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Jacobsen B, Lindemann C, Petzina R, Verthein U. The Universal and Primary Prevention of Foetal Alcohol Spectrum Disorders (FASD): A Systematic Review. JOURNAL OF PREVENTION (2022) 2022; 43:297-316. [PMID: 35286547 PMCID: PMC9114092 DOI: 10.1007/s10935-021-00658-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/24/2022]
Abstract
Foetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of 7.7 per 1000 population, FASD is a leading cause of prenatal developmental disorders. The extent of physical, mental, and social consequences for individuals with FASD can be vast and negatively affect their social environment, daily life, school, relationships, and work. As treatment for FASD is labour- and cost-intensive, with no cure available, prevention is key in reducing FASD prevalence rates. As most systematic reviews conducted so far have focused on specific FASD risk groups, we investigated the effectiveness of universal FASD prevention and primary preventive strategies. We identified a total of 567 potentially pertinent records through PubMed, Cochrane Library, EBSCO, PubPsych, and DAHTA published from 2010 to May 2020, of which 10 studies were included in this systematic review. Results showed a substantial heterogeneity in the studies' quality, although all preventive measures, except one, proved effective in both increasing knowledge and awareness of FASD, as well as decreasing the risk of an alcohol exposed pregnancy. Limiting factors such as small sample sizes and a lack of behavioural change testing require further studies to support existing evidence for FASD prevention and its implementation, as well as detecting the best course of action for FASD prevention when creating and implementing prevention and intervention approaches.
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Affiliation(s)
- Britta Jacobsen
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Medical School Hamburg (MSH), University of Applied Sciences and Medical University, Hamburg, Germany
| | - Christina Lindemann
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Medical School Hamburg (MSH), University of Applied Sciences and Medical University, Hamburg, Germany
| | - Rainer Petzina
- Medical School Hamburg (MSH), University of Applied Sciences and Medical University, Hamburg, Germany
| | - Uwe Verthein
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Graves L, Carson G, Poole N, Patel T, Bigalky J, Green CR, Cook JL. Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1158-1173.e1. [PMID: 32900457 DOI: 10.1016/j.jogc.2020.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence. INTENDED USERS Health care providers who care for pregnant women and women of child-bearing age. TARGET POPULATION Pregnant women and women of child-bearing age and their families. EVIDENCE Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus. VALIDATION METHODS The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, COSTS Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Graves DL, Carson DG, Poole N, Patel DT, Bigalky J, Green CR, Cook JL. Directive clinique n o 405 : Dépistage et conseils en matière de consommation d'alcool pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1174-1192.e1. [PMID: 32900458 DOI: 10.1016/j.jogc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIF Établir des normes pancanadiennes fondées sur les meilleures données probantes actuelles sur le dépistage et les conseils en matière de consommation d'alcool et de troubles de consommation d'alcool chez les femmes enceintes ou en âge de procréer. PROFESSIONNELS CONCERNéS: Les fournisseurs de soins qui prodiguent des soins aux femmes enceintes et aux femmes en âge procréer. POPULATION CIBLE Les femmes enceintes, les femmes en âge de procréer et leurs familles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, Embase et CENTRAL avec le thème « alcohol use and pregnancy ». Les résultats ont été filtrés de façon à obtenir des publications parues entre 2010 et septembre 2018. Les termes de recherche ont été mis au point à partir des termes du thésaurus de référence biomédicale MeSH et de mots clés, dont les suivants : pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring et brief intervention. Les données probantes retenues proviennent d'essais cliniques, d'études observationnelles, de revues de la littérature, d'analyses systématiques et méta-analyses, de lignes directrices et de conférences de consensus. MéTHODES DE VALIDATION: Les auteurs ont rédigé et accepté le contenu et les recommandations de la présente directive. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des données probantes a été évaluée au moyen des critères de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation) (consulter les tableaux A1 et A2 de l'annexe en ligne). BéNéFICES, RISQUES, COûTS: La mise en œuvre des recommandations de la présente directive à l'aide d'outils de dépistage validés et de stratégies d'intervention brève peut améliorer la capacité des fournisseurs de soins obstétricaux à reconnaître la consommation d'alcool et la consommation problématique d'alcool chez les femmes enceintes ou en âge de procréer. Il est attendu des fournisseurs de soins de santé qu'ils deviennent confiants et compétents en matière de prise en charge et de soutien de ces femmes afin qu'elles puissent avoir la meilleure santé possible et une issue de grossesse optimale. DÉCLARATIONS SOMMAIRES (CLASSEMENT GRADE ENTRE PARENTHèSES): RECOMMANDATIONS (CLASSEMENT GRADE ENTRE PARENTHèSES).
