusionsshouldbebasedontheevidence,ratherthanusingpublichealthasameanstoassertcontroloverwomen’ssexualbehavior.
27
12. Roberts,S.C.M.,Ralph,L.J.,Wilsnack,S.C.,Foster,D.G.,&Roberts,S.C.M.(2016b).Whichwomenaremissedbyprimaryhealth-carebasedinterventionsforalcoholanddruguse?AddictiveBehaviors,55,32-37.doi:10.1016/j.addbeh.2015.12.015
Theauthorsassessedtheassociationsbetweenbingedrinking,alcoholrelatedproblemsymptoms(APS),substanceusebeforepregnancyconfirmation,andhavingausualsourceofhealthcare(USOC)(e.g.adoctor'soffice,clinic,healthdepartmentclinic,orPlannedParenthoodclinic).BaselineinterviewdatafromtheTurnawayStudywasanalyzed,aprospectivecohortstudywhichinvolved956womenseekingterminationoftheirpregnancyat30facilitiesintheUS;someofwhomreceivedterminationsandsomerefusedterminationsduetolategestation.OverhalfofthewomenreportedhavingaUSOC;womenwithanAPSwerelesslikelytohaveanUSOC(44%vs60%;p<0.05),andwomenreportingsubstanceusewerealsolesslikelytohaveanUSOC(51%vs.61%;p<0.05).Thisassociationwasnotfoundforbingedrinking.Inmultivariateanalyses,havingAPSwere,butsubstanceusewasnot,associatedwithalackofUSOC.Theauthorsconcludethatprimaryhealthcarepreventionapproachesmaynotreachthemajorityofwomenwhoareatriskofhavinganalcoholexposedpregnancy.
13. Symon,A.,Rankin,J.,Butcher,G.,Smith,L.,&Cochrane,L.(2016a).Evaluationof
aretrospectivediaryforperi-conceptualandmid-pregnancydrinkinginScotland:across-sectionalstudy.ActaObstetriciaetGynecologicaScandinavica.doi:10.1111/aogs.13050
(Seeabstractabove)14. Symon,A.,Rankin,J.,Sinclair,H.,Butcher,G.,Smith,L.,Gordon,R.,&Cochrane,L.
(2016b).Peri-ConceptualandMid-PregnancyAlcoholConsumption:AComparisonbetweenAreasofHighandLowDeprivationinScotland.Birth:IssuesinPerinatalCare,43(4),320-327.doi:10.1111/birt.12252
(Seeabstractabove)
15. Veryga,A.,&Tubelyte,E.(2016).P.7.a.002-Culturalandotheraspectsoffetal
alcoholspectrumdisorderpreventionandidentificationinLithuania.EuropeanNeuropsychopharmacology,26,S710-S711.doi:10.1016/S0924-977X(16)31850-8
Thisbriefreportrecordsthefindingsoftwoquestionnairesadministeredtoa)generalpractitionersandobstretricians-gynegologistsonattitudesonalcoholuseinpregnancy(n=74),andb)neonatologists(n=27)todeterminetheprevalenceofFASDsymptomsamongnewbornsintheirpracticeinLithuania.Theauthorsfoundthatdespitestrongscientificrecommendationstoabstainfromalcoholduringpregnancy,12%ofphysiciansrecommendalcoholasaremedyforpregnantpatients;and43%ofparticipantsclaimedthattheirpregnantpatientsusealcoholfollowingrecommendationsofanotherdoctor.Duringtheperiodof2007–201110casesofFASwereofficiallydiagnosedinLithuania,whileinonlyoneLithuanianhospitalneonatologiststreatmorethan100newbornswithtypicalFASsymptomsperyear.GiventhemuchhigherFASmorbidityrateworldwide,itappearsthesyndromeisunderdiagnosedinLithuaniaandneedsmoreattentionfromhealthcaresystem.
28
16. Watt,M.H.,Eaton,L.A.,Dennis,A.C.,Choi,K.W.,Kalichman,S.C.,Skinner,D.,&Sikkema,K.J.(2016).AlcoholuseduringpregnancyinaSouthAfricancommunity:Reconcilingknowledge,norms,andpersonalexperience.MaternalandChildHealthJournal,20(1),48-55.doi:10.1007/s10995-015-1800-4
(Seeabstractabove)
17. Wright,T.E.,Terplan,M.,Ondersma,S.J.,Boyce,C.,Yonkers,K.,Chang,G.,&
Creanga,A.A.(2016).Theroleofscreening,briefintervention,andreferraltotreatmentintheperinatalperiod.AmericanJournalofObstetrics&Gynecology,215(5),539-547.doi:10.1016/j.ajog.2016.06.038
Thisarticlediscussestheconclusionsofanexpertpanelconvenedin2012bytheUSCentresforDiseaseControlontheneedfor,andbenefitsof,screening,briefintervention,andreferraltotreatmentbyprenatalcareproviderstoreducetheburdenofsubstanceuseinpregnancy.Theyconcludedthatscreeningforsubstanceuseduringpregnancy,andrespondingbasedonlevelofriskshouldbeuniversal.Womenatlowriskshouldreceivebriefadvice,thoseclassifiedasmoderateriskshouldreceiveabriefinterventionusingtheprinciplesofmotivationalinterviewing,whereasthosewhoarehighriskneedreferraltospecialtycare.Giventhatscreening,briefintervention,andreferraltotreatmenthasthepotentialtoreducetheburdenofsubstanceuseinpregnancyitshouldbeintegratedintoprenatalcare.18. Wulp,N.Y.,Hoving,C.,&Vries,H.(2016).Correlatesofpartnersupportto
abstainfromprenatalalcoholuse:across-sectionalsurveyamongDutchpartnersofpregnantwomen.Health&SocialCareintheCommunity,24(5),614-622.doi:10.1111/hsc.12235
(Seeabstractabove)
Preconceptioninterventions
1. Balachova,T.,Bard,D.,Bonner,B.,Chaffin,M.,Isurina,G.,Tsvetkova,L.,&Volkova,E.(2016).Doattitudesandknowledgepredictat-riskdrinkingamongRussianwomen?TheAmericanJournalofDrugandAlcoholAbuse,42(3),306-315.doi:10.3109/00952990.2016.1141914
(Seeabstractabove)
29
