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Joyce KM, Davidson M, Manly E, Stewart SH, Al-Hamdani M. A systematic review on the impact of alcohol warning labels. J Addict Dis 2024; 42:170-193. [PMID: 37212771 DOI: 10.1080/10550887.2023.2210020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Findings on the effects of alcohol warning labels (AWLs) as a harm reduction tool have been mixed. This systematic review synthesized extant literature on the impact of AWLs on proxies of alcohol use. PsycINFO, Web of Science, PubMED, and MEDLINE databases and reference lists of eligible articles. Following PRISMA guidelines, 1,589 articles published prior to July 2020 were retrieved via database and 45 were via reference lists (961 following duplicate removal). Article titles and abstracts were screened, leaving the full text of 96 for review. The full-text review identified 77 articles meeting inclusion/exclusion criteria which are included here. Risk of bias among included studies was examined using the Evidence Project risk of bias tool. Findings fell into five categories of alcohol use proxies including knowledge/awareness, perceptions, attention, recall/recognition, attitudes/beliefs, and intentions/behavior. Real-world studies highlighted an increase in AWL awareness, alcohol-related risk perceptions (limited findings), and AWL recall/recognition post-AWL implementation; these findings have decreased over time. Conversely, findings from experimental studies were mixed. AWL content/formatting and participant sociodemographic factors also appear to influence the effectiveness of AWLs. Findings suggest conclusions differ based on the study methodology used, favoring real-world versus experimental studies. Future research should consider AWL content/formatting and participant sociodemographic factors as moderators. AWLs appear to be a promising approach for supporting more informed alcohol consumption and should be considered as one component in a comprehensive alcohol control strategy.
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Affiliation(s)
- Kayla M Joyce
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Myles Davidson
- Department of Psychology at Saint Mary's University, Halifax, Nova Scotia, Canada
| | - Eden Manly
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sherry H Stewart
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
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Zuckermann AME, Morissette K, Boland L, Garcia AJ, Domingo FR, Stockwell T, Hobin E. The effects of alcohol container labels on consumption behaviour, knowledge, and support for labelling: a systematic review. Lancet Public Health 2024; 9:e481-e494. [PMID: 38942559 DOI: 10.1016/s2468-2667(24)00097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/30/2024]
Abstract
Alcohol container labels might reduce population-level alcohol-related harms, but investigations of their effectiveness have varied in approach and quality. A systematic synthesis is needed to adjust for these differences and to yield evidence to inform policy. Our objectives were to establish the effects of alcohol container labels bearing one or more health warnings, standard drink information, or low-risk drinking guidance on alcohol consumption behaviour, knowledge of label message, and support for labels. We completed a systematic review according to Cochrane and synthesis without meta-analysis standards. We included all peer-reviewed studies and grey literature published from Jan 1, 1989, to March 6, 2024, in English, French, German, or Spanish that investigated the effects of alcohol container labels compared with no-label or existing label control groups in any population on alcohol consumption behaviour, knowledge of label message, or support for labels. Data were synthesised narratively as impact statements and assessed for risk of bias and certainty in the evidence. A protocol was preregistered (PROSPERO CRD42020168240). We identified 40 publications that studied 31 labels and generated 17 impact statements. 24 (60%) of 40 publications focused on consumption behaviour and we had low or very low certainty in 13 (59%) of 22 outcomes. Alcohol container labels bearing health warnings might slow the rate of alcohol consumption (low certainty), reduce alcoholic beverage selection (moderate certainty), reduce consumption during pregnancy (low certainty), and reduce consumption before driving (moderate certainty). Interventions with multiple types of rotating alcohol container labels likely substantially decrease alcohol use (moderate certainty) and reduce alcohol sales (high certainty). To the best of our knowledge, this is the first systematic review on multiple types of alcohol container labels assessing their effects for certainty in the evidence. Limitations included heterogeneity in label designs and outcome measurements. Alcohol container labels probably influence some alcohol consumption behaviour, with multiple rotating messages being particularly effective, although effects might vary depending on individual health literacy or drinking behaviour. Alcohol container labels might therefore be effective components of policies designed to address population-level alcohol-related harms.
