At a Juncture: Exploring Patterns and Trends in FASD Prevention Research from 2015 – 2021 Using the Four-Part Model of Prevention
Main Article Content
Background and Objective: FASD prevention efforts have been expanded in the last 25 years to go beyond the moral panic that guided early public awareness campaigns and policy responses. In Canada, a Four-Part Model of FASD Prevention has been developed and used that describes a continuum of multi-sectoral efforts for women, girls, children, and their support networks, 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. The purpose of this article is to describe the state of the evidence on FASD prevention from 2015 – 2021, including the prevalence and influences on alcohol use during pregnancy, interventions at each of the four levels of the Four-Part Model, as well as systemic, destigmatizing, and ethical considerations.
Materials and Methods: Using EBSCO Host, seven academic databases were annually searched for articles related to FASD prevention from 2015 – 2021. English language articles were screened for relevance to alcohol use in pregnancy and FASD prevention. Using outlined procedures for thematic analysis, the findings were categorized within the following key themes: prevalence and influences on women’s drinking; Level 1 prevention; Level 2 prevention; Level 3 prevention; Level 4 prevention; and systemic, destigmatizing, and ethical considerations.
Results: From January 2015 – December 2020 n = 532 articles were identified that addressed the prevalence and influences on alcohol use during pregnancy, interventions at each of the four levels, and systemic, destigmatizing, and ethical considerations. The most recent research on FASD prevention published in English was generated in the United States (US; n = 216, 40.6%), Canada (n = 91, 17.1%), the United Kingdom (UK; n = 60, 11.3%), and Australia (n = 58, 10.9%). However, there was an increase in studies published from other countries over the last six years. The literature heavily focused on prevalence and influences on alcohol use during pregnancy (n = 182, 34.2%), with an increase of prevalence research from countries outside of Canada, the US, Australia, and the UK, and on Level 2 prevention efforts (n = 174, 32.7%), specifically around the efficacy and implementation of brief interventions. Across Level 1 and Level 2 prevention efforts, there was an increase in literature published on the role of technology in supporting health promotion, education, screening, and brief interventions. Attention to Levels 3 and 4 demonstrated nuanced multi-service, trauma-informed, relational, and holistic approaches to supporting women and their children. However, efforts are needed to address stigma, which acted as a systemic barrier to care across each level of prevention.
Conclusion: Research and practice on FASD prevention has continued to expand. Through our generated deductive themes, this review synthesized the findings and demonstrated how the work on FASD prevention has been amplified in recent years and how efforts to support women and children’s health are complex and interconnected. The findings highlight opportunities for prevention through research and evidence-informed policy and practice.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Racine E, Bell E, Zizzo N, et al. Public discourse on the biology of alcohol addiction: Implications for stigma, self-control, essentialism, and coercive policies in pregnancy. Neuroethics 2015;8(2):177–186. https://doi.org/10.1007/s12152-014-9228-x
3. Aspler J, Bogossian A, Racine E. “It’s ignorant stereotypes”: Key stakeholder perspectives on stereotypes associated with fetal alcohol spectrum disorder, alcohol, and pregnancy. J Intellect Dev Disabil 2022;47(1):53–64. https://doi.org/10.3109/13668250.2020.1865649
4. Poole N. Fetal Alcohol Spectrum Disorder (FASD) Prevention:Canadian Perspectives. 2008, Public Health Agency of Canada:Ottawa, ON.
5. Reid N. Fetal alcohol spectrum disorder in Australia: What is the current state of affairs? Drug Alcohol Rev 2018;37(7):827–830. https://doi.org/10.1111/dar.12855
6. Poole N, Schmidt RA, Green C, et al. Prevention of Fetal Alcohol Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps. Substance Abuse: Research and Treatment 2016; 2016(1):1–11. https://doi.org/10.4137/SART.S34545
7. Giglia RC, Reibel T. Has a national policy guideline influenced the practice of raising the topic of alcohol and breastfeeding by maternal healthcare practitioners? Aust J Prim Health 2019;25(3):275–280. https://doi.org/10.1071/PY18103
8. Stockwell T, Wettlaufer A, Vallance K, et al. Strategies to Reduce Alcohol-Related Harms and Costs in Canada: A Review of Provincial and Territorial Policies. 2019, Canadian Institute for Substance Use Research, University of Victoria:Victoria, BC.
9. May PA, Miller JH, Goodhart KA, et al. Enhanced case management to prevent fetal alcohol spectrum disorders in Northern Plains communities. Matern Child Health Journ 2008; 12(6):747–759. https://doi.org/10.1007/s10995-007-0304-2
10. Pei J, Carlson E, Tremblay M, et al. Exploring the contributions and suitability of relational and community‐centered fetal alcohol spectrum disorder (FASD) prevention work in First Nation communities. Birth Defects Res 2019; 111(12):835–847. https://doi.org/10.1002/bdr2.1480
11. Shaw MR, Grant T, Barbosa-Leiker C, et al. Intervention with substance-abusing mothers: Are there rural-urban differences? Am J Addict 2015;24(2):144–152 9p. https://doi.org/10.1111/ajad.12155
12. Schmidt R, Poole N. FASD Prevention: An Annotated Bibliography of Articles Published in 2015. 2016, BC Centre of Excellence for Women’s Health. p. 46.