2. Bye,A.,Shawe,J.,Stephenson,J.,Bick,D.,Brima,N.,&Micali,N.(2016).Differencesinpre-conceptionandpregnancyhealthylifestyleadvicebymaternalBMI:Findingsfromacrosssectionalsurvey.Midwifery,42,38-45.doi:10.1016/j.midw.2016.09.013
Theauthorsusedasurveywithpregnantwomen(n=1,173)attendingantenatalcareintheUKtodeterminedifferencesinpre-pregnancyandpregnancyhealthylifestyleadvicetheyreceivedfromhealthcarepractitioners.ResearchersexaminedroutineadviceprovidedonweightmanagementbasedonBMI,tobaccocessation,andalcoholintake,aswellastobaccoandalcoholusebeforeandduringpregnancy.Availabledataonpre-pregnancyBMIshowedthat69%ofwomenwereofnormalweight,25%wereobeseoroverweight,and6%wereunderweight.AdviceofferedtowomenofnormalBMIorlowBMIwassimilar(OR2.55,95%CI1.64-3.96),whilewomenofhighBMIwereofferedspecificpre-conceptionadviceonhealthyweight(OR1.79,95%CI1.26-2.54),preconceptiondiet(OR1.58,95%CI1.06-2.37),reducingalcoholuse(OR1.63,95%CI1.06-2.51)andsmokingcessation(OR1.62,95%CI1.05-2.50).Duringpregnancy,alcoholuseforallwomenwaslowerthanpre-conception;aroundhalfofallwomenreportedalcoholconsumptionatsomepointduringtheirpregnancy.Forbestpregnancyoutcomes,preconceptioncareshouldadviseallwomenoftheimportanceofahealthylifestyleforbestpregnancyoutcomesaswellasmanageanypre-existinghealthconditions.3. McBride,N.,&Johnson,S.(2016).Fathers'RoleinAlcohol-ExposedPregnancies:
SystematicReviewofHumanStudies.AmericanJournalofPreventiveMedicine,51(2),240-248.doi:10.1016/j.amepre.2016.02.009
(Seeabstractabove)
4. Poole,N.,Schmidt,R.A.,Green,C.,&Hemsing,N.(2016).PreventionofFetal
AlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps.SubstanceAbuse:ResearchandTreatment,2016(Suppl.1),1-11.doi:10.4137/SART.S34545
(Seeabstractabove)
30
Level3Prevention
1. Acquavita,S.P.,Kauffman,S.S.,Talks,A.,&Sherman,K.(2016).Pregnantwomenwithsubstanceusedisorders:Theintersectionofhistory,ethics,andadvocacy.SocialWorkinHealthCare,55(10),843-860.doi:10.1080/00981389.2016.1232670
Effortstodevelopeffectiveinterventionstomitigateharmsfromsubstanceusedisorders(SUD)amongpregnantwomenarehamperedbecausepregnantwomenarelargelyexcludedfromclinicaltrials.Theauthorsexaminethehistoryandconsequencesofexcludingandincludingwomenofchildbearingpotentialfromclinicaltrialsoverthelast60years.Inadiscussionoftheethicalissues,theyarguethatexcludingpregnantwomenwithSUDfromclinicalstudieswhilemanyaresubjectedtodrugtestingandpunitivepracticesforusingthemiscontrarytotheethicalprinciplesof“autonomy,beneficenceandjustice.”Further,exclusionpracticesimpedethediscoveryofandimprovementsincareoutcomesforthevulnerablepopulationtheypurporttoprotect.AmodelforincludingpregnantwomeninSUDclinicaltrialsusingan“empowereddecision-makingethicalframework”thatprioritizesprenatalcare,preventionandeducation,andaccesstovoluntarytreatmentservicesispresentedanddiscussed.FuturestepstoimprovingresearchandoutcomesforwomenwithSUDaresuggested.2. Knopf,A.(2016).PregnantandpostpartumwomenwithSUDsneedfull
continuumofcare.Alcoholism&DrugAbuseWeekly,28(8),1-4.doi:10.1002/adaw.30479
ThisissueofAlcohol&DrugAbuseWeeklyincludesnewsontheUSfederallyfundedsystemthatgivespregnantandpostpartumwomenprioritytreatmentforsubstanceusedisorders.Thenewsbriefdiscusses:aresidentialgrantprogramforpregnantandpostpartumwomen,andSubstanceAbusePreventionandTreatment(SAPT)blockgrantsgiventostates;medicationforpregnantwomenaddictedtoopioids;andchallengesthatsubstanceusetreatmentprovidersencounterwhenworkingwithpregnantwomenwithsubstanceusedisorders,includingtheinvolvementofthecriminaljusticesystemandchildprotectionservices.3. Meixner,T.,Milligan,K.,Urbanoski,K.,&McShane,K.(2016).Conceptualizing
integratedservicedeliveryforpregnantandparentingwomenwithaddictions:Definingkeyfactorsandprocesses.CanadianJournalofAddiction,7(3),49-57.
Theauthorsusedconceptmappingtoexploretheissueofintegratedservicedeliveryforwomenwhoarepregnant/parentingandlivingwithaddictions.TheprojectwasconductedinOntario,Canada,and30stakeholderswithexpertiseinresearch,servicedelivery,integratedservicemanagement,andpolicywereincludedinthestudy.Conceptmappingoccurredinseveralphases,andclusterswereidentifiedinthefollowingareas(inorderofperceivedimportance):holisticcareformother,baby,anddyadwithafocusonempowerment;enhancedaccesstoandcoordinationofcareforclients;engagementofmultipleministries;individuallytailoredandcontinuousservicedeliverythroughoutlifestages;partnershipscharacterizedbyinnovationandcoordination;andsustainability,leadership,andinvestmentinprogramstaff.Theauthorsassertthatthisstudyidentifiedkeyfactorsandcomplexprocessrelatedtoeffectiveservicedeliveryforpregnantorparentingwomenwithaddictions,andhighlightedthenecessityofintegrationandcoordinationacrossprogramming,administration,andpolicy.
