The Prevention Conversation: A Shared Responsibility Project

By writing that studies are “ambiguous” in “Five myths about pregnancy” [Outlook, May 14], Amy Tuteur framed the issue of a safe level of alcohol use during pregnancy as an ongoing debate between opposing sides, each with scientific validity. In fact, the science is settled: There is no amount of risk-free alcohol use during pregnancy. This is the position of every scientific and public-health institute and medical and behavioral health association in the United States, including the Centers for Disease Control and Prevention, the National Institutes of Health, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.

A meta-analysis of 34 published cohort studies found an association between light-to-moderate levels of prenatal alcohol exposure — less than daily drinking — and developmental problems. Though other studies have not found deficits on a few specific behavioral measures, none has found any level of prenatal alcohol consumption that is non-toxic to human development.

While, in general, the lower the alcohol exposure, the lower the risk, critical genetic factors that make one pregnancy more vulnerable than another are unknown. Why tempt harm when all risk can be avoided? The best advice is a respectful but clear message encouraging mothers-to-be — with the support of their partners, family and friends — to set aside alcohol during pregnancy.

Tom Donaldson, Washington

The writer is president of the
National Organization on Fetal Alcohol Syndrome.

Haywood L. Brown, Washington

The writer is president of the
American College of Obstetricians
and Gynecologists.

Safest not to drink during pregnancy, best recommendation

CanFASD cautions that although conversation about stigmatization is important, there is still no established safe level of alcohol to consume during pregnancy.

May 19, 2017 — CanFASD, Canada’s leading FASD research network, says that a recent article posted by the The Guardian presents potentially harmful information about pregnancy and alcohol. The article posted on Thursday, May 18th claimed that warning pregnant women over dangers of alcohol goes too far. A similar article posted to The Telegraph states that advising women not to drink while pregnant is “sexist” and causes “needless anxiety”.

The two articles are based on a news release issued by the British Pregnancy Advisory Service promoting an upcoming conference entitled, Policing Pregnancy: Who Should be a Mother?

CanFASD agrees that although conversation around compassionate, non-judgmental ways to communicate this message to women and expectant mothers is indeed important—the current recommendations do not overstate risk, nor do they remove a woman’s right or ability to make a choice, rather, they provide clear, essential information in order that she may do so. Providing women with accurate information and a supportive, safe environment to make the healthiest choice for herself and her developing baby are essential in reducing prevalence of FASD.

Dr. Nancy Poole, Director of the Centre of Excellence for Women’s Health and Prevention Lead with CanFASD Research Network says:

“It is indeed a challenge to give helpful health messaging to women about alcohol and pregnancy, when there is no known safe level of alcohol consumption when pregnant. As the Guardian article correctly points out, alcohol is a teratogen, which means it causes birth defects. Women have a right to know this. The message that it is “safest not to drink alcohol in pregnancy” seems a quite clear and non-threatening way to state the risk.

Then women make the best decisions they can, with the support of their health care providers, on their use not only of alcohol, but also use/exposure to tobacco, some prescribed medications, and environmental chemicals known to cause congenital abnormalities. Clear public health messaging, coupled with the opportunity to discuss the risks with a compassionate and informed health care provider are critical to support women’s and fetal health.”

The recommendations in question come from the UK chief Medical Officers who last year altered guidelines to advise avoiding alcohol altogether for the duration of a pregnancy. The recommendations, which align with those from The Public Health Agency of Canada, are based on the fact that, despite extensive research, there is still no established safe level of alcohol to consume during pregnancy.

The previous guidelines encouraged exercising moderation through one to two units of alcohol once or twice a week. However, terms such as moderate, low level and light are unclear and subjective. Conflicting messages in the media about how much alcohol can be safely consumed perpetuate confusion. The clearest message is that not consuming alcohol at all during pregnancy is completely safe.

CanFASD encourages a discussion that pushes people to question the place of alcohol in society and our reluctance to consider its harms. ”Instead of questioning how much is safe to drink while pregnant, CanFASD encourages discussion around society’s resistance to accept the harmfulness of alcohol.” says Audrey McFarlane, CanFASD executive director.

For more information or to speak to Dr. Nancy Poole, please contact:
Abby Sherstan, Berlin Communications
asherstan@BRLN.ca
780.995.5695

About CanFASD:

The Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) is a collaborative, interdisciplinary research network, with researchers and partners across the nation. CanFASD’s unique partnership brings together many scientific viewpoints to address complexities of FASD, with a focus on ensuring that research knowledge is translated to community and policy action. Our 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.