13. Schmidt R, Poole N, Talbot C, et al. FASD Prevention: An Annotated Bibliography of Articles Published in 2016. 2017, Centre of Excellence for Women’s Health & CanFASD Research Network. p. 45.
14. Schmidt R, Harding K, Talbot C, et al. FASD Prevention: An Annotated Bibliography of Articles Published in 2017. 2018, Centre of Excellence for Women’s Health & CanFASD Research Network. p. 60.
15. Schmidt R, Poole N, Harding K, et al. FASD Prevention: An Annotated Bibliography of Articles Published in 2018. 2019, Centre of Excellence for Women’s Health & CanFASD Research Network. p. 32.
16. Schmidt R, Poole N, Harding K, et al. FASD Prevention: An Annotated Bibliography of Articles Published in 2019. 2020, Centre of Excellence for Women’s Health & CanFASD Research Network. p. 38.
17. Wolfson L, Poole N, Harding K, et al. FASD Prevention: An Annotated Bibliography of Articles Published in 2020. 2021, Centre of Excellence for Women’s Health & CanFASD Research Network.
18. Braun V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa
19. Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 2005;10(1):6–20. https://doi.org/10.1258/1355819054308576
20. English L, Mugyenyi GR, Ngonzi J, et al. Prevalence of Ethanol Use Among Pregnant Women in Southwestern Uganda. J Obstet Gynaecol Can 2015;37(10):901–902. https://doi.org/10.1016/S1701-2163(16)30027-5
21. Lamy S, Houivet E, Marret S et al. Risk factors associated to tobacco and alcohol use in a large french cohort of pregnant women. Arch Womens Ment Health 2018;22(2):267–277. https://doi.org/10.1007/s00737-018-0892-4
22. Petersen-Williams P, Mathews C, Jordaan E et al. Predictors of Alcohol Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa. Subst Use Misuse 2017;1–11. https://doi.org/10.1080/10826084.2017.1408654
23. Addila EA, Bisetegn TA, Gete YK et al., Alcohol consumption and its associated factors among pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis' as given in the submission system. Subst Abuse Treat Prev Policy 2020;15(1):29. https://doi.org/10.1186/s13011-020-00269-3
24. Ishitsuka K, Hanada-Yamamoto K, Mezawa H, et al. Determinants of Alcohol Consumption in Women Before and After Awareness of Conception. Matern Child Health J 2020;24(2):165–176. https://doi.org/10.1007/s10995-019-02840-2
25. Popova S, Lange S, Probst C, et al. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health 2017;5(3):e290–e299. https://doi.org/10.1016/S2214-109X(17)30021-9
26. Mårdby AC, Lupattelli A, Hensing G, et al. Consumption of alcohol during pregnancy-A multinational European study. Women Birth 2017. https://doi.org/10.1016/j.wombi.2017.01.0032
27. Lange S, Probst C, Heer N, et al. Actual and predicted prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean: systematic literature review and meta-analysis. Pan Am J Public Health 2017;41:e89–e89. https://doi.org/10.26633/RPSP.2017.89
28. Lange S, Probst C, Rehm J, et al. Prevalence of binge drinking during pregnancy by country and World Health Organization region: Systematic review and meta-analysis. Reprod Toxicol 2017;73:214–221. https://doi.org/10.1016/j.reprotox.2017.08.004
29. Romero‐Rodríguez E, Cuevas L, Simón L, et al. Changes in Alcohol Intake During Pregnancy in Spain, 1980 to 2014. Alcohol Clin Exp Res 2019;43(11):2367–2373. https://doi.org/10.1111/acer.14193
30. Blaauw Isaksen A, Østbye T, Theophil Mmbaga B, et al. Alcohol consumption among pregnant women in Northern Tanzania 2000-2010: a registry-based study. BMC Pregnancy Childbirth 2015;15(1):1–10. https://doi.org/10.1186/s12884-015-0630-0
31. Abernethy C, McCall KE, Cooper G, et al. Determining the pattern and prevalence of alcohol consumption in pregnancy by measuring biomarkers in meconium. Arch Dis Child Fetal Neonatal Ed 2018;103(3):F216–F220. https://doi.org/10.1136/archdischild-2016-311686
32. Symon A. Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study. Acta Obstet et Gynecol Scand 2017;96(1):53–60. https://doi.org/10.1111/aogs.13050
33. Ramos AM, Marceau K, Neiderhiser JM, et al. Maternal consistency in recalling prenatal experiences at 6 months and 8 years postnatal. J Dev Behav Pediatr 2020;41:698–705. https://doi.org/10.1097/DBP.0000000000000841
34. Fortin M, Muckle G, Jacobson SW, et al. Alcohol use among Inuit pregnant women: Validity of alcohol ascertainment measures over time. Neurotoxicol Teratol 2017;64:73–78. https://doi.org/10.1016/j.ntt.2017.10.007
