Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention

Roozen, Sylvia; Black, Diane; Peters, Gjalt-Jorn; Kok, Gerjo; Townend, David; Nijhuis, Jan G.; Koek, Ger H.; Curfs, Leopold

doi:10.1007/s40474-016-0101-y

Cited by 30 publications

(20 citation statements)

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“…In light of this, we may need to reframe discussions around harm prevention or whether there is a potentially ‘safe’ threshold, to messages about the importance of alcohol abstinence in optimising health and cognitive outcomes for the unborn child. At the population level, FASD-specific mass media campaigns, based on proven behaviour change principles and with messages which combine threat (addressing perceived susceptibility and severity) and self-efficacy (promoting confidence in ability to abstain) have been shown to be effective in the past [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Pregnant women’s understanding and conceptualisations of the harms from drinking alcohol: a qualitative study

Gibson

Nagle

Paul

et al. 2019

Preprint

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20Background: Despite women's awareness that drinking alcohol in pregnancy can lead to lifelong 21 disabilities in a child, it appears that an awareness alone does not discourage some pregnant women 22 from drinking. 23Objectives: To explore influences on pregnant women's decision making around alcohol use in a 24 population with frequent and heavy peer drinking (i.e. in two Indigenous Australian communities) 25 and another of non-Indigenous pregnant women attending antenatal care in a range of 26 socioeconomic settings. 27Methods: Individual and group discussions were held with both Indigenous Australian and non-28 Indigenous pregnant women attending a variety of antenatal care models, including two Indigenous 29 maternity services in Australia. Data were analysed using inductive content analysis. 30 Results: A total of 14 Indigenous Australian and 14 non-Indigenous pregnant women participated 31 in this study. Analysis identified five main influences on pregnant women's alcohol use: the level 32 and detail of women's understanding of harm; women's information sources on alcohol use in 33 pregnancy; how this information influenced their choices; how women conceptualised their 34 pregnancy; and whether the social and cultural environment supported abstinence. 35 Conclusions for practice: This study provides insight into how Indigenous Australian and non-36 Indigenous pregnant women understand and conceptualise the harms from drinking alcohol, 37 including how their social and cultural environments impact their ability to abstain. Strategies for 38 behaviour change need to: correct misinformation about supposed 'safe' timing, quantity and types 39 of alcohol; develop a more accurate perception of Fetal Alcohol Spectrum Disorder; reframe 40 messages about harm to messages about optimising the child's health and cognitive outcomes; and 41 develop a holistic approach encompassing women's social and cultural context.42 Page 3 43 Introduction 44 Current research suggests that alcohol use in pregnancy continues to be prevalent despite antenatal 45 guidelines advising against drinking. The 2009 Australian National Guidelines to Reduce Health 46Risks from Drinking Alcohol recommend that it is safest for women to abstain from drinking 47 alcohol completely throughout the duration of their pregnancy [1]. However, data from two large 48 national surveys of Australian women aged 18 to 45 years found that 34 to 49% of women 49 consumed alcohol in pregnancy [2, 3], and that despite women's awareness that drinking alcohol in 50 pregnancy can lead to lifelong disabilities in a child, nearly one third intended to drink alcohol in a 51 future pregnancy [2]. Whilst knowledge of the potential harms of alcohol consumption during 52 pregnancy is important, it is apparent that an awareness alone does not discourage some women 53 from drinking when pregnant. The relatively high prevalence of alcohol consumption during 54 pregnancy has also been reported in other high-income countries. An international cross-cohort 55 comparison of the...

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Section: Discussionmentioning

confidence: 99%

Pregnant women’s understanding and conceptualisations of the harms from drinking alcohol: a qualitative study

Gibson

Nagle

Paul

et al. 2019

Preprint

View full text Add to dashboard Cite

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“…Similarly, further study of approaches combining strategies at both the individual and community levels is important. Future work could incorporate some, or all, of these elements in addressing the behavioural and environmental factors that lead to PAE, whilst ensuring that each component is founded on sound theoretical models of health behaviour [ 66 , 67 ]. Lessons can be learnt from smoking intervention research where the use of such models has provided direction for successful program design and consequent behaviour change [ 67 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is concerning that none of the studies identified in this review adequately evaluated prevention efforts. FASD prevention in Indigenous communities could benefit from systematic approaches to program design, implementation, and evaluation [ 67 ]. High quality intervention trials with rigorous evaluation methods need to be conducted before any conclusions can be drawn about how best to prevent FASD.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities

et al. 2018

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BackgroundFetal alcohol spectrum disorder (FASD) is a preventable, lifelong neurodevelopmental disorder caused by prenatal alcohol exposure. FASD negatively impacts individual Indigenous communities around the world. Although many prevention interventions have been developed and implemented, they have not been adequately evaluated. This systematic review updates the evidence for the effectiveness of FASD prevention interventions in Indigenous/Aboriginal populations internationally, and in specific populations in North America and New Zealand, and offers recommendations for future work.MethodThe MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO, SocINDEX, and Informit databases were searched from inception to 22/08/2017 for all prevention and intervention papers published in peer-reviewed scientific journals, with results, targeting prenatal alcohol exposure and FASD in Indigenous populations. This review was limited to studies published in English and excluded interventions focusing on the workforce. All steps were completed independently by two reviewers with discrepancies resolved via consensus with the senior author.ResultsThere was significant heterogeneity in the ten included studies. Populations targeted included non-pregnant women of child-bearing age, pregnant women, school children and the general public. Study designs included one randomised controlled trial, five cohort studies with pre-post design, one cross-sectional study with different pre- and post-intervention groups, and four studies collected post-intervention data. Studies assessed changes in knowledge, and/or changes in risk for prenatal alcohol exposure including self-reported alcohol consumption, use of birth control or a combination of both. One study was conducted in Australia and nine in the US. The methodological quality of all studies was rated as ‘Poor’ using the systematic review assessment tools developed by The National Heart, Lung and Blood Institute. Studies were subject to substantial bias due to issues such as high loss to follow-up, lack of control groups and the reliance on self-report measures to assess the main outcome.ConclusionOverall, there is little evidence that previous interventions aiming to reduce the risk of prenatal alcohol exposure or FASD in Indigenous populations have been effective. Future intervention studies should address the cultural factors and historical context that are fundamental to successful work with Indigenous populations, and be designed, implemented and evaluated using rigorous methods.This systematic review was registered with PROSPERO, CRD42018086212.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6139-5) contains supplementary material, which is available to authorized users.

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“…Active case ascertainment (ACA) in schools has successfully determined the prevalence and characteristics of FASD in communities in South Africa, Italy, and Croatia (May et al, 2000, 2006, 2007, 2011, 2013, 2016a, 2016b, 2017; Petkovic and Barisic, 2010, 2013; Urban et al, 2008, 2015; Viljoen et al, 2002, 2005). ACA is also a robust method for linking maternal characteristics to child outcomes (May and Gossage, 2001; Roozen et al, 2016a, 2018; Stratton et al, 1996). In ACA studies, physical examinations and neurobehavioral testing are provided to children to determine their characteristic traits (Adnams et al, 2001; Aragon et al, 2008; Kalberg et al, 2013; Kodituwakku et al, 2006), and mothers are interviewed about alcohol use and other health‐related behavior during the index pregnancy (Ceccanti et al, 2014; May et al, 2005, 2008, 2010, 2013; Viljoen et al, 2002).…”

Section: Active Case Ascertainmentmentioning

confidence: 99%

Fetal Alcohol Spectrum Disorders in a Midwestern City: Child Characteristics, Maternal Risk Traits, and Prevalence

May

Hasken²,

Baete

et al. 2020

Alcoholism Clin & Exp Res

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Objective: To determine the characteristics of children with fetal alcohol spectrum disorders (FASD) and their mothers in a Midwestern city.Methods: Case-control samples were drawn from 2 separate first-grade cohorts (combined N = 4,047) in every city school using different methods. In Cohort Sample 1, all consented small children (≤25th centile on height, weight, and/or head circumference) entered the study along with a random sample from all enrolled students. Cohort Sample 2 was drawn totally at random. Child growth, dysmorphology, and neurobehavior were assessed using the Collaboration on FASD Prevalence (CoFASP) criteria, and mothers were interviewed.Results: For the samples combined, 891 children received dysmorphology examinations, and 692 were case-conferenced for final diagnosis. Forty-four children met criteria for FASD. Total dysmorphology scores differentiated diagnostic groups: fetal alcohol syndrome (FAS), 16.7; partial FAS, 11.8; alcohol-related neurodevelopmental disorder (ARND), 6.1; and typically developing controls, 4.2. Neurobehavioral tests distinguished children with FASD from controls, more for behavioral problems than cognitive delay. Children with ARND demonstrated the poorest neurobehavioral indicators. An adjusted regression model of usual prepregnancy drinking indicated that maternal reports of 3 drinks per drinking day (DDD) were significantly associated with a FASD diagnosis (p = 0.020, OR = 10.1, 95% CI = 1.44 to 70.54), as were 5 or more DDD (p < 0.001, OR = 26.47, 95% CI = 4.65 to 150.62). Other significant maternal risk factors included the following: self-reported drinking in any trimester; smoking and cocaine use during pregnancy; later pregnancy recognition and later and less prenatal care; lower maternal weight, body mass index (BMI), and head circumference; and unmarried status. There was no significant difference in FASD prevalence by race, Hispanic ethnicity, or socioeconomic status at this site, where the prevalence of FASD was 14.4 to 41.2 per 1,000 (1.4 to 4.1%).Conclusion: This city displayed the lowest prevalence of FASD of the 4 CoFASP sites. Nevertheless, FASD were common, and affected children demonstrated a common, recognizable, and measurable array of traits.

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Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention

Cited by 30 publications

References 31 publications

Pregnant women’s understanding and conceptualisations of the harms from drinking alcohol: a qualitative study

Pregnant women’s understanding and conceptualisations of the harms from drinking alcohol: a qualitative study

A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities

Fetal Alcohol Spectrum Disorders in a Midwestern City: Child Characteristics, Maternal Risk Traits, and Prevalence

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