31
4. Myra,S.M.,Ravndal,E.,Torsteinsson,V.W.,&Wiig,E.M.(2016).Pregnantsubstance-abusingwomenininvoluntarytreatment:Attachmentexperienceswiththeunbornchild.NordicStudiesonAlcoholandDrugs,33(3),299-313.doi:10.1515/nsad-2016-0023
Since1996,theuseofinvoluntarytreatmentforwomenwhousesubstancesduringpregnancyhasbeenlegalinNorway.Inthisstudy,qualitativeinterviewswereconductedwitheightwomenintoexaminehowwomenperceiveattachmentwiththeirunbornbabyinthecontextofmandatorytreatment.Thewomenhadexperiencedlowlevelsofsocialsupport,economicdisadvantage,andmanyhadexperiencedabuseand/orlivedwithparentswhosubstanceuseissues.Theanalysisofthequalitativedatarevealedthreemainthemes:1)theinvoluntarytreatmentwasperceivedaspromotingsafetyandconnectiontotheirunbornbaby;2)womenreportedexperiencingreflexiveattachmenttotheirunbornbabyuponconfirmationofpregnancy/atthefirstultrasounds;and3)womenspokeabouttheirexperiencesoftrauma,abuse,neglectandsubstanceabuseintheirfamilies.Theauthorsconcludethatwomen’sadversechildhoodexperiencesarethemainbarriertoattachmentwiththeirbaby,andthatmandatorytreatmentmayprovideacontextinwhichtobegintofacilitatepositiveattachment,andbreakthetransmissionofrisktothenextgeneration.5. Poole,N.,Schmidt,R.A.,Green,C.,&Hemsing,N.(2016).PreventionofFetal
AlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps.SubstanceAbuse:ResearchandTreatment,2016(Suppl.1),1-11.doi:10.4137/SART.S34545
(Seeabstractabove)6. Robinowitz,N.,Muqueeth,S.,Scheibler,J.,Salisbury-Afshar,E.,&Terplan,M.
(2016).Familyplanninginsubstanceusedisordertreatmentcenters:Opportunitiesandchallenges.SubstanceUse&Misuse,51(11),1477-1483.doi:10.1080/10826084.2016.1188944
Theauthorsconductedfocusgroupsandindepthinterviewswithclients(n=41),staff(n=23)andmedicalproviders(n=9)todeterminethefeasibilityandacceptabilityofofferingfamilyplanningservicesatthreesubstanceusetreatmentcentresinBaltimore.Clientsreportedthattheywereinterestedinreceivingfamilyplanningservices,astheyoftenencounterbarriersaccessingtheseserviceswhileintreatment,andpreferredtoaccessfamilyplanningonsiteatthetreatmentcentre.Althoughtreatmentprovidersidentifiedbarrierstoimplementationincludingtimeconstraints,theyalsoagreedthatitwouldbebesttoprovidetheseservicesonsite.Theauthorsconcludethattreatmentcentrescanplayaroleinofferingpreventativeandhealthservicesincludingfamilyplanningservices,whichmayreducefuturesubstanceexposedpregnanciesandimprovethereproductivehealthofsubstanceusingwomen.
32
7. VanScoyoc,A.,Harrison,J.A.,&Fisher,P.A.(2016).Beliefsandbehaviorsofpregnantwomenwithaddictionsawaitingtreatmentinitiation.Child&AdolescentSocialWorkJournal.doi:10.1007/s10560-016-0474-0
Thisstudyexaminedtheprotectivebehaviorsthatwomenwithaddictionsengageinduringtheperiodoftimebetweenwhentheyfirstfindouttheyarepregnantandwhentheybegintreatmentforsubstanceuseproblems.Semi-structuredinterviewswereconductedwith15womenwhowerepregnantorpostpartum,whohadusedillicitsubstancesduringpregnancy,andwerecurrentlyreceivinginpatienttreatmentservices.Participantsretrospectivelyreportedontheirexperiences.Womenreportedbeingconcernedabouttheconsequencesofprenatalexposureandmakingeffortstoprotectthebabyfromharm.Ontheirown,theysoughtinformationanonymously,increasedtheirengagementinhealth-promotingbehaviors,anddecreasedtheiruseofalcoholandotherdrugs.Theauthorsconcludethatsubstance-usingwomenareoftenmotivatedtoprotecttheirbabyfromharmandactivelyengageinharmreductioneffortspriortoaccessingtreatmentservices.
Level4Prevention
1. Knopf,A.(2016).PregnantandpostpartumwomenwithSUDsneedfullcontinuumofcare.Alcoholism&DrugAbuseWeekly,28(8),1-4.doi:10.1002/adaw.30479
(Seeabstractabove)2. Ondersma,S.J.,Svikis,D.S.,Thacker,L.R.,Beatty,J.R.,&Lockhart,N.(2016).A
randomisedtrialofacomputer�deliveredscreeningandbriefinterventionforpostpartumalcoholuse.DrugandAlcoholReview,5(6),710-718.doi:10.1111/dar.12389
Universalscreeningandbriefintervention(SBIR)isapromisingpracticeforreducingalcoholuseduringpregnancy.Researchshowsthatmostwomencutdownorabstainfromalcoholwhiletheyarepregnant,butmostreturntopreviousdrinkingpatternspost-partum.Maintainingreducedalcoholuseinthepost-partumperiodcouldpositivelyaffectoutcomesforchildrenandfamilies.Usingarandomisedcontrolgroupofwomen(n=123),theauthorscomparedresultsofthosecompletinga20-minuteelectronic-basedbriefintervention(n=63)andthosenotreceivingtheintervention(n=62).Unlikeaparallelstudyarounddruguse,theyfoundnoevidencethatthisparticulare-SBIRwaseffectiveinreducingalcoholuseamongpostpartumwomen.Indiscussingtheirfindings,theymakesuggestionsforimprovingthecontent,deliveryandmethodsoftheintervention.Becauseofthesignificantadvantagesinherentintechnology-basedapproaches,suchascost-effectiveness,interventionreach,andeaseofimplementation,theysupportfurtherresearchofe-SBIRinordertoidentifythekeycomponentsforsuccess.