35. McCormack C, Hutchinson D, Burns L, et al. Prenatal Alcohol Consumption Between Conception and Recognition of Pregnancy. Alcohol Clin Exp Res 2017;41(2):369–378. https://doi.org/10.1111/acer.13305
36. Balachova T, Bard D, Bonner B, et al. Do attitudes and knowledge predict at-risk drinking among Russian women? Am J Drug Alcohol Abuse 2016;42(3):306–315. https://doi.org/10.3109/00952990.2016.1141914
37. Fletcher OV, May PA, Seedat S, et al. Attitudes toward alcohol use during pregnancy among women recruited from alcohol-serving venues in Cape Town, South Africa: A mixed-methods study. Soc Sci Med 2018;215:98–106. https://doi.org/10.1016/j.socscimed.2018.09.008
38. Bitew MS, Zewde M F, Wubetu M, Alemu AA. Consumption of alcohol and binge drinking among pregnant women in Addis Ababa, Ethiopia: Prevalence and determinant factors. PLoS ONE 2020; 15(12). https://doi.org/10.1371/journal.pone.0243784
39. Brittain K, Remien RH, Phillips T, et al. Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. Drug Alcohol Depend 2017;173:69–77. https://doi.org/10.1016/j.drugalcdep.2016.12.017
40. Onah MN, Field S, van Heyningen T, et al. Predictors of alcohol and other drug use among pregnant women in a peri-urban South African setting. Int J Mental Health Syst 2016;10. https://doi.org/10.1186/s13033-016-0070-x
41. Popova S, Lange S, Temple V, et al. Profile of Mothers of Children with Fetal Alcohol Spectrum Disorder: A Population-Based Study in Canada. Int J Environ Res Public Health 2020;17(21). https://doi.org/10.3390/ijerph17217986
42. Latuskie KA, Andrews NCZ, Motz M, et al. Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study. Women Birth 2018. https://doi.org/10.1016/j.wombi.2018.04.001
43. Currie CL, Sanders JL, Swanepoel LM, Davies CM. Maternal adverse childhood experiences are associated with binge drinking during pregnancy in a dose-dependent pattern: Findings from the All Our Families cohort. Child Abuse Negl 2020;101. https://doi.org/10.1016/j.chiabu.2019.104348
44. Racine N, McDonald S, Chaput K, et al. Maternal substance use in pregnancy: Differential prediction by childhood adversity subtypes. Prev Med 2020;141. https://doi.org/10.1016/j.ypmed.2020.106303
45. Shahram SZ, Bottorff JL, Kurtz DLM, et al. Understanding the life histories of pregnant-involved young aboriginal women with substance use experiences in three Canadian cities. Qual Health Res 2017;27(2):249–259. https://doi.org/10.1177/1049732316657812
46. Gonzales KL, Jacob MM, Mercier A, et al. An indigenous framework of the cycle of fetal alcohol spectrum disorder risk and prevention across the generations: Historical trauma, harm and healing. Ethn Health 2018. https://doi.org/10.1080/13557858.2018.1495320
47. Shahram SZ, Bottorff JL, Oelke ND, et al. The cedar project: using indigenous-specific determinants of health to predict substance use among young pregnant-involved aboriginal women. BMC Women's Health 2017;17:1–13. https://doi.org/10.1186/s12905-017-0464-1
48. Shrestha U, Weber TL, Hanson JD. “But Problems Dwell so the Urge Is Constant…” Qualitative Data Analysis of the OST CHOICES Program. Alcohol Clin Exp Res 2018; 42(9):1807–1814. https://doi.org/10.1111/acer.13968
49. Deutsch AR. The Importance of Intimate Partner Violence in Within‐Relationship and Between‐Person Risk for Alcohol‐Exposed Pregnancy. Alcohol Clin Exp Res 2019; 43(4):679–689. https://doi.org/10.1111/acer.13968
50. Tesfaye G, Demlew D, G/tsadik, M, et al. The prevalence and associated factors of alcohol use among pregnant women attending antenatal care at public hospitals Addis Ababa, Ethiopia, 2019, BMC Psychiatry;2020:20(1):337. https://doi.org/10.1186/s12888-020-02747-1
51. Kelly JF, Ward CL. Women who drank while pregnant: The importance of social context in the lives of South African pregnant women. Drugs: Educ Prev Policy;2017:1-8. https://doi.org/10.1080/09687637.2017.1316703
52. Mpelo M, Kibusi SM, Moshi F, et al. Prevalence and Factors Influencing Alcohol Use in Pregnancy among Women Attending Antenatal Care in Dodoma Region, Tanzania: A Cross-Sectional Study. Journal of Pregnancy 2018;2018:1-7. https://doi.org/10.1155/2018/8580318
53. Kitsantas P¸ Gaffney KF, Wu H. Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women. J Perinat Medicine 2015;43(1):43–52 10p.
