Alcohol Use and Pregnancy

Prevention Efforts Must… … move the focus from women’s alcohol use to an increased understanding of related health and social problems that contribute to FASD.

Determinants of Health Income and social status Social support networks Education Employment and working conditions Social environments Physical environment Gender Culture Personal health practices and coping skills Healthy child development Health services Biology and genetic endowment

Our responsibility is to … … provide a network of supports that directly address these contributing factors

Key Messages Drinking alcohol during pregnancy can cause birth defects There are no known safe limits It is best to plan ahead and to stop drinking before you get pregnant It is never too late to stop drinking

Don’t Forget …. Emphasize the importance of the health of both the woman and the fetus/child Be sensitive to physical/sexual trauma (past and present) Address family issues and offer support to family members, whenever possible

Alcohol Risk Assessment No risk Low Risk Moderate Risk High Risk Problems have not developed Problems have developed Risk Reduction Early Intervention Treatment/ Intervention Health Enhancement Risk Avoidance 70% of women who drink will avoid alcohol during their pregnancy if they understand it will cause damage to the developing fetus 20% of women will require support of their partner, family and friends to avoid alcohol 10% of women will require specific intervention to reduce and/or eliminate alcohol (harm reduction)

Screening Tools Brief alcohol screening questionnaires developed to detect periconception risk-drinking associated with adverse pregnancy outcomes (defined as two or more drinks per day) Tools assess alcohol intake indirectly by asking about tolerance to alcohol’s effects, i.e., psychological consequences and significant other’s concerns

T-ACE How many drinks does it take to make you feel high? (Score 2 for 3 or more drinks) Have people annoyed you by criticizing your drinking? (Score 1 for yes) Have you ever felt you ought to cut down your drinking? (Score 1 for yes) Have you ever had a drink in the morning to steady your nerves or get rid of a hang over? (Score 1 for yes) Score of 2 or more = high risk, 0 or 1 = low risk

TWEAC Tolerance (number of drinks) Worry about drinking (has anyone worried about your drinking in the past year?) Eye-openers Amnesia (blackouts) Cut down on alcohol

Stages of Change (Prochaska, DiClemente 1984) Pre-contemplation Contemplation Preparation Action Maintenance Relapse

Stages of Change: Pre-contemplation Characteristics: Not thinking about their drinking Not currently considering change Interventions Validate lack of readiness Clarify the decision is theirs Encourage re-evaluation of current behaviour Encourage sel-exploration, not action Explain and personalize the risk

Stages of Change: Contemplation Characteristics: Thinking about quitting but not ready to quit May feel ambivalent about change Interventions Validate lack of readiness Clarify: the decision is theirs Encourage evaluation of pros and cons of behaviour change Identify and promote new, positive outcome expectations

Stages of Change: Preparation Characteristics: Getting ready to quit The decision to quit is made and steps are taken to get ready Interventions Help select best action/approach to change, reduce barriers, strengthen self-efficacy Help identify social support Verify that she has underlying skills for behaviour change Encourage initial steps

Stages of Change: Action Characteristics: Quitting or actively trying to quit Using several techniques to quit High risk to relapse Interventions Bolster self-efficacy for dealing with obstacles Acknowledge and find support in learning cessation techniques and planning small achievable goals Help overcome feelings of loss and reiterate long-term benefits

Stages of Change: Maintenance Characteristics: Remaining alcohol-free Learned to anticipate and handle temptation Able to use new ways of coping Interventions Plan for follow-up support for lifestyle changes Help identify and use relapse prevention strategies Affirm her resolve and self-efficacy Reinforce internal rewards Discuss coping with relapse

Stages of Change: Relapse Characteristics: Resumption of old behaviour Normal occurrence Interventions Evaluate trigger for relapse Reassess motivation and barriers Plan stronger coping strategies Help resume process of change

Fathers-to-be Clarify that their drinking cannot cause FASD, but can lead to infertility and less viable sperm Important role in supporting partner through pregnancy Their behavior can help a partner stop drinking

Things to Keep in Mind There are no known safe limits and no safe time to drink during pregnancy Raise awareness without raising panic Information is not enough Promote the benefits of a planned pregnancy Working on prevention can raise community interest in support for those with FASD

Resources Keys to a Successful Alcohol and Pregnancy Campaign, index.html index.html Alberta Alcohol and Drug Abuse Commission

Resources “Father Involvement and FASD: Developing Best Practices,” Rutman, D., Callahan, M., Lundquist, A., Jackson, S., Field, B. Substance Use and Pregnancy: Conceiving Women in the Policy- Making Process. Status of Women, Canada, August British Columbia Reproductive Care Program. BCRCP Guidelines for Alcohol Use in the Perinatal Period and Fetal Alcohol Spectrum Disorder Leslie, M., Reynolds, W. The Smart Guide: Motivational Approaches Within the Stages of Change for Pregnant Women Who Use Alcohol: A Training Manual for Service Providers, March 2002

Thank you!