3. Poole,N.,Schmidt,R.A.,Green,C.,&Hemsing,N.(2016).PreventionofFetal
AlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps.SubstanceAbuse:ResearchandTreatment,2016(Suppl.1),1-11.doi:10.4137/SART.S34545
(Seeabstractabove)
33
4. Walker,L.O.,Murphey,C.L.,&Xie,B.(2016).MissedOpportunitiesforPostpartumBehavioralandPsychosocialHealthCareandAcceptabilityofScreeningOptions.JournalofObstetric,Gynecologic,AndNeonatalNursing:JOGNN/NAACOG,45(5),614-624.doi:10.1016/j.jogn.2016.05.004
Thisstudysurveyedwomeninthepostpartumperiodaboutdiscussionswithhealthcareprovidersonarangeofhealthissues,theacceptabilityofscreening,andaccesstoaproviderwithwhomtocomfortablydiscusssensitivetopics.Arandomsampleofwomenstratifiedonrace/ethnicityandincome,drawnfromvitalrecords,inasouthwesternUScommunity(n=168)whowereintheirfirstpostpartumyearweremailedaquestionnaireabouthealthcareandscreeningfordepression,diet,physicalactivity,smoking,andalcoholuseduringthepostpartumperiod.Womenreportedthatdiscussionofdepressionmostoftenoccurred(51%)duringhealthcareencounters,anddiscussionofweightwereoftenoccurred(14%).Morethan94%ofwomenindicatedtheywould"welcome"or"notmind"screeningsfordepression,diet,physicalactivity,alcoholuse,orsmokingathealthcarevisits.Methodsandcontextsforscreeningseenasacceptablewere:screeningduringtheirinfants'pediatrichealthcarevisits(>90%),screeningonanelectronicdeviceattheirhealthcarevisits(86%),screeningathomeonawebsite(84%).Morewomenwithouthealthinsurance(58%)comparedwiththosewithinsurance(24%)indicatedthattheylackedahealthprofessionalwithwhomtheycouldcomfortablydiscusssensitivetopicssuchasdepression.Considerablegapsexistinpostpartumhealthscreeninganddiscussions,yetmostwomenfindavarietyofscreeningsettingsandmethodsacceptable.
Other
1. Abadir,A.M.,&Ickowicz,A.(2016).Fetalalcoholspectrumdisorder:reconsideringblame.CMAJ:CanadianMedicalAssociationJournal,188(3),171-172.doi:10.1503/cmaj.151425
WomenwhohavechildrenwithFASDareoftenblamedforeitherdrinkingduringpregnancy,orforhavinguntreatedaddictionissues.Theassumptionisthatmotherschoosetodrinkwhilepregnantdespiteknowingtheteratogeniceffectsofalcoholontheirunbornchildrenandare,therefore,unfit.Researchonthesocialdeterminantsofhealthrevealstheseassumptionsasincorrect,andidentifiesthelargerroleplayedbylackofinformationandsupport,andforhavinguntreatedaddictionissues.Theauthorschallengetheassumptionisthatmotherschoosetodrinkwhilepregnantdespiteknowingtheteratogeniceffectsofalcoholontheirunbornchildrenandare,therefore,unfit.Further,recentepigeneticresearchlinksbothpaternalandmaternalalcoholconsumptionduringthepreconceptionperiodtoFASDinchildren.Consequently,theauthorsrecommendthatinterventionstargetbothmenandwomenandpromoteabstainingfromalcoholbeforeandduringpregnancy.2. EBCOG.(2016).EBCOGPositionPaperonAlcoholandpregnancy.European
JournalofObstetrics&Gynecology&ReproductiveBiology,202,99-100.doi:10.1016/j.ejogrb.2016.04.020
ManywomeninEuropecontinuetodrinkduringpregnancyandunplannedpregnanciescanbeparticularlyimpactedbyalcoholexposure.TheEuropeanBoardandCollegeofObstetricsandGynaecology(EBCOG)reviewstheknownnegativeeffectsrelatedtostageofpregnancy,amountsofalcohol,andthenegativeeffectsuponIQofevenlowlevelsofalcoholexposure.Theyrecommendthatprovidersandhealtheducators:1)educatethepublicontherisksofunprotectedsexandalcoholuse,andtheeffectsonthefetusofalcoholconsumptionduringpregnancy;and,2)resolvetoidentifywomenwithalcoholdisordersintheearlieststagesofpregnancyand,preferably,pre-conception,andtoreferthemtoappropriatesupportandtreatment.
34
3. Hotham,E.D.,Ali,R.L.,White,J.M.,&Robinson,J.S.(2016).Ethical
considerationswhenresearchingwithpregnantsubstanceusersandimplicationsforpractice.AddictiveBehaviors,60,242-243.doi:10.1016/j.addbeh.2016.03.007
Inthisbriefcommentary,theauthorsdiscusstheethicalissuesrelatedtoresearchingpregnantsubstanceusersandtheimplicationsoftheseissuesontheoutcomesofresearchrelatedtopractice.Theauthorpositsthatthereisacommonlyheldbeliefamongmuchofsocietythatsubstanceuseduringpregnancyisharmfultothefetus,abeliefthatmaynotbesharedwithsubstanceusers.Thedisapprovalofsubstanceusers,aswellastheimportanceplacedfoetalhealthoverwomen’shealthmayleadtoadelayoravoidanceofantenatalcare.“Engagingsubstanceusersinresearchinantenatalsettings,whetherornotatreatmentinterventionisinvolved,takesplaceagainstthisbackgroundofdisapprovalcoupledwithageneralreluctancetoinvolveanypregnantwomeninresearch.”Theauthorsconcludethatresearchwithsubstanceusingpregnantwomendependsonacontextoftrustandtheabsenceofjudgmentandthatvalidresearchfindingswillonlybeidentifiedifconfidentialityisadequatelyaddressed.4. Pei,J.,Tremblay,M.,McNeil,A.,Poole,N.,&McFarlane,A.(2016).
