FASD PREVENTION: AN ANNOTATED BIBLIOGRAPHY OF …€¦ · FASD PREVENTION: AN ANNOTATED...

FASDPREVENTION:ANANNOTATED

BIBLIOGRAPHYOFARTICLESPUBLISHEDIN

2016

Preparedby

RoseSchmidt,NancyPoole,Christina

Talbot,NatalieHemsingandKatyFlannigan

CentreofExcellenceforWomen’sHealth

andCanFASDResearchNetwork

March2017

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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.

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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

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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)

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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.

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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)

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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.

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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

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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.

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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.

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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.

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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.

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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.”

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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


(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.

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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)



(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


(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.



(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


Cohenetal.(2016)

PartnerInvolvementDuringPregnancyandMaternalHealthBehaviors


Englishetal.(2016)

PrevalenceofEthanolUseamongPregnantWomeninSouthwesternUganda

Crosssectional SouthAfrica 5

Greenetal.(2016)

VitalSigns:Alcohol-ExposedPregnancies--UnitedStates,2011-2013


Kesmodeletal.(2016)

TimeTrendsinAlcoholIntakeinEarlyPregnancyandOfficialRecommendationsinDenmark,1998-2013

Crosssectional Denmark 6

Kreshaketal.(2016)

ADescriptiveRegionalStudyofDrugandAlcoholUseinPregnantWomenUsingResultsfromUrineDrugTestingbyLiquidChromatography-TandemMassSpectrometry


37


Matusiewicz,Ilgen,&Bohnert(2016)

ChangesinAlcoholUseFollowingtheTransitiontoMotherhood:FindingsfromtheNationalEpidemiologicSurveyonAlcoholandRelatedConditions

Longitudinal USA 7

Mayetal.(2016)

BreastfeedingandMaternalAlcoholUse:PrevalenceandEffectsonChildOutcomesandFetalAlcoholSpectrumDisorders


Mugglietal.(2016)

DidYouEverDrinkMore?ADetailedDescriptionofPregnantWomen'sDrinkingPatterns

ProspectiveCohort

Australia 8

Niemelaetal.(2016)

FetalAlcoholSyndromeandMaternalAlcoholBiomarkersinSera:ARegister-BasedCase-ControlStudy

Case-control Finland 8

Onahetal.(2016)

PredictorsofAlcoholandOtherDrugUseamongPregnantWomeninaPeri-UrbanSouthAfricanSetting


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


Symonetal.(2016a)

EvaluationofaRetrospectiveDiaryforPeri-ConceptualandMid-PregnancyDrinkinginScotland:ACross-SectionalStudy

Crosssectional Scotland 12

Symonetal.(2016b)

Peri-ConceptualandMid-PregnancyAlcoholConsumption:AComparisonbetweenAreasofHighandLowDeprivationinScotland


Thapaetal.(2016)

AlcoholConsumptionPracticesamongMarriedWomenofReproductiveAgeinNepal:APopulationBasedHouseholdSurvey

Crosssectional Nepal 12

Urbanetal.(2016)

ChangesinDrinkingPatternsDuringandafterPregnancyamongMothersofChildrenwithFetalAlcoholSyndrome:AStudyinThreeDistrictsofSouthAfrica


Washioetal.(2016)

CharacteristicsofLow-IncomeRacial/EthnicMinorityPregnantWomenScreeningPositiveforAlcoholRisk


Winter(2016)

Alcohol,PregnancyandthePrecautionaryPrinciple

Commentary UK 13

Influencesandfactorsassociatedwithdrinkinginpregnancy

n=21

Balachovaetal.(2016)



Brownetal.(2016)

HealthInsurance,AlcoholandTobaccoUseamongPregnantandNon-PregnantWomenofReproductiveAge


Cohenetal.(2016)

PartnerInvolvementDuringPregnancyandMaternalHealthBehaviors


Englishetal.(2016)

PrevalenceofEthanolUseamongPregnantWomeninSouthwesternUganda


Greenetal.(2016)

VitalSigns:Alcohol-ExposedPregnancies--UnitedStates,2011-2013


Haydon,Obst,&Lewis(2016)

BeliefsUnderlyingWomen'sIntentionstoConsumeAlcohol


Hogbergetal.(2016

AlcoholConsumptionamongPartnersofPregnantWomeninSweden:ACrossSectionalStudy

Crosssectional Sweden 15

39


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


Onwukaetal.(2016)

PrevalenceandPredictorsofAlcoholConsumptionDuringPregnancyinSouth-EasternNigeria

Crosssectional Nigeria 9

Pettigrewetal.(2016)

AComparisonofAlcoholConsumptionIntentionsamongPregnantDrinkersandTheirNonpregnantPeersofChild-BearingAge


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


Washioetal.(2016)

CharacteristicsofLow-IncomeRacial/EthnicMinorityPregnantWomenScreeningPositiveforAlcoholRisk


40


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


Kesmodeletal.(2016)

TimeTrendsinAlcoholIntakeinEarlyPregnancyandOfficialRecommendationsinDenmark,1998-2013

Crosssectional Denmark 6

Leeetal.(2016)

FromScientificArticletoPressReleasetoMediaCoverage:AdvocatingAlcoholAbstinenceandDemocratisingRiskinaStoryAboutAlcoholandPregnancy

Qualitative(Contentandthematicanalysis)

UK 21

41


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)



Roberts(2016a)

ConclusionOverreachinAlcoholandPregnancyArticle

Lettertotheeditor

USA 26

Roberts(2016b)

WhichWomenAreMissedbyPrimaryHealth-CareBasedInterventionsforAlcoholandDrugUse?

Longitudinal USA 27

Symoneta.(2016a)

EvaluationofaRetrospectiveDiaryforPeri-ConceptualandMid-PregnancyDrinkinginScotland:ACross-SectionalStudy


Symoneta.(2016b)

Peri-ConceptualandMid-PregnancyAlcoholConsumption:AComparisonbetweenAreasofHighandLowDeprivationinScotland


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)



43


Byeetal.(2016)

DifferencesinPre-ConceptionandPregnancyHealthyLifestyleAdvicebyMaternalBmi:FindingsfromaCrossSectionalSurvey

Crosssectional UK 29

McBride&Johnson(2016)

Fathers'RoleinAlcohol-ExposedPregnancies:SystematicReviewofHumanStudies

Systematicreview

Australia 16

Pooleetal.(2016)



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)



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


Pooleetal.(2016)



Walker,Murphey,&Xie(2016)

MissedOpportunitiesforPostpartumBehavioralandPsychosocialHealthCareandAcceptabilityofScreeningOptions


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


Seiler(2016)AlcoholandPregnancy:CDC’sHealthAdviceandtheLegalRightsofPregnantWomen

Commentary USA 35

Stewart(2016)

FictionsofPrevention:FetalAlcoholSpectrumDisorderandNarrativesofResponsibility


Walker,Edwards,&Herrington(2016)

FetalAlcoholSpectrumDisorders:Prevention,Identification,andIntervention

Selectiveliteraturesummary

USA 35

Wilkinsonetal.(2016)

ProtectingFutureChildrenfromin-UteroHarm

Commentary UK 36

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