Twenty years ago, Astley, Bailey, Talbot, and Clarren (2000)  published a study that revealed how common intimate partner violence (IPV) was amongst mothers of children with FASD. The study showed the importance of thinking broadly about the risk factors and influences of FASD and demonstrated that preventing violence against women is also a preventative measure for FASD. Research efforts since Astley et al.’s study in 2000 have continued to show that IPV is an important factor to consider when supporting pregnant women who use alcohol and other substances .
This year, researchers at the Centre of Excellence for Women’s Health (CEWH) have been conducting a rapid review to understand the complex, multi-directional relationship between IPV and substance use during the COVID-19 pandemic and provide available and accessible research evidence to frontline providers . Since the implementation of stay at home orders and social distancing recommendations, use of substances and experiences of IPV have increased. Canadians have reported an 18% increase in alcohol consumption due to the stress, boredom, and lack of a regular schedule brought on by the COVID-19 pandemic. One in 10 Canadian women are concerned for their safety and calls to the Battered Women’s Support Services in Vancouver have tripled, demonstrating an increase in help seeking by women. These findings highlight the importance of understanding how public health policies and recommendations that help curb the spread of COVID-19 can be used by partners who cause harm in coercive and controlling ways.
In our efforts to prevent and reduce substance use during pregnancy, collaboration among service providers in substance use and IPV services is essential. Understanding the interconnectedness of these issues and how they are affected by pandemics and disasters can help us address them collectively. As examples, the Learning Network at the Centre for Research & Education on Violence Against Women & Children  and Calgary Women’s Emergency Shelter  have developed educational materials to help us understand how to support women who are experiencing IPV during the ongoing pandemic. As we deepen our understanding of the risk factors for FASD to include psychosocial factors such as IPV, materials like these can help us incorporate holistic support into service provisions and better support women who are experiencing violence and aggression during the COVID-19 pandemic.
Astley, S. J., Bailey, D., Talbot, C., & Clarren, S. K. (2000). Fetal alcohol syndrome (FAS) primary prevention through fas diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and alcoholism (Oxford, Oxfordshire), 35(5), 509–519. https://doi.org/10.1093/alcalc/35.5.509
How health care providers communicate with women about alcohol use during pregnancy is very important for FASD prevention. The authors of this study evaluated 61 midwives in a southwestern U.S. state to understand how their personal alcohol use compared to their professional recommendations about alcohol consumption during pregnancy. They found that:
All midwives reported that they typically screen a patient for alcohol use during their initial visit
Some midwives reported providing advice that does not align with the current accepted guidelines around alcohol consumption during pregnancy (i.e., that the safest option for women is not to consume alcohol).
8.2% of midwives advised that patients could drink “once in a while”
6.6% of midwives instructed patients to have no more than one drink per day
There was no difference between the responses of certified nurse midwives and certified professional midwives
Key takeaway: Advocating for the health of health care practitioners is very important, as is ensuring appropriate communication to discuss the risks of alcohol use during pregnancy in ways that align with current best-practices, emphasizing that there is no safe amount of alcohol consumption during pregnancy.
Olusanya, O.A., Barry, A. E. (2020). Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State. Journal of Midwifery & Women’s Health. https://doi.org/10.1111/jmwh.13
Researchers conducted an online survey to better understand the measures that are being used by clinicians in Canada to evaluate brain function in individuals assessed for FASD. They found that:
Clinicians reported using 182 unique measures as part of FASD assessments across the country
Almost all of the most frequently reported measures align with the 2015 Canadian Diagnostic Guideline
Several commonly reported measures are not in the guideline but may be useful to include in future iterations of the guideline as assessment and diagnosis continue to evolve
Key takeaway: The findings from this study underscore the importance of establishing and maintaining consistency within and across FASD assessment. Ongoing training for FASD clinicians, and continued evaluation of the current body of research evidence, will help to guide FASD best practice.
Flannigan, K. R., Coons-Harding, K. D., Turner, O., Symes, B. A., Morrison, K., & Burns, C. (2020). A survey of measures used to assess brain function at FASD clinics in Canada. Canadian Psychology/Psychologie canadienne. Advance online publication. https://doi.org/10.1037/cap000024
For individuals with FASD, self-regulation is often a challenge. Targeted interventions can help individuals with FASD learn strategies to self-regulate. Two kinds of strategies that may be helpful for people with FASD are sensory-based strategies (i.e., taste, move, touch, look, listen), aimed at improving emotional state, and non-sensory strategies (i.e., thinking), aimed at self-monitoring arousal levels. Researchers studied the experiences of 23 adolescents with FASD who participated in an intervention program designed to give them the skills and knowledge to improve self-regulation. The researchers found that:
Participants increasingly used the skills they learned in this program in their everyday lives; the majority reported using these skills at school
Overall, the participants were satisfied with the intervention program
96% of participants enjoyed the program
91% of participants reported that the things they learned in the program helped them in their daily lives
Participants reported having increased capacity for their own self-regulation
Overall, the participants gravitated towards sensory strategies first to improve self-regulation
However, 28% chose non-sensory strategies or a combination between the two
When participants are engaged in the process of identifying strategies, they may think beyond program boundaries to find solutions that work for them
Key Takeaway: Adolescents with FASD can learn and apply strategies to help improve their self-regulation. Co-creating strategies, fostering relationships, and individualizing strategies for each individual are key factors in engaging the individual and encouraging the use of these strategies at home and at school.