NeuropsychologicalAspectsofPreventionandInterventionforFASDinCanada.JournalofPediatricNeuropsychology.doi:10.1007/s40817-016-0020-1
Inthisreviewandcalltoaction,theauthorsdetailefforts,successes,andrecommendationsforfivemajorareasofFASD:epidemiology,conceptualization,research,prevention,andintervention.InthesectionFASDPreventioninCanada,theyoverviewthenationalFASDpreventionframeworkwhichlaysoutfourareasforinvolvement:a)raisingawareness,b)briefcounselling,c)prenatalsupport,and,d)post-partumsupport.Provincialandstrategicplansandmulti-sectoralapproachescallforuniversalFASDpreventioneffortsaswellasselectiveeffortstoreachspecificsubgroupsofwomenandtoreducestigma.UniversalprenatalscreeningsareinplaceinsomeprovincesandrecommendedforallofCanada.ProgramssuchasP-CAPinAlbertasupportwomenatthehighest-riskwithwrap-aroundservicesandsupporttothemandtheirchildren.MoreevaluationisneededtosupportasystematicFASDpreventionapproachthatlinkslevelsandsectors,andincreasesinter-agencycollaborationandcooperation.Overall,itwillbecrucialtocontinuecross-sectoral,high-qualityresearchandevaluationtoimproveeffectiveFASDpreventionandinterventionefforts. 5. Popova,S.,Lange,S.,Burd,L.,&Rehm,J.(2016c).TheEconomicBurdenofFetal
AlcoholSpectrumDisorderinCanadain2013.AlcoholandAlcoholism(Oxford,Oxfordshire),51(3),367-375.doi:10.1093/alcalc/agv117
Thisstudyassessedthecost-of-illnessattributedtoFASDinCanada,byexaminingdirectcostsfor:healthcareresources,lawenforcement,children/youthincare,housing,specialeducation,longtermcareservices,andresearchandprevention.Theauthorsalsoanalyzedtheindirectcosts,including:lossofproductivityforthoseaffectedbyFASD,increasedmorbidityandearlymortality.Thetotalestimatedcostwas$1.8billion(rangingfromalowerestimateof$1.3billiontoahigherestimateof$2.3billion).ThegreatestFASDrelatedcostwasthelossofproductivityduetomorbidityandmortalitywhichmadeup41%ofthetotalcost($532millionto$1.2billion).ThesecondgreatestcostwerethoseincurredbytheCanadiancorrectionalsystem,estimatedat29%ofthetotalcost(or$378.3million).Thethirdgreatestcostwerehealthcarecosts,whichcomprised10%ofthetotalcosts(or$128.5-$226.3million).TheauthorsconcludethattheeconomiccostsofFASDinCanadaaresignificant,andpoliciesandinterventionsthatpreventFASDcouldreducemanyofthesecosts.
35
6. Rutman,D.(2016).BecomingFASDInformed:StrengtheningPracticeandProgramsWorkingwithWomenwithFASD.SubstanceAbuse:ResearchandTreatment,10(Suppl1),13-20.doi:10.4137/SART.S34543
ThisarticleidentifieskeycomponentsofanFASDinformedapproachtoserviceprovision,tosupporttheworkofhealthandsocialcareproviders,workingwithwomen,adults,andyoungpeoplewhomayhaveFASD.TheCanadianauthordrawsontheemergingliterature,researchonsupportneeds,andevaluationsofFASD-relatedprograms.ThearticlediscusseswhatanFASD-informedapproachis,andprovidesexamplesofFASD-informedadaptationstopractice,programming,andthephysicalenvironmentusefultothoseworkingincommunity-basedprogramswithwomenoryoungpeoplewithsubstanceuseproblemsand/orwhohaveexperiencedviolence,maltreatment,ortrauma,whomayalsohaveFASD.7. Seiler,N.K.(2016).AlcoholandPregnancy:CDC'sHealthAdviceandTheLegal
RightsofPregnantWomen.PublicHealthReports,131(4),623-627. ThisarticlediscussestheunintendedharmsassociatedwithlawsrequiringmandatoryreportingofalcoholusenotinalignmentwiththeUSCentresforDiseaseControl’srecommendationthatwomenofreproductiveageavoidalcoholwhentheyarepregnant,areattemptingtobecomepregnant,orcouldbecomepregnant.TheauthoroverviewcurrentlawsrelatedtoalcoholuseduringpregnancyincludingidentifyingthenumberofUSstateswherelawsarepunitive.Theythenestimatenumberofcaseswherewomenhavefacedcivilorcriminalsanctions,suchascivilcommitment(i.e.,involuntarytreatmentorprotectivecustody)duringpregnancy,orwiththetemporaryorpermanentremovalofchildrenbychildprotectiveservicesagenciesafterbirth.Theimportanceofthepublichealthcommunity’sawarenessofhowinformationdesignedtopromotepositivehealthbehaviorscanhaveseriouslegalconsequencesisnoted,dependingonhowlawenforcementauthoritiesusesuchinformationtoshapetheirownpractices.8. Stewart,M.(2016).FictionsofPrevention:FetalAlcoholSpectrumDisorderand
NarrativesofResponsibility.NorthAmericanDialogue,19(1),55-66.doi:10.1111/nad.12040
Thiscommentaryexaminesthenarratives,policiesanddiscoursesurroundingFASDasadisability,substanceuserisk,andFASDprevention;andtheresultantimplicationsofthesenarrativesforlegal,healthandsocialserviceinterventions.Thecommentarytakesthecontroversial2016adviceissuedbytheUSCentresforDiseaseControlaboutdrinkingandcontraceptionusebywomenofchildbearingyearsasitstartingpoint,andtheauthorarguesforamorenuancedandcontextualizedunderstandingofthecontextinwhichFASDmayarise,thatwillresultinimprovedwomen’shealth,legalandchildwelfarepolicyandpractice.9. Walker,D.S.,Edwards,W.E.R.,&Herrington,C.(2016).Fetalalcoholspectrum
disorders:Prevention,identification,andintervention.NursePractitioner,41(8),28-35.doi:10.1097/01.NPR.0000488709.67444.92
ThisnarrativereviewprovidesaselectivereviewofevidenceaimedatnursestoprovideanoverviewofFASDandcurrentrecommendationssupportingabstinencefromalcoholduringpregnancy.Aswell,clinicalmethodsrelatedtoscreening,intervention,treatmentandmanagementofbothpregnantwomenandtheirchildrenaredetailed,includingachartcomparingalcoholscreeningquestionnaires.Underscoringtheimportanceoftreatmentforwomen,theyconcludethatAPRNs(nurses)areuniquelypositionedtoleadpreventioneffortsaroundscreening,intervention,andreferral.
36
10. Wilkinson,D.,Skene,L.,Decrespigny,L.,&Savulescu,J.(2016).ProtectingFutureChildrenfromIn-UteroHarm.Bioethics,30(6),425-432.doi:10.1111/bioe.12238
Thisarticleconsidersethicalissuesrelatedtoheavyalcoholuseinpregnancy,women’sautonomy,fetalharm,andthepossiblelegalcaseforinterventiontopreventfetalharm.Theauthorslistarangeofinterventionstopreventharmto‘futurechildren’,andnotethatnotalllegalprotectivemeasuresthatmightbepossiblearejustifiableorpracticable.Amongotheravenuesforpossibleaction,theauthorsnotethatmeasuresthataremostlikelytobesuccessfulandwidelysupportedareeducation,supportandcounselling,andsuggestthatsystemicresponsibilityforprovidingthesecouldbeexpanded.