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Affiliation(s)
- Alexandra M E Zuckermann
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Kate Morissette
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Laura Boland
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | | | - Francesca Reyes Domingo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease, and Injury Prevention, Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Erng MN, Reid N, Moritz KM, van Driel M. Prenatal alcohol exposure risk perception dimensions and influencing factors: A systematic review and conceptual model. Aust N Z J Public Health 2023; 47:100047. [PMID: 37075515 DOI: 10.1016/j.anzjph.2023.100047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/26/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE This paper aims to explore the available literature to understand how risks regarding prenatal alcohol exposure are perceived. METHODS A systematic review (PROSPERO; CRD 42020212887) was undertaken. PubMed, Embase, PsycINFO, and CINAHL were searched for relevant quantitative and qualitative studies. A thematic analysis of the studies was performed. RESULTS Fifteen articles-nine quantitative and six qualitative studies met the inclusion criteria. Three dimensions of risk perceptions were identified-perceived susceptibility, perceived severity, and affective risk perception. Three influencing factors of these dimensions were also identified: information (i.e., consistency, confirmation bias, strength of the evidence, and perceived relevance), sociocultural (i.e., social inclusivity, cultural context, and risk interpretation), and individual (i.e., risks versus benefits, controllability, and experience). These dimensions and influencing factors were brought together to create the proposed novel Pregnancy Alcohol Risk Perception (PARP) conceptual model. CONCLUSIONS The novel PARP conceptual model developed from the current literature provides a framework to guide understanding of risk perceptions, which includes a wide range of potential influencing factors. IMPLICATIONS FOR PUBLIC HEALTH The novel PARP conceptual model provides the groundwork for further refinement with stakeholders, which could in turn be used to inform the design of interventions and health promotional materials to support harm reduction approaches and prevention of prenatal alcohol exposure.
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Affiliation(s)
- May N Erng
- The University of Queensland, Child Health Research Centre, South Brisbane, 4101, Australia.
| | - Natasha Reid
- The University of Queensland, Child Health Research Centre, South Brisbane, 4101, Australia
| | - Karen M Moritz
- The University of Queensland, School of Biomedical Sciences, St Lucia, 4067, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, The University of Queensland, Herston, 4006, Australia
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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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Lacoste-Badie S, Droulers O, Dossou G, Gallopel-Morvan K. Improving the effectiveness of pregnancy warning labels displayed on alcohol containers: a French eye-tracking study. Public Health 2022; 212:22-27. [PMID: 36182747 DOI: 10.1016/j.puhe.2022.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Every year, foetal alcohol spectrum disorders impact 1 in 100 live births in France. France is one of the few countries with mandated labelling that must include a pregnancy warning. However, as the regulation passed with minimal specifications regarding the size and colour of the ensuing pictogram, the current pregnancy warning labels (PWLs) is often barely visible. This study investigated the potential influence of the PWL design on women's attention and alcohol product choice. STUDY DESIGN The study used a within-subject experiment, with participants exposed to four PWL conditions. METHODS An eye-tracking method was adopted. Eye movement was used as a proxy for measuring visual attention. In total, 4752 observations were collected (99 participants × 48 wine bottles) among women of childbearing age. RESULTS The results show that almost none of the participants paid attention to the current French PWL. However, the findings also indicate that a larger colourful PWL, with a combined text and pictogram, attracts far more attention, and that participants chose the bottles of wine displaying this type of PWL less frequently. CONCLUSIONS The study indicates that the current French PWL is insufficient to draw women's attention and suggests improvements to the PWL design to help increase its effectiveness.
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Affiliation(s)
| | - O Droulers
- Univ. Rennes 1, CNRS NeuroLab CREM (UMR 6211), F-35000 Rennes, France.
| | - G Dossou
- Univ. Lille, LUMEN (ULR 4999), F-59000 Lille, France.
| | - K Gallopel-Morvan
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, F-35000 Rennes, France.