Aamena Kapasi , Jacqueline Pei , Kathryn Kryska , Vannesa Joly , Kamaldeep Gill , Sandra Thompson-Hodgetts , Kaitlyn McLachlan , Gail Andrew & Carmen Rasmussen (2020): Exploring Self-Regulation Strategy Use in Adolescents with FASD, Journal of Occupational Therapy, Schools, & Early Intervention, DOI: 10.1080/19411243.2020.1822260
Although there are a number of programs in the U.K. to reduce the stress of caregivers in general, there are no programs specifically designed for caregivers of people with FASD. The aim of this study was to understand the stress faced by caregivers of individuals with FASD and to suggest ways that programs can mitigate this stress. The researchers found that:
Caregivers reported clinically significant levels of stress, warranting further professional consultation
High levels of caregiver stress were related to specific challenges in their child’s adaptive functioning, executive functioning, and behaviours
Caregivers need evidence-based interventions focused on helping them to develop skills to manage their child’s functional difficulties in order to reduce stress
Key Takeaway: There is a need to create evidence-based interventions to support caregivers to help reduce the clinically high levels of stress they experience.
Mohamed, A., Carlisle, A.C.S., Livesey, A. C., and Mukherjee, R.A.S. (2020). Carer stress in Fetal Alcohol Spectrum Disorders: the implications of data from the UK national specialist FASD clinic for training carers. Adoption & Fostering. 44(3):242-254.https://doi.org/10.1177/0308575920945112.
This blog is intended to provide a summary of some of the recent literature on FASD. For a more complete and nuanced understanding of these findings, read the full research papers. Please note this is not a comprehensive list of all research published on FASD in September 2020.
This mini-course provides a self-study option for maternal and child health program staff working with pregnant women and their families. It gives a basic overview of the scope and impacts of alcohol and drug use during pregnancy, as a necessary foundation for supporting women and connecting them to prevention, screening, treatment, and recovery resources.
The Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) is a collaborative, interdisciplinary research network, with collaborators, researchers and partners across the nation. It is Canada’s first comprehensive national Fetal Alcohol Spectrum Disorder (FASD) research network.
CanFASD’s unique partnership brings together many scientific viewpoints to address complexities of FASD, with a focus of ensuring that research knowledge is translated to community and policy action. Their mission is to produce and maintain national, collaborative research designed for sharing with all Canadians, leading to prevention strategies and improved support services for people affected by Fetal Alcohol Spectrum Disorder.
Over the past months, CanFASD has created and shared numerous webinars on FASD. Have you seen them all? If not, take a peek!
Over the years, Albertans have gotten the message that smoking or use of alcohol while pregnant or breastfeeding should be avoided. Now the introduction of legal cannabis products requires an equally important message from Alberta Gaming, Liquor & Cannabis (AGLC), the Government of Alberta’s Crown commercial enterprise and agency overseeing cannabis distribution and retail licensing in the province: It’s safest not to use cannabis while pregnant or breastfeeding.
While the risks of smoking any product while pregnant or breastfeeding are broadly understood, the introduction of new products, such as cannabis extracts, edibles or cannabis-infused drinks, has made the case for avoiding the inhalation or ingestion of cannabis products less clear to some.
Although cannabis is a ‘natural’ plant product, it doesn’t make it safe to use while pregnant or breastfeeding. Cannabis use during pregnancy can negatively impact a baby’s health and developing brain.
THC, the psychoactive component of cannabis products, is stored in the same body fat tissues that produce milk and can stay in the mother’s tissue for days or even weeks potentially posing serious health concerns for the baby.
Cannabis is a complex plant, with hundreds of compounds and chemicals that have not been fully studied yet. There have been few complete studies on the use of either THC or cannabidiol (CBD) during pregnancy, let alone the other chemicals and compounds found in cannabis products.
Being aware of the potentially harmful effects of cannabis on pregnancy and a baby’s development is critical. Since research still hasn’t given us all the answers about the effects of THC or CBD on pregnancy and a baby’s development, the safest choice is to avoid using any amount of cannabis while pregnant or breastfeeding.
Here’s what we know now.
Frequent cannabis use during pregnancy is associated with negative outcomes for the baby and an increased risk of early labour. This can result in lower birth weight, breathing difficulties, temperature irregularities, hospitalization and even potential cognitive problems for the baby when compared to the outcome for full-term infants.