54. Dunney C, Muldoon K, Murphy DJ. Alcohol consumption in pregnancy and its implications for breastfeeding. Br Midwifery 2015;23(2):126–134. https://doi.org/10.12968/bjom.2015.23.2.126
55. Ortega-Garcia JA, López-Hernández FA, Azurmendi Funes, M.L., et al., My partner and my neighbourhood: The built environment and social networks' impact on alcohol consumption during early pregnancy. Health Place 2020;61. https://doi.org/10.1016/j.healthplace.2019.102239
56. Watt MH, Eaton LA, Dennis AC, et al. Alcohol use during pregnancy in a South African community: Reconciling knowledge, norms, and personal experience. Matern Child Health J, 2015. https://doi.org/10.1007/s10995-015-1800-4
57. Brown QL, Hasin DS, Keyes KM, et al. Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age. Drug Alcohol Depend 2016;166:116–124. https://doi.org/10.1016/j.drugalcdep.2016.07.001
58. Tran NT, Najman JM, Hayatbakhsh R. Predictors of maternal drinking trajectories before and after pregnancy: evidence from a longitudinal study. Aust N Z J Obstet Gynaecol 2015;55(2):123–130. https://doi.org/10.1111/ajo.12294
59. CanFASD (Canada FASD Research Network). What do we mean by Level 1 Prevention? N.D.; Available from: https://canfasd.ca/topics/prevention/#Level1.
60. Bell E, Zizzo N, Racine E. Caution! Warning Labels About Alcohol and Pregnancy: Unintended Consequences and Questionable Effectiveness. Am J of Bioeth 2015;15(3):18–20. https://doi.org/10.1080/15265161.2014.998376
61. Driscoll DL, Barnes VR, Johnston JM, et al. A formative evaluation of two FASD prevention communication strategies. Alcohol Alcohol 2018;53(4):461–469. https://doi.org/10.1093/alcalc/agx122
62. Subbaraman MS, Thomas S, Treffers R, et al. Associations Between State-Level Policies Regarding Alcohol Use Among Pregnant Women, Adverse Birth Outcomes, and Prenatal Care Utilization: Results from 1972 to 2013 Vital Statistics. Alcohol Clin Exp Res 2018;42(8):1511¬–1517. https://doi.org/10.1111/acer.13804
63. Roberts SCM, Mericle AA, Subbaraman MS, et al. State Policies Targeting Alcohol Use during Pregnancy and Alcohol Use among Pregnant Women 1985–2016: Evidence from the Behavioral Risk Factor Surveillance System. Women's Health Issues 2019;29(3):213–221. https://doi.org/10.1016/j.whi.2019.02.001
64. Zhao J, Stockwell T, Vallance K, et al. The Effects of Alcohol Warning Labels on Population Alcohol Consumption: An Interrupted Time Series Analysis of Alcohol Sales in Yukon, Canada. J Stud Alcohol Drugs 2020;81(2):225–237. https://doi.org/10.15288/jsad.2020.81.225
65. Crawford-Williams F, Fielder A, Mikocka-Walus A, et al. Does the poor quality of Australian health education documentation undermine the message? A review of documents informing pregnant women about alcohol. Evid Based Midwifery 2015;13(2):40–46 7p.
66. Crawford-Williams F, Fielder A, Mikocka-Walus A, et al. A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women. Drug Alcohol Rev 2015;34(2):154–161. https://doi.org/10.1111/dar.12152
67. Garcia TA, Bacio GA, Tomlinson K, et al. Effects of sex composition on group processes in alcohol prevention groups for teens. Exp Clin Psychopharmacol 2015;23(4):275–283. https://doi.org/10.1037/pha0000032
68. Mukherjee, R., Wray, E., Hollins, S., et al., What does the general public in the UK know about the risk to a developing foetus if exposed to alcohol in pregnancy? Findings from a UK mixed methodology study. Child: Care Health Deve 2015;41(3):467–474 8p. https://doi.org/10.1111/cch.12187
69. Lee E, Sutton RM, Hartley BL. From scientific article to press release to media coverage: advocating alcohol abstinence and democratising risk in a story about alcohol and pregnancy. Health Risk Soc 2016;18(5/6):247–269. https://doi.org/10.1080/13698575.2016.1229758
70. Parackal M, Parackal S, Eusebius S, et al. The Use of Facebook Advertising for Communicating Public Health Messages: A Campaign Against Drinking During Pregnancy in New Zealand. JMIR Public Health Surveill 2017;3(3):e49. https://doi.org/10.2196/publichealth.7032
71. Choate P, Badry D, MacLaurin B, et al. Fetal Alcohol Spectrum Disorder: What does Public Awareness Tell Us about Prevention Programming? Int J Environ Res Public Health 2019;16(21):4229. https://doi.org/10.3390/ijerph16214229
72. Cook ML, Geoffrey-Pennay, Amy. Change Over Time in Australian Newspaper Reporting of Drinking During Pregnancy: A Content Analysis (2000–2017). Alcohol Alcohol 2020;55(6). https://doi.org/10.1093/alcalc/agaa072
73. Parackal M, Parackal S. A renewed media-mix, based on the dynamic transactional model, for communicating the harms of alcohol to women in New Zealand. Health Promot Int 2019;34(5)921–930. https://doi.org/10.1093/heapro/day033
74. Roberts SCM, Thomas S, Treffers R, et al. Forty Years of State Alcohol and Pregnancy Policies in the USA: Best Practices for Public Health or Efforts to Restrict Women's Reproductive Rights? Alcohol Alcohol 2017;52(6):715–721. https://doi.org/10.1093/alcalc/agx047
75. Roberts SCM, Berglas NF, Subbaraman MS, et al. Racial differences in the relationship between alcohol/pregnancy policies and birth outcomes and prenatal care utilization: A legal epidemiology study. Drug Alcohol Depend 2019;201:244–252. https://doi.org/10.1016/j.drugalcdep.2019.04.020
76. Woodruff K, Roberts SCM. "Alcohol During Pregnancy? Nobody Does That Anymore": State Legislators' Use of Evidence in Making Policy on Alcohol Use in Pregnancy. J Stud Alcohol Drugs 2019;80(3):380–388. https://doi.org/10.15288/jsad.2019.80.380
77. Barreca A, Page, M. A pint for a pound? Minimum drinking age laws and birth outcomes. Health Econ 2015;24(4):400–418. https://doi.org/10.1002/hec.3026
78. Hui K, Angelotta C, Fisher CE. Criminalizing substance use in pregnancy: Misplaced priorities. Addiction 2017;112(7):1123–1125. https://doi.org/10.1111/add.13776
79. Adebiyi BO, Mukumbang FC, Erasmus C. The Distribution of Available Prevention and Management Interventions for Fetal Alcohol Spectrum Disorder (2007 to 2017): Implications for Collaborative Actions. Int J Environ Res Public Health 2019;16(12):2244. https://doi.org/10.3390/ijerph16122244
80. Adebiyi BO, Mukumbang FC, Beytell AM. A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa. BMC Health Services Res 2019;19(1):1-13. https://doi.org/10.1186/s12913-019-4677-x
81. Olusanya OA, Olokunlade, Temitope, Rossheim, Matthew E, Greene, Kaylin, Barry, Adam E. Alcohol messages disseminated to pregnant women by midwives. Am J Drug Alcohol Abuse 2020;11:1–10.
