Health advice on alcohol consumption in pregnant women in Seville (Spain)

Scoping review on the role of the family doctor in the prevention and care of patients with foetal alcohol spectrum disorder

BACKGROUND

Foetal alcohol spectrum disorder (FASD) is the leading preventable cause of nongenetic mental disability. Given the patient care pathway, the General Practitioner (GP) is in the front line of prevention and identification of FASD. Acknowledging the importance of the prevalence of FASD, general practitioners are in the front line both for the detection and diagnosis of FASD and for the message of prevention to women of childbearing age as well as for the follow-up.

OBJECTIVES

The main objective of the scoping review was to propose a reference for interventions that can be implemented by a GP with women of childbearing age, their partners and patients with FASD. The final aim of this review is to contribute to the improvement of knowledge and quality of care of patients with FASD.

METHODS

A scoping review was performed using databases of peer-reviewed articles following PRISMA guidelines. The search strategy was based on the selection and consultation of articles on five digital resources. The advanced search of these publications was established using the keywords for different variations of FASD: "fetal alcohol syndrome," "fetal alcohol spectrum disorder," "general medicine," "primary care," "primary care"; searched in French and English.

RESULTS

Twenty-three articles meeting the search criteria were selected. The interventions of GPs in the management of patients with FASD are multiple: prevention, identification, diagnosis, follow-up, education, and the role of coordinator for patients, their families, and pregnant women and their partners. FASD seems still underdiagnosed.

CONCLUSION

The interventions of GPs in the management of patients with FASD are comprehensive: prevention, identification, diagnosis, follow-up, education, and the role of coordinator for patients, their families, and pregnant women and their partners. Prevention interventions would decrease the incidence of FASD, thereby reducing the incidence of mental retardation, developmental delays, and social, educational and legal issues. A further study with a cluster randomized trial with a group of primary care practitioners trained in screening for alcohol use during pregnancy would be useful to measure the impact of training on the alcohol use of women of childbearing age and on the clinical status of their children.

Rethinking Local Economic Development for Fetal Alcohol Spectrum Disorder in Renosterberg Local Municipality, South Africa

Two towns in Renosterberg Local Municipality (RLM) in the Northern Cape Province of South Africa, Petrusville and Philipstown, have high Fetal Alcohol Spectrum Disorder (FASD) prevalence rates. FASD is linked to poverty and imposes high national economic costs. Thus, it is critical to understand the local economic development (LED) strategies used to mitigate the high prevalence of FASD. Moreover, there is sparse literature examining adult communities where FASD children reside. Understanding these adult communities is important because FASD cannot exist without adult gestational exposure to alcohol consumption. Using a mixed-method approach, this study uses a six-phase analytic approach to investigate the drinking culture and drinking motives in RLM, applied to two cross-sectional in-depth community needs assessments, five in-depth interviews, and three focus groups. This study also evaluates how the RLM targets FASD, as well as binge and risky drinking, in its municipal economic strategy by analysing its Integrated Development Plan (IDP) with respect to an eight-stage policy development process. The results indicate that 57% of respondents expressed concern regarding the unhealthy drinking culture in RLM, 40% felt that the residents of RLM drank in response to unemployment-related hopelessness, and 52% attributed the drinking culture to a lack of hobbies and recreational opportunities. The results of an analysis of the RLM IDP through the lens of Ryder's eight-stage policy development process suggest that the decisive policy development process is not open to the public and that, furthermore, FASD is neglected. A dedicated alcohol consumption census-style study is recommended to broadly capture alcohol consumption in RLM, allowing researchers to identify the exact alcohol consumption patterns and priority areas for the IDP and public health policy. RLM should directly publicise its policy development process so that its IDP is inclusively formulated to address FASD, risky drinking, binge drinking, and gestational alcohol consumption.

Nutritionists' Practices and Knowledge about the Risks of Alcohol Consumption during Pregnancy: An Israeli Survey

Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities and the leading preventable cause of developmental disabilities. Antenatal care providers may influence pregnant women’s dietary practices and their awareness of the risks of alcohol consumption during pregnancy. This study aimed to assess nutritionists’ self-reported knowledge about the risks of drinking alcohol during pregnancy, professional practices in this respect, and self-perceived competence to assess and guide women about alcohol consumption during pregnancy in Israel. A sample of 526 professional nutritionists completed an anonymous online questionnaire. Results showed significant differences between the nutritionists’ knowledge and professional practices scores. About 349 (66.3%) of the sample agreed (to any degree) that they did not have enough knowledge to guide pregnant women regarding drinking alcohol. The number of years of experience, combined with self-perceived competence and the mean knowledge score, explained 18% of the variance in professional practices. Nutritionists and other health professionals may have a crucial role in preventing FASD and should prioritize appropriate screening for prenatal alcohol use. Eliminating alcohol consumption at any point in pregnancy would reduce the risk for FASDs.

