1. FASEout Project 2006 www.faseout.ca Alcohol Use and Pregnancy

2. FASEout Project 2006 www.faseout.ca Age & Drinking During Pregnancy Age

3. FASEout Project 2006 www.faseout.ca Awareness in Canada Health Canada Study released January 2000 Health Canada Study released January 2000 High level of knowledge re: alcohol use in pregnancy can lead to life long problems (89%) High level of knowledge re: alcohol use in pregnancy can lead to life long problems (89%) Most women said they would stop or cut back if pregnant (73%), only 4% said they would not change Most women said they would stop or cut back if pregnant (73%), only 4% said they would not change Confusion on when to stop drinking, safe drinking levels and characteristics of Confusion on when to stop drinking, safe drinking levels and characteristics of FASD FASD

4. FASEout Project 2006 www.faseout.ca Adolescent Girls and Young Women: Alcohol Use and Pregnancy Survey found 22% of girls in grade 10, 12% in grade 8, and 2% in grade 6 reported drinking an alcoholic beverage once a week or more Survey found 22% of girls in grade 10, 12% in grade 8, and 2% in grade 6 reported drinking an alcoholic beverage once a week or more Research indicates that girls out of the mainstream have higher rates of alcohol use and riskier patterns of use Research indicates that girls out of the mainstream have higher rates of alcohol use and riskier patterns of use

5. FASEout Project 2006 www.faseout.ca Adolescent Girls and Young Women: Alcohol Use and Pregnancy Studies have shown that young people are more likely to engage in sex without the use of contraception when they are drinking Studies have shown that young people are more likely to engage in sex without the use of contraception when they are drinking Some indication that young women identify their pregnancy later in term than older women Some indication that young women identify their pregnancy later in term than older women

6. FASEout Project 2006 www.faseout.ca Why do some women use alcohol while pregnant? Many women don’t plan to get pregnant Many women don’t plan to get pregnant Some women are unaware of, misinformed, about the consequences of alcohol’s effect on the developing fetus Some women are unaware of, misinformed, about the consequences of alcohol’s effect on the developing fetus Most will want to reduce or stop alcohol use when they find out they are pregnant Most will want to reduce or stop alcohol use when they find out they are pregnant Women who are addicted may not be able to stop drinking Women who are addicted may not be able to stop drinking

7. FASEout Project 2006 www.faseout.ca Those Who Keep Drinking Addiction Addiction Social acceptance Social acceptance Family/peer/professional pressure Family/peer/professional pressure Cope with painful feelings or stressful events Cope with painful feelings or stressful events Self medicate a mental health condition Self medicate a mental health condition

8. FASEout Project 2006 www.faseout.ca Barriers to Seeking Support Denial of drinking problem Denial of drinking problem Guilt and shame Guilt and shame Fear of losing children Fear of losing children Childcare, finances, loss of home Childcare, finances, loss of home Opposition from family & friends Opposition from family & friends Stigma associated with alcohol use during pregnancy and FASD Stigma associated with alcohol use during pregnancy and FASD

9. FASEout Project 2006 www.faseout.ca 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.

10. FASEout Project 2006 www.faseout.ca Determinants of Health Income and social status Income and social status Social support networks Social support networks Education Education Employment and working conditions Employment and working conditions Social environments Social environments Physical environment Physical environment Gender Gender Culture Culture Personal health practices and coping skills Personal health practices and coping skills Healthy child development Healthy child development Health services Health services Biology and genetic endowment Biology and genetic endowment

11. FASEout Project 2006 www.faseout.ca Our responsibility is to … … provide a network of supports that directly address these contributing factors

12. FASEout Project 2006 www.faseout.ca Key Messages Drinking alcohol during pregnancy can cause birth defects Drinking alcohol during pregnancy can cause birth defects There are no known safe limits There are no known safe limits It is best to plan ahead and to stop drinking before you get pregnant It is best to plan ahead and to stop drinking before you get pregnant It is never too late to stop drinking It is never too late to stop drinking

