Monthly Archives: March 2015

Parenting In Ottawa: Great Resource No Matter Where You Live!

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Parenting in Ottawa is a new resource for parents created by Ottawa Public Health and its community partners. It was designed to make parenting in Ottawa a little bit easier. Browse the website to find information written by local health experts.

Wondering what foods to avoid during pregnancy?  That’s in our Becoming a Parent and Pregnancy section.

Getting ready to breastfeed for the first time?  You’ll find useful tips in our Breastfeeding section.

Wondering when your child can start eating solid foods?  Check out the Babies and Toddlers section.

Need to know what vaccines your child requires to attend school?  That can be found in our Children section.

Need tips for talking to your youth about mental health?  We’re here to help. Visit the Youth section.

Just click to see the site! www.parentinginottawa.com

The Sensible Guide to a Healthy Pregnancy

If you are pregnant, or are planning to become pregnant, this guide is for you!
Having a baby can be a wonderful experience, but it can also be a time of uncertainty. Many women have questions and concerns as they face all the changes that pregnancy brings.
But with advice coming from everyone, it’s tough to know who to listen to. That’s why having accurate information is so important! It will help you to make good decisions about how to take care of yourself before, during and after your pregnancy.
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Click to download booklet!

Moments to Milestones: Engaging with People who use Substances

This 30-minute video is intended as an education resource for first responders, including police, paramedics and emergency room staff. Also, this video has relevance for anyone working with people who use substances. It illustrates the remarkable, positive difference that can be made when people who use substance are approached in an attuned manner that fosters respect, compassion and inclusion.

Prevention Matters 2015 Conference

Edmonton and area Fetal Alcohol Network Society

Prevention Matters 2015 will be held September 30 – October 2, 2015 in Saskatoon, Saskatchewan. The conference is hosted by the Saskatchewan Prevention Institute and the University of Saskatchewan.

The conference theme is “Prevention Matters for Children, Families, and Communities” and will provide opportunities to explore primary prevention efforts and highlight environmental and societal factors that positively influence the health and health behaviours of children and families.

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Several of the presentations address FASD prevention and supporting healthy pregnancies, including:
  • Preventing FASD in an Alocogenic Culture: Relationship, Contraception, and Alcohol Practices of 20somethings (Brooke Ramsay, Stewardship and Engagement Coordinator, Foothills Fetal Alcohol Society)
  • Aboriginal Maternal Mental Health and Resilience (Angela Bowen, Associate Professor, College of Nursing, University of Saskatchewan)
  • Pregnets: Pregnancy and Smoking (Jessica Penner, Knowledge Translation Coordinator, Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto)
  • Baby’s Best Start Prenatal Program (Veronica Hawley, Public Health Nurse, Five Hills Health…

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An art project ‘Pop Bottles’ aims to raise awareness about social issues like alcohol consumption while pregnant.

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The Italian designer Anna Utopia Giordano has come up with an art project in 2012 with a humorous design concept that mixes famous alcohol brands and kids toy makers. She created Pop Bottles, a series of alcohol bottles branded with iconic names like Lego, Nintendo and Disney, and complete with rubber baby bottle tops. There are a number of mash-ups including Fisher Price and Jack Daniels whiskey, Marvel and Martini, and Barbie and Absolut vodka. Giordano says:

The bottles are NOT for sale, they are part of an art exhibition. This is an art project to raise social awareness on topics such as alcohol abuse by teens, alcohol abuse by pregnant women, the disinterest of some parents towards their children (abandoned for days between toys and video games), how far marketers can go to gain the attention of their younger customers. There are no commercial purposes.

Retrieved from: http://the-design-ark.com/2012/02/pop-bottles-by-anna-utopia-giordano/

What do you think of this social awareness campaign through art?

FASD Prevention Video by the Bissell Centre

Bissell Centre and the Edmonton and area Fetal Alcohol Network Society teamed up to create this new music video on Fetal Alcohol Spectrum Disorder (FASD) to raise awareness and to educate the community.

Do you have a creative FASD prevention campaign, let us know about it!