82. Oni HT, Buultjens M, Blandthorn J, Davis D, Abdel-Iatif M, Islam MM. Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives' experience. Midwifery 2020;81. https://doi.org/10.1016/j.midw.2019.102595
83. Sword W, Green C, Akhtar-Danesh N et al. Screening and Intervention Practices for Alcohol Use by Pregnant Women and Women of Childbearing Age: Results of a Canadian Survey. J of Obstet Gynaecol Canada 2020;42(9):1121–1128. https://doi.org/10.1016/j.jogc.2020.02.114
84. McLellan JM, O'Carroll RE, Cheyne H, et al. Investigating midwives' barriers and facilitators to multiple health promotion practice behaviours: a qualitative study using the theoretical domains framework. Implement Sci 2019;14(1):N.PAG-N.PAG. https://doi.org/10.1186/s13012-019-0913-3
85. Oni HT, Buultjens M, Abdel-Latif ME et al. Barriers to screening pregnant women for alcohol or other drugs: A narrative synthesis. Women Birth 2019;32(6):479–486. https://doi.org/10.1016/j.wombi.2018.11.009
86. Petersen-Williams P, Petersen Z, Sorsdahl K, et al. Screening and brief interventions for alcohol and other drug use among pregnant women attending midwife obstetric units in Cape Town, South Africa: A qualitative study of the views of health care professionals. J Midwifery Wom Health 2015;60(4):401–409. https://doi.org/10.1111/jmwh.12328
87. Bagley K, Badry D. How Personal Perspectives Shape Health Professionals' Perceptions of Fetal Alcohol Spectrum Disorder and Risk. Int J Environ Res Public Health 2019;16(11):1936. https://doi.org/10.3390/ijerph16111936
88. Zizzo N, Racine E. Ethical challenges in FASD prevention: Scientific uncertainty, stigma, and respect for women's autonomy. Can J Public Health 2017;108(4):e414. https://doi.org/10.17269/CJPH.108.6048
89. Nikoo N, Nikoo M, Song M et al. Effectiveness of prenatal screening for substance use: Critical consciousness, a promising curriculum for compassionate screening. Ment Health Fam Med 2017;13:401–406. https://doi.org/10.25149/1756-8358.1301003
90. Shah PV, Tong S, Hwang SS et al. Racial/Ethnic Differences in Prenatal and Postnatal Counseling About Maternal and Infant Health-Promoting Practices Among Teen Mothers. J Pediatr Adolesc Gynecol 2021;34(1):40–46. https://doi.org/10.1016/j.jpag.2020.10.002
91. Schölin L, Hughes K, Bellis MA, et al. "I think we should all be singing from the same hymn sheet" – English and Swedish midwives' views of advising pregnant women about alcohol. Drugs: Ed Prev Policy 2019;26(5):394–400. https://doi.org/10.1080/09687637.2018.1478949
92. Nathoo T, Wolfson L, Gelb K, Poole N. New approaches to brief intervention on substance use. Can J Midwifery Res Prac 2019;18(1):10–21.