Summaryofincludedstudiesbymethodandcountryofstudy
Table2:Includedstudiesbymethod,countryandpagenumber
Author Title Method Country Page
PrevalenceofDrinkingDuringPregnancy
n=24
Alshaarawy,Breslau,&Anthony(2016)
MonthlyEstimatesofAlcoholDrinkingDuringPregnancy:UnitedStates,2002-2011
Crosssectional USA 4
Balachovaetal.(2016)
DoAttitudesandKnowledgePredictat-RiskDrinkingamongRussianWomen?
Crosssectional Russia 4
Brownetal.(2016)
HealthInsurance,AlcoholandTobaccoUseamongPregnantandNon-PregnantWomenofReproductiveAge
Crosssectional USA 5
Cohenetal.(2016)
PartnerInvolvementDuringPregnancyandMaternalHealthBehaviors
Crosssectional USA 5
Englishetal.(2016)
PrevalenceofEthanolUseamongPregnantWomeninSouthwesternUganda
Crosssectional SouthAfrica 5
Greenetal.(2016)
VitalSigns:Alcohol-ExposedPregnancies--UnitedStates,2011-2013
Crosssectional USA 6
Kesmodeletal.(2016)
TimeTrendsinAlcoholIntakeinEarlyPregnancyandOfficialRecommendationsinDenmark,1998-2013
Crosssectional Denmark 6
Kreshaketal.(2016)
ADescriptiveRegionalStudyofDrugandAlcoholUseinPregnantWomenUsingResultsfromUrineDrugTestingbyLiquidChromatography-TandemMassSpectrometry
Crosssectional USA 7
37
Author Title Method Country Page
Matusiewicz,Ilgen,&Bohnert(2016)
ChangesinAlcoholUseFollowingtheTransitiontoMotherhood:FindingsfromtheNationalEpidemiologicSurveyonAlcoholandRelatedConditions
Longitudinal USA 7
Mayetal.(2016)
BreastfeedingandMaternalAlcoholUse:PrevalenceandEffectsonChildOutcomesandFetalAlcoholSpectrumDisorders
Crosssectional SouthAfrica 7
Mugglietal.(2016)
DidYouEverDrinkMore?ADetailedDescriptionofPregnantWomen'sDrinkingPatterns
ProspectiveCohort
Australia 8
Niemelaetal.(2016)
FetalAlcoholSyndromeandMaternalAlcoholBiomarkersinSera:ARegister-BasedCase-ControlStudy
Case-control Finland 8
Onahetal.(2016)
PredictorsofAlcoholandOtherDrugUseamongPregnantWomeninaPeri-UrbanSouthAfricanSetting
Crosssectional SouthAfrica 9
Onwukaetal.(2016)
PrevalenceandPredictorsofAlcoholConsumptionDuringPregnancyinSouth-EasternNigeria
Crosssectional Nigeria 9
Pettigrewetal.(2016)
AComparisonofAlcoholConsumptionIntentionsamongPregnantDrinkersandTheirNonpregnantPeersofChild-BearingAge
Crosssectional Australia 10
Popovaetal.(2016a)
PrevalenceofalcoholconsumptionduringpregnancyandFetalAlcoholSpectrumDisordersamongthegeneralandaboriginalpopulationsinCanadaandtheUnitedStates
Systematicreviewsandmeta-analysis
Canada 10
Popovaetal.(2016b)
ActualandPredictedPrevalenceofAlcoholConsumptionDuringPregnancyintheWhoAfricanRegion
Systematicreviewsandmeta-analysis
Canada 11
Singaletal.(2016)
ManitobaMothersandFetalAlcoholSpectrumDisordersStudy(Mbmomsfasd):ProtocolforaPopulation-BasedCohortStudyUsingLinkedAdministrativeData
Studyprotocol Canada 11
38
Author Title Method Country Page
Symonetal.(2016a)
EvaluationofaRetrospectiveDiaryforPeri-ConceptualandMid-PregnancyDrinkinginScotland:ACross-SectionalStudy
Crosssectional Scotland 12
Symonetal.(2016b)
Peri-ConceptualandMid-PregnancyAlcoholConsumption:AComparisonbetweenAreasofHighandLowDeprivationinScotland
Crosssectional Scotland 12
Thapaetal.(2016)
AlcoholConsumptionPracticesamongMarriedWomenofReproductiveAgeinNepal:APopulationBasedHouseholdSurvey
Crosssectional Nepal 12
Urbanetal.(2016)
ChangesinDrinkingPatternsDuringandafterPregnancyamongMothersofChildrenwithFetalAlcoholSyndrome:AStudyinThreeDistrictsofSouthAfrica
Crosssectional SouthAfrica 13
Washioetal.(2016)
CharacteristicsofLow-IncomeRacial/EthnicMinorityPregnantWomenScreeningPositiveforAlcoholRisk
Crosssectional USA 13
Winter(2016)
Alcohol,PregnancyandthePrecautionaryPrinciple
Commentary UK 13
Influencesandfactorsassociatedwithdrinkinginpregnancy
n=21
Balachovaetal.(2016)
DoAttitudesandKnowledgePredictat-RiskDrinkingamongRussianWomen?