 

Dr Hayley Mills, Dr Marlize De Vivo and Dr Chris Beedie, all from the Sport and Exercise Sciences programme, respond to yesterday’s news suggesting that women are being unfairly alarmed with regard to consuming alcohol when pregnant. 

Yesterday’s news indicating the potential overplaying of the risk of alcohol in pregnancy highlights the professional and ethical tensions that scientists and evidence-based practitioners face on a daily basis. On the one side is the often incredible power of medical and scientific knowledge, on the other the daily encroachment of medicine and science into every aspect of our lives, what is termed ‘medicalisation’.

Many academics and even practitioners have presented coherent and powerful arguments against medicalisation, often identifying the worrying role of commercial, political and similar interested agencies in its apparently insidious spread.

But there are occasions in which these arguments, no matter how well made, no matter how reasonable, and no matter how well intentioned, can be counter-productive. Yesterday’s media around alcohol and pregnancy may be just such an example.

As scientists with a keen interest in exercise and pregnancy, we have to daily consider the tensions between common sense and an un-medicalised approach, and one based on scientific evidence, even if that evidence is not complete. The bottom line, however, is that we also have to veer on the side of caution.

Exercise was once considered a risk to pregnant mothers, we now know the benefits. The risks were overplayed in early research, and subsequent evidence indicated the positive effects of exercise on health during pregnancy. Likewise, evidence for the harmful effects of alcohol may have been overplayed, but where is the evidence for benefit? It is a maxim of knowledge that lack of evidence for something is not the same as evidence for the lack of something. Unlike many areas of science, it is problematic to research the real effects of alcohol during pregnancy, it is an emotive issue riddled with ethical and pragmatic challenges.

But there is a further risk. Any practitioner in public health will be happy to tell you that many people will hear what they want to hear, they will ignore the 99% of messages that indicate, for example, that smoking is harmful, and hear the 1% that indicates a lack of harm.

Scientists and academics should challenge scientific data, it is how science and knowledge progress. But in doing so we must exercise caution because the difference between the message sent – the evidence is not as strong as we like to think – and the messages that people hear – that it’s not as dangerous as we thought to drink alcohol during pregnancy – is stark.

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As a provincial FASD prevention campaign in Alberta, we support having non-judgemental, sensitive conversations with women about alcohol and pregnancy. Shaming or blaming women for their choices is NOT part of our prevention efforts. As there is no known safe threshold of alcohol consumption in pregnancy we recommend abstaining from all alcohol intake while pregnant and planning a pregnancy.

Women are being unfairly alarmed by official guidelines that warn them to avoid alcohol completely during pregnancy, experts claim.

Some mothers-to-be may even be having an abortion because they are worried they have damaged their unborn child by drinking too much, it is claimed.

The British Pregnancy Advisory Service, maternal rights campaign group Birthrights and academics specialising in parenting say official advice on drinking in pregnancy is too prescriptive.

Revised guidelines that came into force in January 2016 are not based on reliable evidence, they say. The advice, endorsed by the four UK nations’ chief medical officers, deleted a longstanding reference to pregnant women potentially having one or two units of alcohol once or twice a week while expecting and instead said that they should not drink at all.

“We need to think hard about how risk is communicated to women on issues relating to pregnancy. There can be real consequences to overstating evidence or implying certainty when there isn’t any,” said Clare Murphy, director of external affairs at BPAS, the contraception and abortion charity.

Cannabis has been identified as a potential substitute for users of legal or illicit opioids, but a new Vancouver-based study shows the drug may also help reduce people’s cravings for another highly addictive substance: crack cocaine.

Scientists at the BC Centre on Substance Use tracked 122 people who consumed crack in and around Vancouver’s Downtown Eastside over a three-year period and found they reported using that drug less frequently when they opted to also consume cannabis.

“We’re not saying that these results mean everyone will be able to smoke a joint and forget the fact that they are dependent on crack,” said M.J. Milloy, an infectious-disease epidemiologist at the centre and senior author of the study. “What our findings do suggest is that cannabinoids might play a role in reducing the harms of crack use for some people.

“That’s the next test: to what extent and for who?”

These results, published in the latest issue of the international peer-reviewed journal Addictive Behaviors, echo a smaller study of 25 crack users in Brazil that found just more than two-thirds of them were able to stop consuming that drug while using cannabis.

A recent global estimate pegs the number of people addicted to cocaine at about seven million, Dr. Milloy said, with many of them marginalized people smoking crack in cities across the Americas.

Brazil is struggling to cope with an epidemic that has made it the largest consumer of crack cocaine in the world. But the drug is also widely used by Canadians, Dr. Milloy said.