93. Chiandetti A, Hernandez G, Mercadal-Hally M, et al. Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers. Reprod Health 2017;14:1–12. https://doi.org/10.1186/s12978-017-0385-3
94. Ferraguti G, Ciolli P, Carito V, et al. Ethylglucuronide in the urine as a marker of alcohol consumption during pregnancy: Comparison with four alcohol screening questionnaires. Toxicol Lett 2017;275:49–56. https://doi.org/10.1016/j.toxlet.2017.04.016
95. Howlett H, Abernethy S, Brown NW, et al. How strong is the evidence for using blood biomarkers alone to screen for alcohol consumption during pregnancy? A systematic review. Eur J Obstet Gynecol Reprod Biol 2017;213:45–52 https://doi.org/10.1016/j.ejogrb.2017.04.005
96. Eichler A, Grunitz J, Grimm J, et al. Did you drink alcohol during pregnancy? Inaccuracy and discontinuity of women's self-reports: On the way to establish meconium ethyl glucuronide (EtG) as a biomarker for alcohol consumption during pregnancy. Alcohol 2016;54:39–44. https://doi.org/10.1016/j.alcohol.2016.07.002
97. Olmstead TA, Yonkers KA, Ondersma SJ, et al. Cost‐effectiveness of electronic‐ and clinician‐delivered screening, brief intervention and referral to treatment for women in reproductive health centers. Addiction 2019;114(9):1659–1669. https://doi.org/10.1111/add.14668
98. Xu, X., Yonkers, K.A., Ruger, J.P., et al., Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial. BMC Pregnancy Childbirth 2017;17:1–8. https://doi.org/10.1186/s12884-017-1260-5
99. Joya X, Mazarico E, Ramis J, et al. Segmental hair analysis to assess effectiveness of single-session motivational intervention to stop ethanol use during pregnancy. Drug Alcohol Depend 2016;158:45–51. https://doi.org/10.1016/j.drugalcdep.2015.10.028
100. Babor TF, Del Boca F, Bray JW. Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice. Addiction 2017;112:110–117. https://doi.org/10.1111/add.13675
101. Erng MN, Smirnov A, Reid N. Prevention of alcohol-exposed pregnancies and fetal alcohol spectrum disorder among pregnant and postpartum women: A systematic review. Alcohol Clin Exp Res 2020;44(12). https://doi.org/10.1111/acer.14489
102. Hussein N, Kai J, Qureshi N. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. Eur J Gen Prac 2015;1–11. https://doi.org/10.3109/13814788.2015.1099039
103. Montag AC, Brodine SK, Alcaraz JE, et al. Preventing alcohol‐exposed pregnancy among an American Indian/Alaska Native population: Effect of a screening, brief intervention, and referral to treatment intervention. Alcohol Clin Exp Res 2015;39(1):126–135. https://doi.org/10.1111/acer.12607
104. Price SK, Coles DC, Wingold T. Integrating Behavioral Health Risk Assessment into Centralized Intake for Maternal and Child Health Services. Health Soc Work 2017;42(4): 231–238. https://doi.org/10.1093/hsw/hlx037
105. Bountress KE, Metzger IW, Maples-Keller JL, et al. Reducing sexual risk behaviors: secondary analyses from a randomized controlled trial of a brief web-based alcohol intervention for underage, heavy episodic drinking college women. Addict Res Theory 2017; 25(4):302–309. https://doi.org/10.1080/16066359.2016.1271416
106. Hanson JD, Nelson ME, Jensen JL, et al. Impact of the CHOICES Intervention in Preventing Alcohol-Exposed Pregnancies in American Indian Women. Alcohol Clin Exp Res 2017;41(4):828–835. https://doi.org/10.1111/acer.13348
107. Ondersma SJ, Beatty JR, Svikis DS, et al. Computer-Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial. Alcohol Clin Exp Res 2015;39(7):1219–1226 8p. https://doi.org/10.1111/acer.12747
108. van Dijk MR, Oostingh EC, Koster MPH, et al. The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial. BMC Pregnancy Childbirth 2017;17(1):46–46. https://doi.org/10.1186/s12884-017-1228-5
109. Lee Y, Cho S. Technology-Supported Interventions for Pregnant Women: A Systematic Review. Comput Inform Nurs 2019;37(10):501–512. https://doi.org/10.1097/CIN.0000000000000535
110. Milligan K, Usher AM, Urbanoski KA. Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs. Addict Res Theory 2017;25(3):251–261. https://doi.org/10.1080/16066359.2016.1259617
111. Motz M, Andrews NCZ, Bondi BC, et al. Addressing the impact of interpersonal violence in women who struggle with substance use through developmental-relational strategies in a community program. Int J Environ Res Public Health 2019;16(21). https://doi.org/10.3390/ijerph16214197
112. Hubberstey C, Rutman D, Schmidt RA, et al. Multi-service programs for pregnant and parenting women with substance use concerns: women's perspectives on why they seek help and their significant changes. Int J Environ Res Public Health, 2019;16(18). https://doi.org/10.3390/ijerph16183299
113. Frazer Z, McConnell K, Jansson LM. Treatment for substance use disorders in pregnant women: Motivators and barriers. Drug Alcohol Depend 2019;205:107652. https://doi.org/10.1016/j.drugalcdep.2019.107652
114. Rutman D, Hubberstey C, Poole N, et al. Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients' perspectives on wraparound programming. BMC Pregnancy Childbirth 2020;20(1). https://doi.org/10.1186/s12884-020-03109-1
115. de Vries MM, Joubert B, Cloete M, et al. Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management. Int J Environ Res Public Health 2015;13(1). https://doi.org/10.3390/ijerph13010076
116. Krahn J, Caine V, Chaw-Kant J, et al. Housing interventions for homeless, pregnant/parenting women with addictions: a systematic review. J Soc Distress Homeless 2018. 27(1):75–88. https://doi.org/10.1080/10530789.2018.1442186