Meconium Screening for Fetal Alcohol Spectrum Disorder in Pregnancy

Meconium Screening for Fetal Alcohol Spectrum Disorder in Pregnancy

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By: Sterling K. Clarren, MD, FAAP, Jocelynn L. Cook., PhD., MBA Canada Fetal Alcohol Spectrum Disorder Research Network (retrieved from: http://www.canfasd.ca/wp-content/uploads/2014/01/Meconium-screening-for-FASD-in-pregnancy-FINAL.pdf)

Newborn_ThinkerIssue:

Identifying prenatal exposure to alcohol is important for prevention and diagnosis, but information about maternal alcohol consumption is often difficult to obtain. It has been suggested that measuring the presence of fatty acid ethyl esters in meconium may be used as a “biomarker” to establish maternal problem drinking.

Background:

Meconium is the product of the first bowel movements of the newborn. It is composed of wastes accumulated in the gastrointestinal tract during gestation and before milk consumed by mouth has entered the gastrointestinal tract. Fatty acid ethyl esters (FAEE) are found in the meconium and are the normal breakdown products of naturally occurring low levels of alcohols produced during fetal formation. FAEE begin to accumulate after the bowel is established at the end of the first trimester of pregnancy and become more plentiful in the last half of pregnancy. When liquor, wine or beer (all containing ethyl alcohol or “ethanol”) are consumed by the mother, the alcohol passes freely through the placenta and the fetus. Most of the alcohol will be metabolized by the mother, but some will also be metabolized by the fetus and both will produce extra levels of FAEE. Although normal metabolism produces very low levels of FAEE that are not related to maternal alcohol consumption, high amounts of FAEE are usually the result of maternal ethanol consumption. The cut-off level that differentiates naturally produced FAEE production from that related to maternal alcohol consumption is not known, so the meaning of intermediate amounts of FAEE are often uncertain. It is also not known how timing, frequency and patterns of drinking (binge versus daily) affect the amount and type of FAEE in the meconium.

It has been suggested that measurement of FAEE in meconium has the potential to be a biomarker for prenatal alcohol exposure and, thus, Fetal Alcohol Spectrum Disorder (FASD) and researchers have been studying this relationship since the late 1990s. (1-3) Despite the promise, there are some limitations. For example, testing meconium for FAEE is technically challenging. The material must be collected shortly after it is expressed and must be kept cold in storage and in shipping until analyzed. Not all laboratories have been able to demonstrate consistent results in analysis but, under optimum conditions, FAEE have been shown to be a reliable marker for both acute and chronic alcohol intake by the mother in the latter periods of pregnancy. (4-6) Some locations in Canada and Internationally offer meconium testing services.

The uses of meconium are indeed limited. When high levels of FAEE are found, the infant can be placed in an “at risk” category for FASD. The identification of “at risk” would allow for physical examinations and neuropsychological testing over time that could confirm FASD. However, it must be emphasized that no specific level of FAEE has been established that would actually confirm a diagnosis of FASD without subsequent testing of the child. A diagnosis within FASD is rarely made in infancy, even with maternal confirmation of alcohol use. The process of diagnosis often begins during early or middle childhood. The risk-relationship between the level of FAEE and FASD is not yet fully understood, but no level would ever be found that would guarantee that the child would have FASD. Further, because the meconium test is only applicable later in pregnancy, it will completely miss infants that should be identified as “at risk” for FASD who were only exposed to alcohol in the first trimester, when exposure is actually the most dangerous.

Meconium testing is different than nearly all other prenatal screening. In most cases, the prenatal test can detect a medical problem that is unknown to the parents. However, in the case of meconium testing, alcohol use is known to the mother. This issue has raised ethical concerns in the use of the test. (7) The difficulty rests with parental resistance to disclosing this information. One might reason that simply asking women (and men) about their alcohol use in pregnancy through a structured or unstructured interview would be simpler, cheaper, more honest and more likely, if done properly, to engage the family in a discussion of preparation for a potentially “at risk” infant for FASD. While this approach has been proposed and implemented in some places, there is no evidence yet as to the sensitivity or specificity in the interview outcomes.

