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Wolfson L, Poole N. Supportive alcohol policy as a key element of fetal alcohol spectrum disorder prevention. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231151838. [PMID: 36718116 PMCID: PMC9893348 DOI: 10.1177/17455057231151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In Canada, a Four-Part Model of Fetal Alcohol Spectrum Disorder (FASD) Prevention has been developed that describes a continuum of multi-sectoral efforts, including broad awareness campaigns, safe and respectful conversations around pregnancy and alcohol use, and holistic and wraparound support services for pregnant and postpartum women with alcohol, and other health and social concerns. Supportive alcohol policy is at the centre of the four mutually reinforcing levels of prevention. The purpose of this narrative review is to describe alcohol policies related to specific levels of FASD prevention, and to consider the implications of alcohol policies on FASD prevention and women's and fetal health. The majority of the evidence focused on alcohol in pregnancy guidelines, alcohol warning labels, and knowledge and uptake of national or regional alcohol and pregnancy guidelines. Several US studies described shifts in alcohol and pregnancy policy over the 7-year period, including moves to punitive approaches that criminalize women's substance use or prompt child apprehension. This review indicates that more attention could be paid to the role of alcohol policy in FASD prevention and in promoting women's and fetal health, and that policy actions and advocacy could be important catalysts for both FASD prevention and women's health promotion. Moving forward, it is essential that alcohol policies are rooted in evidence; attend to and promote women's health including health during pregnancy; and are collaborative in order to prompt a higher standard of care, and more holistically respond to the factors that contribute to women's alcohol use during pregnancy.
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Affiliation(s)
- Lindsay Wolfson
- Centre of Excellence for Women’s Health, Vancouver, BC, Canada,Canada FASD Research Network, Vancouver, BC, Canada,Lindsay Wolfson, Centre of Excellence for Women’s Health, E209-4500 Oak Street Box 48, Vancouver, BC V6H 3N1, Canada.
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC, Canada,Canada FASD Research Network, Vancouver, BC, Canada
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Ortega-García JA, Sánchez-Sauco MF, Zafra-Rodríguez JA, Cabrera-Rivera LT, Díaz-Martínez F, Llegus-Santiago EM, Delgado-Marín JL, Orenes-Piñero E, Kloosterman N, Bach A, Ojeda-Sánchez C, Ramis R. Subjective well-being, happiness, and environmental health factors related to women planning a pregnancy or pregnant, using mobile health intervention. Digit Health 2023; 9:20552076231177146. [PMID: 37284011 PMCID: PMC10240876 DOI: 10.1177/20552076231177146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives To compare the environmental health results in women trying to get pregnant or pregnant using a mobile health application (Green Page) through healthcare professionals or self-completed by women, and to explore the relationship between the subjective well-being of these women with their lifestyles and environmental factors. Methods A descriptive study with mixed methods was conducted in 2018. A mobile health survey was used in two phases. Phase 1 was a cross-sectional study through professionals (n = 1100) followed by phase 2, a convenience sampling through women's self-reporting (n = 3425). A personalized report was downloadable with health recommendations for the well-being of the mother and child. Results Of the 3205 participants (mean age = 33 years, SD = 0.2 years), 1840 were planning a pregnancy and 1365 were pregnant. One in five pregnant women had a low level of happiness. Globally, subjective well-being and happiness were found to be negatively associated with lack of contact with nature, sedentary lifestyle, excess weight, environmental exposure, and older age in pregnancy. Precisely 45%, 60%, and 14% of women were exposed to tobacco, alcohol, and illegal drugs, respectively. The women self-reported levels of risk factors higher than when the tool was used by or through professionals. Conclusions The use of mobile health interventions focused on environmental health during planning or pregnancy periods could help improve the quality of healthcare and foster greater involvement of women in their self-care process, thus promoting empowerment, healthier environments, and lifestyles. Ensuring equity of access and data protection are global challenges to be addressed.