117. Doi L, Jepson R, Cheyne H. A realist evaluation of an antenatal programme to change drinking behaviour of pregnant women. Midwifery 2015;31(10):965–972. https://doi.org/10.1016/j.midw.2015.06.007
118. Baron R, Heesterbeek Q, Manniën J, et al. Exploring health education with midwives, as perceived by pregnant women in primary care: A qualitative study in the Netherlands. Midwifery 2017;46:37–44. https://doi.org/10.1016/j.midw.2017.01.012
119. Geraghty S, Doleman G, De Leo A. Midwives’ attitudes towards pregnant women using substances: Informing a care pathway. Women Birth 2019;32(4):e477–e482. https://doi.org/10.1016/j.wombi.2018.09.007
120. McLeish J, Redshaw, M. "I didn't think we'd be dealing with stuff like this": A qualitative study of volunteer support for very disadvantaged pregnant women and new mothers. Midwifery 2017;45:36–43. https://doi.org/10.1016/j.midw.2016.12.003
121. Damashek A, Kothari C, Berman A, et al. Engagement in home visiting services during the transition from pregnancy to postpartum: A prospective mixed methods pilot study. J Child Fam Stud 2020;29(1). https://doi.org/10.1007/s10826-019-01641-z
122. Rotheram-Borus MJ, Arfer KB, Christodoulou J, et al. The association of maternal alcohol use and paraprofessional home visiting with children’s health: A randomized controlled trial. J Cons Clin Psychol 2019;87(6):551–562. https://doi.org/10.1037/ccp0000408
123. Bhat A, HadleyA. The management of alcohol withdrawal in pregnancy — case report, literature review and preliminary recommendations. Gen Hosp Psychiatry 2015;37(3):273.e1-3 1p. https://doi.org/10.1016/j.genhosppsych.2015.02.001
124. DeVido J, Bogunovic O, Weiss RD. Alcohol Use Disorders in Pregnancy. Harv Rev Psychiatry 2015;23(2):112–121. https://doi.org/10.1097/HRP.0000000000000070
125. Thibaut F, Chagraoui A, Buckley L, et al. WFSBP and IAWMH Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019. 20(1):17–50. https://doi.org/10.1080/15622975.2018.1510185
126. Graves L, Carson G, Poole N, et al. Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy. J obstet gynaecol Can 2020;42. https://doi.org/10.1016/j.jogc.2020.03.002
127. Kramlich D, Kronk R.. Relational care for perinatal substance use: A systematic review. MCN. Am J Matern Child Nurs 2015;40(5):320–326. https://doi.org/10.1097/NMC.0000000000000160
128. Marcellus L, MacKinnon K, Benoit C, et al. Reenvisioning success for programs supporting pregnant women with problematic substance use. Qual Health Res 2015. 25(4):500–512. https://doi.org/10.1177/1049732314551058
129. Meixner T, Milligan K, Urbanoski K, et al. Conceptualizing integrated service delivery for pregnant and parenting women with addictions: Defining key factors and processes. Can J Addict 2016;7(3):49–57. https://doi.org/10.1097/02024458-201609000-00008
130. Forray A, Merry B, Lin H, et al. Perinatal substance use: A prospective evaluation of abstinence and relapse. Drug Alcohol Depend 2015;150:147–155. https://doi.org/10.1016/j.drugalcdep.2015.02.027
131. Specker BL, Wey HE, Minett M, et al. Pregnancy Survey of Smoking and Alcohol Use in South Dakota American Indian and White Mothers. Am Prev Med 2018;55(1):89–97. https://doi.org/10.1016/j.amepre.2018.03.016
132. Fowler C, Rossiter C, Sherwood J, et al. New understandings of mothering: mothers in an abstinence-based drug treatment program. Int J Ment Health Addict 2015;13(2):173–184. https://doi.org/10.1007/s11469-014-9518-x
133. Hanlon-Dearman A, Malik S, Wellwood J, et al. A descriptive study of a community-based home-visiting program with preschool children prenatally exposed to alcohol. Can J Clin Pharmacol 2017;24(2):e61–e71. https://doi.org/10.22374/1710-6126.96.36.199
134. Milligan K, Meixner T, Tremblay M, et al. Parenting interventions for mothers with problematic substance use: A systematic review of research and community practice. Child Maltreat 2019. https://doi.org/10.1177/1077559519873047
135. Rotheram-Borus MJ, Tomlinson M, Roux IL, et al. Alcohol use, partner violence, and depression: A cluster randomized controlled trial among urban South African mothers over 3 years. Am J Prev Med 2015;49(5):715–725. https://doi.org/10.1016/j.amepre.2015.05.004
136. Sadicario JS, Parlier-Ahmad AB, Brechbiel JK, et al. Caring for women with substance use disorders through pregnancy and postpartum during the COVID-19 pandemic: Lessons learned from psychology trainees in an integrated OBGYN/substance use disorder outpatient treatment program. J Subst Abuse Treat 2021;122:108200. https://doi.org/10.1016/j.jsat.2020.108200
137. Marcellus L. A Grounded Theory of Mothering in the Early Years for Women Recovering From Substance Use. J Fam Nurs 2017;23(3):341–365. https://doi.org/10.1177/1074840717709366
138. O'Malley D, Chiang Danielle F, Siedlik Emily A, Ragon Katharine, Dutcher Marcia, Templeton Oneta. A promising approach in home visiting to support families affected by maternal substance use. Matern Child Health J 2020;25:42–53. https://doi.org/10.1007/s10995-020-03015-0
139. Popova S, Lange S, Burd L, et al. The economic burden of fetal alcohol spectrum disorder in canada in 2013. alcohol alcohol 2015;51(3):367–375. https://doi.org/10.1093/alcalc/agv117
140. Greenmyer JR, Popova S, Klug MG, Burd L. Fetal alcohol spectrum disorder: a systematic review of the cost of and savings from prevention in the United States and Canada. Addiction 2020;115. https://doi.org/10.1111/add.14841
141. Cherry AL. Shifting our Focus from Retribution to Social Justice: An Alternative Vision for the Treatment of Pregnant Women Who Harm Their Fetuses. J Law Health 2015;28:5–61.