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Balachova T, Shaboltas A, Nasledov A, Chaffin M, Batluk J, Bohora S, Bonner B, Bryant K, Tsvetkova L, Volkova E. Alcohol and HIV Risk Among Russian Women of Childbearing Age. AIDS Behav 2017; 21:1857-1867. [PMID: 27605367 DOI: 10.1007/s10461-016-1542-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Russia has one of the fastest rising rates of HIV among women in the world. This study sought to identify key factors in HIV transmission among women in Russia. Data were collected as part of a larger clinical trial to prevent alcohol-exposed pregnancies (AEP). Women at risk for an AEP were recruited at women's clinics; 708 women, aged 18-44 (M = 29.04 years), completed HIV risk surveys. Structural Equation Modeling was used to test the relationships between alcohol use and sex behavior constructs with HIV/STI risk. While the model indicated that multiple factors are involved in women's HIV/STI risk, the independent alcohol use variable explains 20 % of the variance in women's HIV/STI risk. The findings suggest that alcohol use directly and indirectly predicts HIV/STI risk among women, and its effect is mediated by alcohol use before sex.
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Affiliation(s)
- Tatiana Balachova
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, 940 N.E. 13th Street, Nicholson Tower, Suite 4900, Oklahoma City, OK, 73104, USA.
| | - Alla Shaboltas
- Psychology Department, St. Petersburg State University, St. Petersburg, Russia
| | - Andrey Nasledov
- Psychology Department, St. Petersburg State University, St. Petersburg, Russia
| | - Mark Chaffin
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, 940 N.E. 13th Street, Nicholson Tower, Suite 4900, Oklahoma City, OK, 73104, USA
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Julia Batluk
- Psychology Department, St. Petersburg State University, St. Petersburg, Russia
| | - Som Bohora
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, 940 N.E. 13th Street, Nicholson Tower, Suite 4900, Oklahoma City, OK, 73104, USA
| | - Barbara Bonner
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, 940 N.E. 13th Street, Nicholson Tower, Suite 4900, Oklahoma City, OK, 73104, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, USA
| | - Larissa Tsvetkova
- Psychology Department, St. Petersburg State University, St. Petersburg, Russia
| | - Elena Volkova
- Psychology Department, St. Petersburg State University, St. Petersburg, Russia
- Nizhny Novgorod State Pedagogical University, Nizhny Novgorod, Russia
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Urban MF, Olivier L, Louw JG, Lombard C, Viljoen DL, Scorgie F, Chersich MF. Changes in drinking patterns during and after pregnancy among mothers of children with fetal alcohol syndrome: A study in three districts of South Africa. Drug Alcohol Depend 2016; 168:13-21. [PMID: 27610936 DOI: 10.1016/j.drugalcdep.2016.08.629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mixed ancestry populations in South Africa have amongst the highest rates of fetal alcohol syndrome (FAS) worldwide. Defining the drinking patterns of women with a FAS child guides FAS preventive interventions. METHODS Data were drawn from FAS prevalence surveys conducted in three districts: Witzenberg (Cape Winelands), Frances Baard (inland mining town) and Saldanha Bay (coastal towns). 156 mothers and 50 proxy informants of school-entry children diagnosed with FAS and partial-FAS were interviewed, and compared with 55 controls recruited in Saldanha Bay. RESULTS Study participants were of low socio-economic status (SES), and a majority of children were either in foster care (12%) or had been cared for by relatives for long periods (44%). Of cases, 123/160 (77%) reported current drinking, similar between sites. During pregnancy, only 35% (49/139) of cases had stopped drinking, varying between sites (from 21% to 54% in chronological order of surveys; p<0.001), while 6% (7/109) increased drinking. Though many women who stopped in pregnancy resumed postpartum, cessation in pregnancy was strongly associated with discontinuation in the long run (OR=3.3; 95%CI=1.2-8.9; p=0.005). At interview, 36% of cases (54/151) and 18% of controls (9/51) were at risk of an alcohol-exposed pregnancy (p=0.02). Median maternal mass of cases was 22kg lower than controls, with 20% being underweight and 14% microcephalic. CONCLUSIONS Increasing rates of drinking cessation during pregnancy over time suggest rising awareness of FAS. Cessation is associated with recidivism after pregnancy but also with reduced long-term drinking. Interventions should target alcohol abstinence in pregnancy, but extend into the puerperium.