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Affiliation(s)
- Juan Antonio Ortega-García
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Pediatric Environmental Health Speciality Unit (PEHSU), Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, El Palmar, Murcia, Spain
| | - Miguel Felipe Sánchez-Sauco
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Pediatric Environmental Health Speciality Unit (PEHSU), Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, El Palmar, Murcia, Spain
| | - José Alberto Zafra-Rodríguez
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- TICARUM, University of Murcia, Murcia, Spain
| | - Laura Teresa Cabrera-Rivera
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Department of Environmental Health, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
- International Exchange Program for Minority Student, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Francisco Díaz-Martínez
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Pediatric Environmental Health Speciality Unit (PEHSU), Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, El Palmar, Murcia, Spain
| | - Eduardo Manuel Llegus-Santiago
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Department of Environmental Health, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
- International Exchange Program for Minority Student, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Juan Luis Delgado-Marín
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen Arrixaca, Fetal Medicine Unit Murcia, IMIB Arrixaca, Región de Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Departament of Biochemistry and Molecular Biology, University of Murcia, Murcia, Spain
| | - Nicole Kloosterman
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- MUSC Health University Medical Center, Charleston, SC, USA
| | - Albert Bach
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Environment and Human Health Laboratory (EH2 Lab), Forest Science and Technology Center of Catalonia, Solsona, Spain
| | - Carlos Ojeda-Sánchez
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Department of Preventive Medicine, Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Rebecca Ramis
- Department of Pediatrics, Global Alliance to Renaturalize Child and Adolescent Health (GreenRooting.org), Spanish Association of Pediatrics, IMIB Arrixaca, University of Murcia, Murcia, Spain
- Cancer and Environmental Epidemiology Unit, National Epidemiology Centre, Carlos III Health Institute and Centre for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública−CIBERESP), Madrid, Spain
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Flannigan K, Pei J, McLachlan K, Harding K, Mela M, Cook J, Badry D, McFarlane A. Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder. Front Psychol 2022; 12:778471. [PMID: 35145454 PMCID: PMC8821085 DOI: 10.3389/fpsyg.2021.778471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- *Correspondence: Katherine Flannigan,
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn McLachlan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Kelly Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Audrey McFarlane
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
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Kar P, Tomfohr-Madsen L, Giesbrecht G, Bagshawe M, Lebel C. Alcohol and substance use in pregnancy during the COVID-19 pandemic. Drug Alcohol Depend 2021; 225:108760. [PMID: 34102507 PMCID: PMC9758579 DOI: 10.1016/j.drugalcdep.2021.108760] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on alcohol and substance use has been a topic of concern. Pregnant women are currently experiencing elevated anxiety and depression symptoms, which may increase risk of substance use, and potentially result in poor perinatal and neurodevelopmental outcomes for children. METHODS Survey results were analyzed from an ongoing study of 7470 pregnant individuals in Canada: Pregnancy during the COVID-19 Pandemic. Participants were asked about current use of alcohol and substances, symptoms of depression and anxiety, and COVID-19 concerns: how much they worry about COVID-19 threatening their baby's life, threatening their own life, care for themselves or the baby, feelings of social isolation, and financial difficulties. RESULTS The percentage of participants who reported use during pregnancy was 6.7 % for alcohol, 4.3 % for cannabis, 4.9 % for tobacco, and 0.3 % for illicit drugs; 2.6 % were using multiple substances. Higher depression symptoms and financial difficulties were associated with more cannabis and/or tobacco use as well as the co-use of substances. There were no associations between alcohol use and mental health or COVID-19 concerns. CONCLUSIONS Self-reported rates of use and co-use were lower or comparable to previous research, perhaps reflecting pandemic-related circumstances or the demographics of this sample. Depression symptoms and pandemic-related financial difficulties were associated with more tobacco use, cannabis use, and substance co-use. It remains important to maintain access to perinatal, mental health, and financial supports during the pandemic to mitigate prenatal alcohol and substance use and prevent poor perinatal and long-term neurodevelopmental outcomes for children.
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Affiliation(s)
- Preeti Kar
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Canada
| | - Lianne Tomfohr-Madsen
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Department of Psychology, University of Calgary, Canada,Department of Pediatrics, University of Calgary, Canada
| | - Gerald Giesbrecht
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Department of Psychology, University of Calgary, Canada,Department of Pediatrics, University of Calgary, Canada
| | - Mercedes Bagshawe
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Canada,Department of Radiology, University of Calgary, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada.
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Rockliffe L, Peters S, Heazell AEP, Smith DM. Factors influencing health behaviour change during pregnancy: a systematic review and meta-synthesis. Health Psychol Rev 2021; 15:613-632. [PMID: 34092185 DOI: 10.1080/17437199.2021.1938632] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pregnancy is an opportune time for women to make healthy changes to their lifestyle, however, many women struggle to do so. Multiple reasons have been posited as to why this may be. This review aimed to synthesise this literature by identifying factors that influence women's health behaviour during pregnancy, specifically in relation to dietary behaviour, physical activity, smoking, and alcohol use. Bibliographic databases (MEDLINE, PsycINFO, CINAHL-P, MIDIRS) were systematically searched to retrieve studies reporting qualitative data regarding women's experiences or perceptions of pregnancy-related behaviour change relating to the four key behaviours. Based on the eligibility criteria, 30,852 records were identified and 92 studies were included. Study quality was assessed using the CASP tool and data were thematically synthesised. Three overarching themes were generated from the data. These were (1) A time to think about 'me', (2) Adopting the 'good mother' role, and (3) Beyond mother and baby. These findings provide an improved understanding of the various internal and external factors influencing women's health behaviour during the antenatal period. This knowledge provides the foundations from which future pregnancy-specific theories of behaviour change can be developed and highlights the importance of taking a holistic approach to maternal behaviour change in clinical practice.
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Affiliation(s)
- Lauren Rockliffe
- Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Debbie M Smith
- Manchester Centre for Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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