Crosssectional Russia 4
Brownetal.(2016)
HealthInsurance,AlcoholandTobaccoUseamongPregnantandNon-PregnantWomenofReproductiveAge
Crosssectional USA 5
Cohenetal.(2016)
PartnerInvolvementDuringPregnancyandMaternalHealthBehaviors
Crosssectional USA 5
Englishetal.(2016)
PrevalenceofEthanolUseamongPregnantWomeninSouthwesternUganda
Crosssectional SouthAfrica 5
Greenetal.(2016)
VitalSigns:Alcohol-ExposedPregnancies--UnitedStates,2011-2013
Crosssectional USA 6
Haydon,Obst,&Lewis(2016)
BeliefsUnderlyingWomen'sIntentionstoConsumeAlcohol
Crosssectional Australia 15
Hogbergetal.(2016
AlcoholConsumptionamongPartnersofPregnantWomeninSweden:ACrossSectionalStudy
Crosssectional Sweden 15
39
Author Title Method Country Page
Holland,McCallum,&Walton(2016)
'I'mNotClearonWhattheRiskIs':Women'sReflexiveNegotiationsofUncertaintyAboutAlcoholDuringPregnancy
Qualitative Australia 15
McBride,&Johnson(2016)
Fathers'RoleinAlcohol-ExposedPregnancies:SystematicReviewofHumanStudies
Systematicreview
Australia 16
Mugglietal.(2016)
DidYouEverDrinkMore?ADetailedDescriptionofPregnantWomen'sDrinkingPatterns
Prospectivecohort
Australia 8
Onahetal.(2016)
PredictorsofAlcoholandOtherDrugUseamongPregnantWomeninaPeri-UrbanSouthAfricanSetting
Crosssectional SouthAfrica 9
Onwukaetal.(2016)
PrevalenceandPredictorsofAlcoholConsumptionDuringPregnancyinSouth-EasternNigeria
Crosssectional Nigeria 9
Pettigrewetal.(2016)
AComparisonofAlcoholConsumptionIntentionsamongPregnantDrinkersandTheirNonpregnantPeersofChild-BearingAge
Crosssectional Australia 10
Robertsetal.(2016)
ModeratorsandMediatorsoftheRelationshipbetweenReceivingVersusBeingDeniedaPregnancyTerminationandSubsequentBingeDrinking
Longitudinal USA 17
Singaletal.(2016)
ManitobaMothersandFetalAlcoholSpectrumDisordersStudy(Mbmomsfasd):ProtocolforaPopulation-BasedCohortStudyUsingLinkedAdministrativeData
Studyprotocol Canada 11
Thapaetal.(2016)
AlcoholConsumptionPracticesamongMarriedWomenofReproductiveAgeinNepal:APopulationBasedHouseholdSurvey
Crosssectional Nepal 12
Urbanetal.(2016)
ChangesinDrinkingPatternsDuringandafterPregnancyamongMothersofChildrenwithFetalAlcoholSyndrome:AStudyinThreeDistrictsofSouthAfrica
Crosssectional SouthAfrica 13
Washioetal.(2016)
CharacteristicsofLow-IncomeRacial/EthnicMinorityPregnantWomenScreeningPositiveforAlcoholRisk
Crosssectional USA 13
40
Author Title Method Country Page
Wattetal.(2016
AlcoholUseDuringPregnancyinaSouthAfricanCommunity:ReconcilingKnowledge,Norms,andPersonalExperience
Qualitative(Interviews)
SouthAfrica 18
Winter(2016)
Alcohol,PregnancyandthePrecautionaryPrinciple
Commentary UK 13
Wulp,Hoving,&Vries(2016)
CorrelatesofPartnerSupporttoAbstainfromPrenatalAlcoholUse:ACross-SectionalSurveyamongDutchPartnersofPregnantWomen
Crosssectional Netherlands 18
Level1Prevention
n=13
Averyetal.(2016)
MechanismsofInfluence:AlcoholIndustrySubmissionstotheInquiryintoFetalAlcoholSpectrumDisorders
Contentanalysis
Australia 19
Belletal.(2016)
It'saShame!StigmaagainstFetalAlcoholSpectrumDisorder:ExaminingtheEthicalImplicationsforPublicHealthPracticesandPolicies
Systematicreview
Canada 19
Charnessetal.(2016)
DrinkingDuringPregnancyandtheDevelopingBrain:IsAnyAmountSafe?
Commentary USA 19
Eguiagarayetal.(2016)
Sympathy,Shame,andFewSolutions:NewsMediaPortrayalsofFetalAlcoholSpectrumDisorders
Contentanalysis(Framinganalysis)
Australia 20
Fitzgeraldetal.(2016)
GenderDifferencesintheImpactofPopulation-LevelAlcoholPolicyInterventions:EvidenceSynthesisofSystematicReviews
Narrativesynthesisofsystematicreviews
UK 20
Haydonetal.(2016)
BeliefsUnderlyingWomen'sIntentionstoConsumeAlcohol
Prospectivedesignsurvey
Australia 15
Kalinowski&Humphreys(2016)
GovernmentalStandardDrinkDefinitionsandLow-RiskAlcoholConsumptionGuidelinesin37Countries
Crosssectional USA 20
Kesmodeletal.(2016)
TimeTrendsinAlcoholIntakeinEarlyPregnancyandOfficialRecommendationsinDenmark,1998-2013
Crosssectional Denmark 6
Leeetal.(2016)
FromScientificArticletoPressReleasetoMediaCoverage:AdvocatingAlcoholAbstinenceandDemocratisingRiskinaStoryAboutAlcoholandPregnancy
Qualitative(Contentandthematicanalysis)
UK 21
41
Author Title Method Country Page
O'Connoratal.(2016)
AlcoholInterventionforAdolescentswithFetalAlcoholSpectrumDisorders:ProjectStepup,aTreatmentDevelopmentStudy
Beforeandafter(pilot)
USA 21
Petticrewetal.(2016)
HealthInformationonAlcoholicBeverageContainers:HastheAlcoholIndustry'sPledgeinEnglandtoImproveLabellingBeenMet?
Crosssectional UK 22
Pooleetal.(2016)
PreventionofFetalAlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps
Crosssectional Canada 22
Roozenetal.(2016)
FetalAlcoholSpectrumDisorders(FASD):AnApproachtoEffectivePrevention
NarrativeReview
Netherlands 22
Level2Prevention
n=18
Charness,Riley,&Sowell(2016
DrinkingDuringPregnancyandtheDevelopingBrain:IsAnyAmountSafe?