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Giesbrecht N, Reisdorfer E, Rios I. Alcohol Health Warning Labels: A Rapid Review with Action Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11676. [PMID: 36141951 PMCID: PMC9517222 DOI: 10.3390/ijerph191811676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
A rapid review of research on health warning labels located on alcohol containers (AWLs) was conducted. Using five search engines (Embase, Medline, Pubmed, Scopus, Psyinfo), 2975 non-duplicate citations were identified between the inception date of the search engine and April 2021. Of those, 382 articles were examined and retrieved. We selected 122 research papers for analysis and narrative information extraction, focusing on population foci, study design, and main outcomes. Research included public opinion studies, surveys of post-AWL implementation, on-line and in-person experiments and real-world quasi-experiments. Many studies focused on the effects of the 1989 United States Alcoholic Beverage Labeling Act on perceptions, intentions and behavior. Others focused on Australia, Canada, the United Kingdom, England or Scotland, Italy and France. There was substantial variation in the design of the studies, ranging from small-scale focus groups to on-line surveys with large samples. Over time, evidence has been emerging on label design components, such as large size, combination of text and image, and specific health messaging, that is likely to have some desired impact on knowledge, awareness of risk and even the drinking behavior of those who see the AWLs. This body of evidence provides guidance to policy-makers, and national and regional authorities, and recommendations are offered for discussion and consideration.
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Affiliation(s)
- Norman Giesbrecht
- Centre for Addiction and Mental Health, 33 Ursulla Franklin St., Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada
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Millot A, Serra M, Gallopel-Morvan K. How the alcohol industry fought against pregnancy warning labels in France. A press coverage analysis spanning 20 years. Front Public Health 2022; 10:933164. [PMID: 36091564 PMCID: PMC9458884 DOI: 10.3389/fpubh.2022.933164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023] Open
Abstract
Background Drinking alcohol while pregnant is dangerous for health. To inform on this issue, various countries have adopted pregnancy warning labels on alcoholic beverages, including France since 2007, where wine holds deep cultural consonance. The aim of this research was to analyze the arguments put forward by the alcohol industry (producers, distributors, wholesalers, allied industries, trade associations, social aspects and public relations organizations, councilors who publicly defend wine-sector interests) via the press in France: (1) in 2007 when pregnancy warnings were first implemented, and (2) in 2018 when larger pregnancy warnings to increase visibility were proposed but not adopted. Methods We used documentary method to analyze the arguments advanced by the alcohol industry in mainstream (national, regional and specialized) press in France from 2000 to 2020, using the Europresse documentary database. Quantitative analysis (number and trend curve of articles, mapping alcohol-industry actors who spoke in the press) and inductive thematic content analysis (analytical framework of the arguments identified) using NVivo software were carried out. Results We found a total of 559 relevant press articles in the database, of which 85 were included in the analysis. Peaks in number of publications were found to coincide with the warning label implementation and with the expansion-project schedule. A large majority of the arguments promoted by the alcohol industry contested the pregnancy warnings measure (very few were in favor). They argued that (1) pregnancy warnings were a questionable measure (e.g., ineffective, or the pictogram clearly links alcohol to mortality), (2) pregnancy warnings would have counterproductive effects (on women and the wider economy), (3) better alternatives exist (e.g., targeted prevention programs, prevention by health professionals). A large majority of the actors who spoke in the press came from the winegrowing sector. Conclusion This study fills a gap in the Anglosphere research on lobbying against alcohol warnings by analyzing lobbyists' arguments over a 20-year period covering both failed and successful industry lobbying. New findings have emerged that are likely related to the wine-oriented culture of France. In order to counter the alcohol lobbying practices we conclude with a number of public health recommendations.
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Affiliation(s)
- Ana Millot
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes, France,*Correspondence: Ana Millot
| | | | - Karine Gallopel-Morvan
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes, France
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Vera BDV, Bonino PM, Arguinzoniz SL, Nocetti G, Salvia N, Martínez Villarreal D, Gigena-Parker D. Consumo de alcohol en mujeres embarazadas y lactantes: factores de riesgo y protección asociados. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n2.94850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Examinar la ocurrencia del consumo de alcohol en mujeres embarazadas o en periodo de lactancia de la provincia de Córdoba (Argentina) y los factores de riesgo/protección que explican ese consumo.
Metodología Participaron 475 mujeres (202 embarazadas y 273 lactantes) entre 18-47 años que completaron una encuesta en línea, que indagó sobre su consumo de alcohol y una serie de factores de riesgo y protección para el consumo de alcohol.