“Crack has not gone away and we have described in previous research how people using crack in a frequent high-intensity manner suffer from not only dependence, but other risks, in particular, HIV and hep C acquisition,” Dr. Milloy said.

Addiction experts in Vancouver can offer those consuming heroin effective – and legal – substitutes such as suboxone and methadone, but there are no pharmaceutical therapies for people addicted to crack cocaine, Dr. Milloy said.

Cannabis was deemed less dangerous than tobacco in a 2010 study that ranked 20 legal and illegal drugs based on the dependence, social and physical harms they caused. The report, published in the British medical journal The Lancet, said both were considered far less dangerous to users and the general public than heroin, cocaine and alcohol.

As Ottawa gets set to legalize cannabis as early as next summer, addictions and public health experts such as Dr. Milloy have urged the federal government to consider the dangers – and potential benefits – that Canada’s example of ending prohibition can offer the world.

One potential public-health benefit is more people may substitute cannabis for alcohol or opioids.

A recent study from the University of British Columbia and funded by licensed cannabis grower Tilray found more than half of the 271 medical-marijuana patients interviewed said they use cannabis to help them get off heavier prescription drugs, with the largest percentage saying pot acts as a substitute painkiller for opioids.

That research added to a small body of science that suggests patients are effectively using marijuana to replace opioids, a class of legal and illicit painkillers that has led to a crisis that last year killed hundreds of Canadians.

Last year, The Globe and Mail found fewer Canadian veterans have sought prescription opioids and tranquillizers in recent years, while at the same time, prescriptions for medical marijuana have skyrocketed.

It is not clear whether the two are related, but the trend echoes what researchers have found in U.S. states with medical-marijuana laws, where significant declines in opioid overdoses suggest that people may be substituting these oft-abused medicines with cannabis.

Retrieved from: http://www.theglobeandmail.com/news/british-columbia/cannabis-may-help-wean-people-off-crack-study-finds/article35003184/

 

4th in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 3

“Research on Reaching and Engaging Women and Children using Approaches that are Theory Based, and have an Equity Lens” – Janet Christie, Addiction Recovery Coach, Canada; Anne Russell of the Russell Family Fetal Alcohol Disorders, Australia; Pippa Williams of UK and European Mothers Network-FASD; Margaret Leslie and Dr. Mary Motz of the Mothercraft/Breaking the Cycle, Canada

One of the highlights of the first Plenary on Prevention at the 2017 International Conference on FASD, was the presentation on supporting women and families dealing with issues of alcohol and FASD.

Janet Christie, Anne Russell and Pippa Williams are three birth mothers who have created supports for women and families dealing with issues of alcohol or FASD. Their experiences have informed and are reflected in many reports and studies: that no woman intends to harm her child; that there are multiple and complex issues that affect women at risk for alcohol-exposed pregnancies; and, that fragmented and inflexible services make it difficult for women and families to get help.

Stigma is one of the biggest barriers affecting access to services. Addiction is still viewed by many as a moral failing rather than a public health issue. Meanwhile the alcohol industry normalizes and glamourizes drinking to women through targeted marketing campaigns. Women are often met with judgement and blame, and fear losing their children if they seek help for an addiction. As well, mothers whose children have FASD need support in dealing with their feelings of guilt and with parenting their children. Often women have complex and intersecting issues, including FASD, that affect their ability to accept support. While these three mothers/advocates are from different countries, they all identify these same issues, and call for programs with wrap-around services to support women and their families.

Margaret Leslie and Dr. Mary Motz then described such a program – Breaking the Cycle in Toronto and its mother-child study “Focus on Relationships”. Based upon well-researched attachment theory, the program focuses on the mother-child dyad during the pre- and post-partum period and on building trust, safety and relational capacity. Relationships extend to staff and service providers. Program efforts to develop collaborative relationships between child welfare, addiction recovery and mental health service agencies have successfully created an integrated and flexible program with the goal of supporting the whole family.

For more on these topics, see earlier posts:

The Mother-Child Study: Evaluating Treatments for Substance-Using Women, March 18, 2015
Supporting Pregnant and Parenting Women Who Use Substances: What Communities are Doing to Help, October 1, 2012
Herway Home ‘One-Stop Access’ Program in Victoria Set to Open, May 20, 2012
“New Choices” for Pregnant and Parenting Women with Addictions, January 9, 2012
Toronto Centre for Substance Use in Pregnancy (T-CUP), December 19, 2011
Clinical Webcast on Breaking the Cycle Program: September 20, 2011, August 2, 2011
Why Would She Drink? Winnipeg Free Press Articles Explore Drinking during Pregnancy, April 4, 2011

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