Commentary USA 19
Eichleretal.(2016
DidYouDrinkAlcoholDuringPregnancy?InaccuracyandDiscontinuityofWomen'sSelf-Reports:OntheWaytoEstablishMeconiumEthylGlucuronide(Etg)asaBiomarkerforAlcoholConsumptionDuringPregnancy
Crosssectional Germany 23
Jensen,Kenyon,&Hanson(2016)
PreventingAlcohol-ExposedPregnancyamongAmerican-IndianYouth
Qualitative USA 23
Joyaetal.(2016)
SegmentalHairAnalysistoAssessEffectivenessofSingle-SessionMotivationalInterventiontoStopEthanolUseDuringPregnancy
Randomizedcontroltrial(RCT)
Spain 24
Lacey(2016)ReducingAlcoholHarm:EarlyInterventionandPrevention
Narrativereview
USA 24
McQuireetal.(2016)
ObjectiveMeasuresofPrenatalAlcoholExposure:ASystematicReview
Systematicreview
UK 24
Montag(2016)
FetalAlcohol-SpectrumDisorders:Identifyingat-RiskMothers
NarrativeReview
USA 25
Palmetal.(2016)
MotivationalInterviewingDoesNotAffectRiskDrinkingamongYoungWomen:ARandomised,Controlled
RCT Sweden 25
42
Author Title Method Country PageInterventionStudyinSwedishYouthHealthCentres
Parrishetal.(2016)
ProcessesofChangeinPreventingAlcoholExposedPregnancy:AMediationAnalysis
RCT USA 26
Pooleetal.(2016)
PreventionofFetalAlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps
Crosssectional Canada 22
Roberts(2016a)
ConclusionOverreachinAlcoholandPregnancyArticle
Lettertotheeditor
USA 26
Roberts(2016b)
WhichWomenAreMissedbyPrimaryHealth-CareBasedInterventionsforAlcoholandDrugUse?
Longitudinal USA 27
Symoneta.(2016a)
EvaluationofaRetrospectiveDiaryforPeri-ConceptualandMid-PregnancyDrinkinginScotland:ACross-SectionalStudy
Crosssectional Scotland 12
Symoneta.(2016b)
Peri-ConceptualandMid-PregnancyAlcoholConsumption:AComparisonbetweenAreasofHighandLowDeprivationinScotland
Crosssectional Scotland 12
Veryga&Tubelyte(20160
CulturalandOtherAspectsofFetalAlcoholSpectrumDisorderPreventionandIdentificationinLithuania
Crosssectional Lithuania 27
Wattetal.(2016
AlcoholUseDuringPregnancyinaSouthAfricanCommunity:ReconcilingKnowledge,Norms,andPersonalExperience
Qualitative(Interviews)
SouthAfrica 18
Wrightetal.(2016)
TheRoleofScreening,BriefIntervention,andReferraltoTreatmentinthePerinatalPeriod
Expertmeetingfindings
USA 28
Wulp,Hoving,&Vries(2016)
CorrelatesofPartnerSupporttoAbstainfromPrenatalAlcoholUse:ACross-SectionalSurveyamongDutchPartnersofPregnantWomen
Crosssectional Netherlands 18
Preconceptioninterventions
n=4Balachovaetal.(2016)
DoAttitudesandKnowledgePredictat-RiskDrinkingamongRussianWomen?
Crosssectional Russia 4
43
Author Title Method Country Page
Byeetal.(2016)
DifferencesinPre-ConceptionandPregnancyHealthyLifestyleAdvicebyMaternalBmi:FindingsfromaCrossSectionalSurvey
Crosssectional UK 29
McBride&Johnson(2016)
Fathers'RoleinAlcohol-ExposedPregnancies:SystematicReviewofHumanStudies
Systematicreview
Australia 16
Pooleetal.(2016)
PreventionofFetalAlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps
Crosssectional Canada 22
Level3Prevention
n=7
Acquavitaetal.(2016)
PregnantWomenwithSubstanceUseDisorders:TheIntersectionofHistory,Ethics,andAdvocacy
NarrativeReview
USA 30
Knopf(2016)PregnantandPostpartumWomenwithSudsNeedFullContinuumofCare
Newsforpolicymakers
USA 30
Meixneretal.(2016)
ConceptualizingIntegratedServiceDeliveryforPregnantandParentingWomenwithAddictions:DefiningKeyFactorsandProcesses
Qualitative(Conceptmapping)
Canada 31
Myraetal.(2016)
PregnantSubstance-AbusingWomeninInvoluntaryTreatment:AttachmentExperienceswiththeUnbornChild
Qualitative Norway 31
Pooleetal.(2016)
PreventionofFetalAlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps
Crosssectional Canada 22
Robinowitzetal.(2016)
FamilyPlanninginSubstanceUseDisorderTreatmentCenters:OpportunitiesandChallenges
Qualitative USA 31
VanScoyoc,Harrison&Fisher(2016)
BeliefsandBehaviorsofPregnantWomenwithAddictionsAwaitingTreatmentInitiation
Qualitative USA 32
Level4Prevention
n=4
Knopf(2016)PregnantandPostpartumWomenwithSudsNeedFullContinuumofCare
Newsforpolicymakers
USA 30
Ondersmaetal.(2016)
ARandomisedTrialofaComputer‚DeliveredScreeningandBriefInterventionforPostpartumAlcoholUse
RCT USA 32
44
Author Title Method Country Page
Pooleetal.(2016)
PreventionofFetalAlcoholSpectrumDisorder:CurrentCanadianEffortsandAnalysisofGaps
Crosssectional Canada 22
Walker,Murphey,&Xie(2016)
MissedOpportunitiesforPostpartumBehavioralandPsychosocialHealthCareandAcceptabilityofScreeningOptions
Crosssectional USA 33
Other
n=10
Abadir&Ickowicz(2016)
FetalAlcoholSpectrumDisorder:ReconsideringBlame
Commentary Canada 33
EBCOG(2016)
EBCOGPositionPaperonAlcoholandPregnancy
Positionpaper Europe 33
Hothametal.(2016)
EthicalConsiderationsWhenResearchingwithPregnantSubstanceUsersandImplicationsforPractice
Commentary Australia 34
Peietal.(2016)
NeuropsychologicalAspectsofPreventionandInterventionforFASDinCanada.JournalofPediatricNeuropsychology
NarrativeReview
Canada 34
Popovaetal.(2016c)
TheEconomicBurdenofFetalAlcoholSpectrumDisorderinCanadain2013
Costofillness Canada 34
Rutman(2016)
BecomingFASDInformed:StrengtheningPracticeandProgramsWorkingwithWomenwithFASD
Commentary Canada 35
Seiler(2016)AlcoholandPregnancy:CDC’sHealthAdviceandtheLegalRightsofPregnantWomen
Commentary USA 35
Stewart(2016)
FictionsofPrevention:FetalAlcoholSpectrumDisorderandNarrativesofResponsibility
Commentary Canada 35
Walker,Edwards,&Herrington(2016)
FetalAlcoholSpectrumDisorders:Prevention,Identification,andIntervention
Selectiveliteraturesummary
USA 35
Wilkinsonetal.(2016)
ProtectingFutureChildrenfromin-UteroHarm
Commentary UK 36