142. Abadir, A.M. and Ickowicz, A., Fetal alcohol spectrum disorder: reconsidering blame. Can Med Assoc J 2016;188(3):171–172. https://doi.org/10.1503/cmaj.151425
143. Martin R, Bruxner G, Ng G, Brewster C, Kothari A. Drowning our sorrows: clinical and ethical considerations of termination in alcohol-affected pregnancy. BMC Pregnancy Childbirth 2020;20(1). https://doi.org/10.1186/s12884-020-03012-9
144. Fitzpatrick JP, Oscar J, Carter M, et al. The Marulu Strategy 2008-2012: overcoming Fetal Alcohol Spectrum Disorder (FASD) in the Fitzroy Valley. Aus N Z J Public Health 2017;41(5):467–473.
145. Wolfson L, Poole N, Morton Ninomiya M, et al. Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33. Int J Environ Res Public Health 2019; 16(9):1589. https://doi.org/10.3390/ijerph16091589
146. Poole N, Schmidt RA, Bocking A, et al. The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies. Int J Environ Res Public Health 2019;16(11):2019. https://doi.org/10.3390/ijerph16112019
147. Eguiagaray I, Scholz B, Giorgi C. Sympathy, shame, and few solutions: News media portrayals of fetal alcohol spectrum disorders. Midwifery 2016;40:49–54. https://doi.org/10.1016/j.midw.2016.06.002
148. Stewart M. Fictions of Prevention: Fetal Alcohol Spectrum Disorder and Narratives of Responsibility. North American Dialogue 2016;19(1):55–66. https://doi.org/10.1111/nad.12040
149. Wilkinson D, Skene L, De crespigny L, et al. Protecting Future Children from In-Utero Harm. Bioethics 2016;30(6):425–432. https://doi.org/10.1111/bioe.12238
150. Lewis MS. Criminalizing Substance Abuse and Undermining Roe v. Wade: The Tension between Abortion Doctrine and the Criminalization of Prenatal Substance Abuse. J Women Law 2016;23:185–218.
151. Lollar CE. Criminalizing pregnancy. Ind L J 2017;92(3):947.
152. Adebiyi BO, Mukumbang FC, Cloete LG, et al. Exploring service providers’ perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study. BMC Public Health 2018;18(1):1–18. https://doi.org/10.1186/s12889-018-6126-x
153. Badry D, Coons-Harding KD, Cook J, et al. Finding answers, improving outcomes: a case study of the Canada fetal alcohol spectrum disorder research network. Adv Dual Diagn 2018. https://doi.org/10.1108/ADD-05-2018-0006
154. Yang Y, Tang L. Understanding women’s stories about drinking: implications for health interventions. Health Ed Res 2018;33(4):271–279. https://doi.org/10.1093/her/cyy016
155. Mello S, Stifano S, Tan A, Sanders-Jackson, A Bigman CA. Gendered conceptions of preconception health: A thematic analysis of men’s and women’s beliefs about responsibility for preconception health behavior. J Health Comm 2020;25(5):374–384. https://doi.org/10.1080/10810730.2020.1775728
156. Corrigan PW, Shah BB, Lara JL, et al. Addressing the public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and health literacy. Drug Alcohol Depend 2018; 185:266–270. https://doi.org/10.1016/j.drugalcdep.2017.12.027
157. Corrigan PW, Shah BB, Lara JL, et al. Stakeholder perspectives on the stigma of fetal alcohol spectrum disorder. Addict Res Theory 2018. https://doi.org/10.1080/16066359.2018.1478413
158. Key KD, Ceremony HN, Vaughn AA. Testing two models of stigma for birth mothers of a child with fetal alcohol spectrum disorder. Stigma health 2018. https://doi.org/10.1037/sah0000134
159. Roozen S, Stutterheim SE, Bos AER. et al. Understanding the Social Stigma of Fetal Alcohol Spectrum Disorders: From Theory to Interventions. Found Sci 2020. https://doi.org/10.1007/s10699-020-09676-y
160. Benoit C, Magnus S, Phillips R, et al. Complicating the dominant morality discourse: mothers and fathers' constructions of substance use during pregnancy and early parenthood. Int J Equity Health 2015;14(1): 1–11. https://doi.org/10.1186/s12939-015-0206-7