Koren and his group have studied meconium testing as an anonymized method for screening selected populations for gestational alcohol exposure. They have recently reported that, in a study of voluntary testing of meconium for FAEE and long-term developmental follow-up of positive cases, the participation rate in the screening program was significantly lower than when testing was conducted anonymously, suggesting that the majority of mothers who consumed alcohol in pregnancy refused to participate. The investigators concluded that, despite the potential benefits of such screening programs, maternal unwillingness to consent, likely due to fear, embarrassment, and guilt, may limit the effectiveness of meconium testing for populationbased open screening, highlighting the need for public education and social marketing efforts for such programs to be of benefit. (8)

Investigators in Prince Edward Island recently completed an anonymous, provincial, population-based study to determine the incidence of prenatal fetal alcohol exposure in PEI newborns. The study results show that at least 3.1% of PEI babies were exposed to frequent prenatal alcohol consumption after the first trimester of pregnancy, placing these children at risk for FASD. (9) Repeated sampling in the same areas over time could help determine if prevention programming was successful. (5,10) This is an attractive, albeit, expensive method for obtaining this information. However, women who are at risk for alcohol consumption during pregnancy and might be ready for treatment will not be found and the stigma associated with drinking in pregnancy that prevents a simple open discussion will not be diminished.

Recommendations:

• A great deal more work needs to be done in delineating the relationship between FAEE and the risk of FASD as well as studying the utility, the ethics and the cost of meconium screening and directly comparing it to other approaches before it will be ready for widespread public health use.

• Implementation of a meconium screening program and the implications related to sensitivity and specificity, the stigma associated with alcohol use during pregnancy and the relationship between the health care provider and the pregnant woman must be carefully considered.

Click link to download issue paper PDF: http://www.canfasd.ca/wp-content/uploads/2014/01/Meconium-screening-for-FASD-in-pregnancy-FINAL.pdf 

 

Bibliography:

1. Ostrea EM Jr. Testing for exposure to illicit drugs and other agents in the neonate: a review of laboratory methods and the role of meconium analysis. Curr Probl Pediatr. 1999 Feb;29(2):37-56.

2. Klein J, Karaskov T, Korent G. Fatty acid ethyl esters: a novel biologic marker for heavy in utero ethanol exposure: a case report. Ther Drug Monit. 1999 Dec;21(6):644-6.

3. Chan D, Caprara D, Blanchette P, Klein J, Koren G. Recent developments in meconium and hair testing methods for the confirmation of gestational exposures to alcohol and tobacco smoke. Clin Biochem. 2004 Jun;37(6):429-38.

4. Peterson j, Kirchner HL, Xue W, Minnes S, Singer LT. Fatty ethyl esters in meconium are associated with porrer neurodevelopmental outcomes to two years of age. J Pediatr, 152: 788-792, 2008.

5. Gareri J, Lynn H, Handley, M, Rao C, Koren G. Prevalence of fetal ethanol exposure in regional population-based sample by meconium analysis of fatty acid ethyl esters, Ther, Drug Monit, 30:239-245, 2008.

6. Pichini S, Pellegrini M, Gareri J, Koren G, Garcia-Algar O. Liquid chromatographytandem mass spectrometry for fatty acid ethyl esters in meconium: assessment in two European cohorts. J. Pharm. Biomed. Anal 48: 927-933, 2008.

7. Marcellus l. Is meconium screening appropriate for universal use? Science and ethics say no. Adv. Neonatal care 7: 207-214, 2007.

8. Zelner I, Shor S, Lynn H, Roukema H, Lum L, Eisinga K, Koren G. Neonatal screening for prenatal alcohol exposure: assessment of voluntary maternal participation in an open meconium screening program. Alcohol. 2012 May;46(3):269-76. doi: 10.1016/j.alcohol.2011.09.029. Epub 2012 Mar 21.

9. Bryantan, J., Bigsby, K et al. http://news.upei.ca/media/2013/01/28/firstcomprehensive-study-prenatal-fetal-alcohol-exposure-pei-newborns. Accessed March 11, 2013.

10. Zelner I, Shor S, Gareri J, Lynn H, Koren G. Universal screening for prenatal alchol exposure: a progress report of a pilot study in the region of Grey Briuce Ontario. Ther. Drug Monit 32: 305-310, 2010.

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