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Affiliation(s)
- Michael F Urban
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium.
| | - Leana Olivier
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa; Governor Kremer's Centre, Maastricht University Medical Centre, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands
| | - Jacobus G Louw
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Chanelle Lombard
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Denis L Viljoen
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium
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Hagan JF, Balachova T, Bertrand J, Chasnoff I, Dang E, Fernandez-Baca D, Kable J, Kosofsky B, Senturias YN, Singh N, Sloane M, Weitzman C, Zubler J. Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure. Pediatrics 2016; 138:e20151553. [PMID: 27677572 PMCID: PMC5477054 DOI: 10.1542/peds.2015-1553] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/24/2022] Open
Abstract
Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient.
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Affiliation(s)
- Joseph F Hagan
- University of Vermont College of Medicine, Burlington, Vermont;
| | - Tatiana Balachova
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | - Elizabeth Dang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Natasha Singh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Sloane
- Western Michigan University, Portage, Michigan; and
| | | | - Jennifer Zubler
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Balachova T, Sobell LC, Agrawal S, Isurina G, Tsvetkova L, Volkova E, Bohora S. Evaluating alcohol use among Russian women at risk for an alcohol-exposed pregnancy: A comparison of three measures of alcohol use. J Ethn Subst Abuse 2016; 17:324-334. [PMID: 27436415 DOI: 10.1080/15332640.2016.1201717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Quick Drinking Screen (QDS) and Timeline Followback (TLFB), measures of alcohol use, have yielded similar reports of drinking with English speakers. The present study, a secondary data analysis, compared three measures of alcohol use (i.e., QDS, TLFB, and AUDIT) among Russian-speaking women. This is the first study to compare all three measures. This study replicated the findings of studies with English speakers and demonstrated that brief screening measures (QDS, AUDIT) provide reliable summary measures of alcohol use when compared to a detailed drinking measure (TLFB). The use of brief screening measures is recommended for use with Russian women.
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Affiliation(s)
- Tatiana Balachova
- a University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma
| | | | | | - Galina Isurina
- d St. Petersburg State University , St. Petersburg , Russia
| | | | - Elena Volkova
- d St. Petersburg State University , St. Petersburg , Russia.,e Nizhny Novgorod State Pedagogical University , Nizhny Novgorod , Russia
| | - Som Bohora
- a University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma
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Abstract
Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these, contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health, and current treatments.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA.
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Bax AC, Geurts CD, Balachova TN. Improving Recognition of Children Affected by Prenatal Alcohol Exposure: Detection of Exposure in Pediatric Care. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015; 2:165-174. [PMID: 26317063 PMCID: PMC4547360 DOI: 10.1007/s40474-015-0057-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Early identification of fetal alcohol spectrum disorders (FASDs) is important for providing services and preventing secondary disabilities. Recent studies indicate that many FASDs are undiagnosed, partly because there is a need to improve detection of prenatal alcohol exposure (PAE). The aims of this review are to characterize existing practices for assessing PAE in pediatric care, identify the most efficient, promising methods of detecting PAE, and recognize the knowledge and practice gaps. This review indicates that maternal self-reports remain the most common method utilized in routine clinical practice and highlights promising methods of PAE identification, including a single binge drinking question. The review yields few studies describing existing strategies to assess PAE in pediatric practice and identifies knowledge gaps that need to be addressed for improving recognition of FASDs in pediatric practice.
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Affiliation(s)
- Ami C. Bax
- University of Oklahoma Health Sciences Center, Department
of Pediatrics, Section on Developmental and Behavioral Pediatrics; 1100 N.E.
13 Street, Oklahoma City, OK 73117
| | - Carrie D. Geurts
- University of Oklahoma Health Sciences Center, Department
of Pediatrics, Section on Developmental and Behavioral Pediatrics; 1100 N.E.
13 Street, Oklahoma City, OK 73117
| | - Tatiana N. Balachova
- University of Oklahoma Health Sciences Center, Department
of Pediatrics, Section on Developmental and Behavioral Pediatrics; 1100 N.E.
13 Street, Oklahoma City, OK 73117
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