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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. Income and social status Social support networks Education Employment and working conditions

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alcohol use and pregnancy

Alcohol Use and Pregnancy 2008

prevention efforts must
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. 2008

determinants of health
Income and social status

Social support networks


Employment and working conditions

Social environments

Physical environment



Personal health practices and coping skills

Healthy child development

Health services

Biology and genetic endowment

Determinants of Health 2008

our responsibility is to
Our responsibility is to …

…provide a network of supports that directly address these contributing factors 2008

key messages
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 2008

don t forget
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 2008

alcohol risk assessment
Alcohol Risk Assessment

Problems have not developed Problems have developed

No risk Low Risk Moderate Risk High Risk





Risk Reduction





  • 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) 2008

screening tools
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 2008

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 2008

  • 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 2008

stages of change prochaska diclemente 1984
Stages of Change(Prochaska, DiClemente 1984)






Relapse 2008

stages of change pre contemplation
Stages of Change: Pre-contemplation


  • Not thinking about their drinking
  • Not currently considering change


  • 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 2008

stages of change contemplation
Stages of Change: Contemplation


  • Thinking about quitting but not ready to quit
  • May feel ambivalent about change


  • 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 2008

stages of change preparation
Stages of Change: Preparation


  • Getting ready to quit
  • The decision to quit is made and steps are taken to get ready


  • 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 2008

stages of change action
Stages of Change: Action


  • Quitting or actively trying to quit
  • Using several techniques to quit
  • High risk to relapse


  • 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 2008

stages of change maintenance
Stages of Change: Maintenance


  • Remaining alcohol-free
  • Learned to anticipate and handle temptation
  • Able to use new ways of coping


  • 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 2008

stages of change relapse
Stages of Change: Relapse


  • Resumption of old behaviour
  • Normal occurrence


  • Evaluate trigger for relapse
  • Reassess motivation and barriers
  • Plan stronger coping strategies
  • Help resume process of change 2008

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 2008

things to keep in mind
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 2008

  • Keys to a Successful Alcohol and Pregnancy Campaign,
  • Alberta Alcohol and Drug Abuse Commission 2008

  • “Father Involvement and FASD: Developing Best Practices,” 2005.
  • 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.
  • 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 2008

thank you
Thank you! 2008