Resultados El 93,1% y 68,1% de las mujeres embarazadas y lactantes indicaron que no consumían alcohol en su condición. Se observó un perfil más riesgoso en mujeres lactantes. En embarazadas, solo la percepción de riesgo permitió explicar su consumo. En lactantes, la percepción de riesgo, el consumo de convivientes, la indicación de no beber en su condición por parte de familiares/amistades y la aprobación del consumo de alcohol en otras mujeres lactantes permitieron explicar su consumo.
Discusión Estos resultados ponen en evidencia la necesidad de brindar información clara y precisa sobre los riesgos asociados al consumo de alcohol durante el embarazo y, especialmente, la lactancia y la necesidad de incorporar cuatro actores sociales en las campañas preventivas: los profesionales de la salud, los/las convivientes, la familia y las amistades de la mujer gestante/lactante.
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Popova S, Dozet D, Akhand Laboni S, Brower K, Temple V. Why do women consume alcohol during pregnancy or while breastfeeding? Drug Alcohol Rev 2021; 41:759-777. [PMID: 34963039 PMCID: PMC9305227 DOI: 10.1111/dar.13425] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Issue Alcohol consumption during pregnancy and breastfeeding cause adverse health outcomes to the mother and child, including Fetal Alcohol Spectrum Disorder (FASD). Approach Systematic literature review and thematic synthesis. Original studies that contained reasons for alcohol consumption in pregnancy and while breastfeeding were included. The Mixed Methods Appraisal Tool (MMAT) and the Confidence in the Evidence of Reviews of Qualitative Research (CerQUAL) approach were utilised. The review protocol is available on PROSPERO (registration number: CRD42018116998). Key Findings Forty‐two eligible studies comprising women from 16 countries were included. Most commonly reported reasons of alcohol use in pregnancy were societal pressure and the belief that only “strong” alcohol and alcohol in large quantities is harmful. Other reasons were: a lack of awareness of adverse effects on the fetus; coping with adverse life experiences; consumption based on intuitive decision‐making and influenced by personal/peer experiences; belief in the beneficial properties of alcohol; advice from medical practitioners; unwanted or unplanned pregnancy; alcohol dependence; and consumption as a cultural/traditional custom. Reasons for alcohol use during breastfeeding included the belief that alcohol stimulates breast milk production, unclear advice from medical practitioners, unawareness of the risks of infant exposure and to improve mood and celebrate events. Implications Understanding the context of reasons for alcohol use in pregnancy is crucial for implementing prenatal health education, and preventing FASD and other adverse maternal and child health outcomes. Conclusion Individual beliefs, knowledge/advice, culture and personal circumstances influence alcohol use in pregnancy. Data are limited for reasons surrounding alcohol use while breastfeeding.
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Affiliation(s)
- Svetlana Popova
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Danijela Dozet
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shahela Akhand Laboni
- Center for Clinical and Translational Science, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Krista Brower
- Edmonton Oliver Primary Care Network, Edmonton, Alberta, Canada.,Department of Educational Research, Lancaster University, Lancaster, UK
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Kokole D, Anderson P, Jané-Llopis E. Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review. Nutrients 2021; 13:3065. [PMID: 34578942 PMCID: PMC8469468 DOI: 10.3390/nu13093065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/16/2023] Open
Abstract
Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- ESADE Business School, University Ramon Llull, Avenida de Pedralbes, 60-62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
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„Pft … dann wechsle ich eben den Frauenarzt“. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1190-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Oei JL. Alcohol use in pregnancy and its impact on the mother and child. Addiction 2020; 115:2148-2163. [PMID: 32149441 DOI: 10.1111/add.15036] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/23/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
AIMS To review the impact of prenatal alcohol exposure on the outcomes of the mother and child. DESIGN Narrative review. SETTING Review of literature. PARTICIPANTS Mothers and infants affected by prenatal alcohol use. MEASUREMENTS Outcomes of mothers and children. FINDINGS Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol-related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol-exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS). CONCLUSION The impact of FASD and FAS is enduring and life-long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.