13. FASEout Project 2006 www.faseout.ca Don’t Forget …. Emphasize the importance of the health of both the woman and the fetus/child Emphasize the importance of the health of both the woman and the fetus/child Be sensitive to physical/sexual trauma (past and present) Be sensitive to physical/sexual trauma (past and present) Address family issues and offer support to family members, whenever possible Address family issues and offer support to family members, whenever possible

14. FASEout Project 2006 www.faseout.ca 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)

15. FASEout Project 2006 www.faseout.ca 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) 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 Tools assess alcohol intake indirectly by asking about tolerance to alcohol’s effects, i.e., psychological consequences and significant other’s concerns

16. FASEout Project 2006 www.faseout.ca T-ACE How many drinks does it take to make you feel high? (Score 2 for 3 or more drinks) 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 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 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) 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 Score of 2 or more = high risk, 0 or 1 = low risk

17. FASEout Project 2006 www.faseout.ca TWEAK Tolerance (number of drinks) Tolerance (number of drinks) Worry about drinking (has anyone worried about your drinking in the past year?) Worry about drinking (has anyone worried about your drinking in the past year?) Eye-openers Eye-openers Amnesia (blackouts) Amnesia (blackouts) Cut down on alcohol Cut down on alcohol

18. FASEout Project 2006 www.faseout.ca Stages of Change Pre-contemplation – not thinking about quitting Pre-contemplation – not thinking about quitting Contemplation – thinking about quitting Contemplation – thinking about quitting Preparation – getting ready to quit Preparation – getting ready to quit Action – process of quitting Action – process of quitting Maintenance – staying substance free Maintenance – staying substance free

19. FASEout Project 2006 www.faseout.ca Increasing Awareness Provide information Provide information Marriage preparation classes Marriage preparation classes Preconception classes Preconception classes Pregnancy support programs Pregnancy support programs Keep up-to-date on information Keep up-to-date on information Make referrals to well informed resources Make referrals to well informed resources Ask what would be helpful Ask what would be helpful

20. FASEout Project 2006 www.faseout.ca Fathers-to-be Clarify that their drinking cannot cause FASD, but can lead to infertility and less viable sperm Clarify that their drinking cannot cause FASD, but can lead to infertility and less viable sperm Important role in supporting partner through pregnancy Important role in supporting partner through pregnancy Their behavior can help a partner Their behavior can help a partner stop drinking stop drinking

21. FASEout Project 2006 www.faseout.ca Things to Keep in Mind There are no known safe limits and no safe time to drink during pregnancy There are no known safe limits and no safe time to drink during pregnancy Raise awareness without raising panic Raise awareness without raising panic Information is not enough Information is not enough Promote the benefits of a planned pregnancy Promote the benefits of a planned pregnancy Working on prevention can raise community interest in support for those with FASD Working on prevention can raise community interest in support for those with FASD

22. FASEout Project 2006 www.faseout.ca Resources Keys to a Successful Alcohol and Pregnancy Campaign, www.beststart.org/resources/alc_reduct ion/index.html Keys to a Successful Alcohol and Pregnancy Campaign, www.beststart.org/resources/alc_reduct ion/index.html www.beststart.org/resources/alc_reduct ion/index.html www.beststart.org/resources/alc_reduct ion/index.html Alberta Alcohol and Drug Abuse Commission Alberta Alcohol and Drug Abuse Commission www.aadac.com www.aadac.com

23. FASEout Project 2006 www.faseout.ca Resources Robin.Gearing@utoronto.ca “Father Involvement and FASD: Developing Best Practices,” 2005. Robin.Gearing@utoronto.ca “Father Involvement and FASD: Developing Best Practices,” 2005. Robin.Gearing@utoronto.ca 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 2000. 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 2000. British Columbia Reproductive Care Program. BCRCP Guidelines for Alcohol Use in the Perinatal Period and Fetal Alcohol Spectrum Disorder. 2005. www.rcp.gov.bc.ca British Columbia Reproductive Care Program. BCRCP Guidelines for Alcohol Use in the Perinatal Period and Fetal Alcohol Spectrum Disorder. 2005. www.rcp.gov.bc.ca 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 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