Relationship between Eating Habits, Physical Activity and Tobacco and Alcohol Use in Pregnant Women: Sociodemographic Inequalities

Pregnant women must maintain or acquire healthy habits during pregnancy to protect both their own health and their child's. Such habits include an adequate eating pattern along with good adherence to the intake of certain supplements, practice of moderate physical activity and avoiding the consumption of toxic products such as tobacco and alcohol. The objective of this study is to assess the interrelation between such habits and their association with sociodemographic variables. To such end, a cross-sectional study was conducted with a representative sample of pregnant women who attended the scheduled morphology echography consultation at the 20th gestational week in their reference public hospital in the city of Seville (Spain). Results: Younger pregnant women and with lower educational levels are the ones that present the worst eating habits and the highest smoking rate. Pregnant women with lower educational levels are the least active. Non-smoking pregnant women present better eating habits than those who smoke. Pregnant women with lower educational levels are those who accumulate more unhealthy habits during pregnancy. This should be taken into account when planning the health care provided to pregnant women and in public health intersectoral policies.

Pregnant women's alcohol consumption and knowledge about its risks: An Israeli survey

BACKGROUND

Alcohol consumption is found in a significant proportion of women during their pregnancies. The only study on the prevalence of alcohol consumption during pregnancy in Israel was conducted over a decade ago. Thus, our study aimed to assess alcohol consumption before and during pregnancy, associations with demographic characteristics, knowledge of possible risks of prenatal alcohol exposure, and relations among such knowledge, sociodemographic characteristics, and drinking habits.

METHODS

A convenience sample of 802 pregnant Israeli women completed an anonymous online questionnaire regarding their alcohol consumption during pregnancy, recommendations received, and knowledge of possible risks.

RESULTS

Of the sample, 539 (67.2 %) women self-reported drinking alcohol in the 2 months prior to learning they were pregnant, and 96 (12 %) during their pregnancy. Twice as many (28.1 %) reported knowing other women who had consumed alcohol during pregnancy. Women with higher education, in their first pregnancies, ethnically Jewish, and secular reported the highest pre-pregnancy rates of alcohol consumption. About 40 % reported receiving no education about the dangers of alcohol consumption during pregnancy.

CONCLUSIONS

A concerning percentage of pregnant women in Israel acknowledge drinking alcohol near and after conception. Although most participants reported discontinuing use after realizing they were pregnant, a worrying percentage continued consumption with little knowledge of the dangers. Actual rates may be higher. Information about risks of prenatal alcohol exposure is not widely disseminated, emphasizing the need to increase public awareness.

Understanding the Relationship between Predictors of Alcohol Consumption in Pregnancy: Towards Effective Prevention of FASD

BACKGROUND

Prenatal alcohol exposure can produce serious changes in neurodevelopment that last a lifetime, as well as a wide range of congenital abnormalities, and is the main non-hereditary, avoidable cause of intellectual disability in developed countries. It is therefore crucial to understand the determinants of alcohol consumption during pregnancy. This study is aimed at determining the factors that predict it, as well as the interactions between them.

METHODS

A cross-sectional study was carried out using a random sample of 426 pregnant women being treated at the outpatient clinic of a public university hospital in Seville (Spain), when they were in their twentieth week of pregnancy. A custom-designed questionnaire was used for data collection and applied in the course of an interview administered by trained health professionals. The data collected were analyzed using hierarchical regression, moderation analysis, and a structural equations model.

RESULTS

Alcohol consumption prior to pregnancy proved to be the most powerful predictor of alcohol intake during pregnancy. Other particularly significant predictors were the percentage of professionals who gave correct advice to the expectant mother-not to consume any alcohol during pregnancy-and perception of the risk from drinking wine during pregnancy. The number of pregnancies correlates positively with alcohol intake during pregnancy, while the expectant mother's level of education correlates negatively.

CONCLUSIONS

Identifying these predictive factors will allow the design of more effective fetal alcohol spectrum disorder (FASD) prevention strategies.

Pregnant Women's Risk Perception of the Teratogenic Effects of Alcohol Consumption in Pregnancy

There is ample evidence of the teratogenic effects of prenatal alcohol exposure, with long-term consequences throughout the entire life cycle. Nevertheless, research on risk perception of alcohol consumption among pregnant women is scarce. In order to analyze risk perception of alcohol consumption during pregnancy, a cross-sectional study was conducted with a random sample of 426 pregnant women (in their 20th week of gestation) receiving care at the outpatient clinics of a public university hospital in the southern European city of Seville (Spain). Data were collected through structured face-to-face interviews conducted by trained health professionals using a customized questionnaire. Data analysis included structural equation modeling. Only 48.1% of the sample indicated that the sequelae from alcohol consumption during pregnancy were life-long. The structural equation model showed that a lower risk perception about beer and wine consumption, and a lower educational level, were related to more frequent alcohol consumption. Younger participants showed lower risk perception concerning beer consumption. Higher levels of education were related to a greater risk perception of beer. Healthcare institutions should articulate programs that facilitate health advice regarding alcohol consumption during pregnancy, particularly when providing care for women with low educational levels.