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Affiliation(s)
- Ju Lee Oei
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.,Department of Newborn Care, the Royal Hospital for Women, Randwick, NSW, Australia.,Drug and Alcohol Services, Murrumbidgee Local Health District, NSW, Australia
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Influences on drinking choices among Indigenous and non-Indigenous pregnant women in Australia: A qualitative study. PLoS One 2020; 15:e0224719. [PMID: 32352991 PMCID: PMC7192424 DOI: 10.1371/journal.pone.0224719] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/13/2020] [Indexed: 12/24/2022] Open
Abstract
Despite women’s awareness that drinking alcohol in pregnancy can lead to lifelong disabilities in a child, it appears that an awareness alone does not discourage some pregnant women from drinking. To explore influences on pregnant women’s choices around alcohol use, we conducted interviews and group discussions with 14 Indigenous Australian and 14 non-Indigenous pregnant women attending antenatal care in a range of socioeconomic settings. Inductive content analysis identified five main influences on pregnant women’s alcohol use: the level and detail of women’s understanding of harm; women’s information sources on alcohol use in pregnancy; how this information influenced their choices; how women conceptualised their pregnancy; and whether the social and cultural environment supported abstinence. Results provide insight into how Indigenous Australian and non-Indigenous pregnant women understand and conceptualise the harms from drinking alcohol when making drinking choices, including how their social and cultural environments impact their ability to abstain. Strategies for behaviour change need to: correct misinformation about supposed ‘safe’ timing, quantity and types of alcohol; develop a more accurate perception of Fetal Alcohol Spectrum Disorder; reframe messages about harm to messages about optimising the child’s health and cognitive outcomes; and develop a holistic approach encompassing women’s social and cultural context.
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Understanding the Relationship between Predictors of Alcohol Consumption in Pregnancy: Towards Effective Prevention of FASD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041388. [PMID: 32098098 PMCID: PMC7068254 DOI: 10.3390/ijerph17041388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 01/14/2023]
Abstract
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.
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[Evaluation and impact of "pregnancy" pharmaceutical pictograms among 281 women]. Therapie 2019; 75:449-458. [PMID: 31831186 DOI: 10.1016/j.therap.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/08/2019] [Accepted: 11/19/2019] [Indexed: 11/22/2022]
Abstract
In France, since 2017 new pharmaceutical pictograms appeared on drugs with a potentieal risk during pregnancy. This apposition, left to the discretion of marketing authorization holders, has uncertain consequences for women's reactions to them. The present survey is the first one interested in the opinion of the women concerned (pregnant or of childbearing age) as well as on the interpretation that they make of it. The survey answers enhanced that the pregnancy pictogram is an initiative welcomed by women who estimate that it secures drug intake. However, we demonstrate a poor understanding of the message conveyed by these pictograms (more than 50 % think they concern breastfeeding and more than 10 % fertility) and inappropriate behavior towards them (more than 80 of women pregnant stopped or decreased their medication immediately, without medical advice). The survey also highlights the need for information of women concerned by these pictograms and the limited information given by health professionals on this subject. It seems urgent to revise the law, to limite the use of these pictograms that appear to be too broad, incoherent and sometimes unjustified. In addition, public information seems an essential issue when focusing on these new pharmaceutical pictograms.
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Corrales-Gutierrez I, Mendoza R, Gomez-Baya D, Leon-Larios F. Pregnant Women's Risk Perception of the Teratogenic Effects of Alcohol Consumption in Pregnancy. J Clin Med 2019; 8:E907. [PMID: 31242606 PMCID: PMC6617049 DOI: 10.3390/jcm8060907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Isabel Corrales-Gutierrez
- Foetal Medicine Unit, University Hospital Virgen Macarena, 41009 Seville, Spain.
- Department of Surgery, University of Seville, 41009 Seville, Spain.
| | - Ramon Mendoza
- Department of Social, Developmental and Educational Psychology, University of Huelva, 21007 Huelva, Spain.
- Research Group on Health Promotion and Development of Lifestyle across the Life Span, University of Huelva, 21007 Huelva, Spain.
- Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO), University of Huelva, 21007 Huelva, Spain.
| | - Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, University of Huelva, 21007 Huelva, Spain.
- Research Group on Health Promotion and Development of Lifestyle across the Life Span, University of Huelva, 21007 Huelva, Spain.
| | - Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain.
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