Author Archives: edmontonfetalalcoholnetwork

CanFASD: MEDIA RELEASE, Safest not to drink during pregnancy, best recommendation


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

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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Warning pregnant women over dangers of alcohol goes too far, experts say

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 may help wean people off crack, study finds


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.

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Daunting new research out of the University of Helsinki claims that drinking alcohol, even during the early weeks of pregnancy, can cause irreversible damage to an unborn baby. The researchers claim that in the early stages of pregnancy, even before many women realize that they are pregnant, alcohol exposure can cause symptoms of fetal alcohol syndrome.

Fetal alcohol syndrome is an often brushed-over topic. Reports focus primarily on stunted growth and learning disabilities, but the reality of alcohol’s impact on a baby can be much more encompassing and individualized — affecting behavior, impulse control, learning, and numerous other areas. The research was done on mice, and the scientists say that this research supports earlier theories that drinking even during very early pregnancy can cause permanent damage to children.

The researchers said that maternal alcohol intake in early pregnancy changed the way genes function in the offspring exposed prenatally to alcohol. The changes were lasting and irreversible. The researchers warned that drinking alcohol, even as early as three weeks after conception, can cause symptoms that mirror fetal alcohol syndrome, including structural changes to the face and skull, and lasting, age-inappropriate hyperactivity.

Other symptoms of fetal alcohol exposure include teeth and mouth problems, hearing and ear problems, immune system weakness, defects in organs, muscular problems, hormonal disorders, and many more physical and cognitive issues. Lara Crutchfield, FASD trainer with FASD Today, detailed the specific physical and neurological damage that can be caused when a woman drinks during pregnancy. Some of this damage is unique to fetal alcohol exposure.

The researchers warned that early pregnancy is an especially dangerous time to consume alcohol, because it’s such an active time for cell division and differentiation, according to the Daily Mail. The research into maternal alcohol consumption during early pregnancy focused on the memory and learning center of the brain known as the hippocampus, which is especially sensitive to alcohol exposure. This exposure resulted in typical symptoms of fetal alcohol syndrome, but it also altered the epigenome and the function of many genes in the hippocampi. This damage lasted into the adulthood of the test subjects. The alcohol also changed the gene function of bone marrow. Dr Kaminen-Ahola explained.

“The results support our assumption that alcohol permanently alters gene regulation at a very early stage. This would be significant for the challenging diagnostics of alcohol-induced damage. The mechanisms and biological markers which can aid in diagnosis are studied so that we can offer the developmental support necessitated by the damage as early as possible. Ideally, a swipe sample from inside the mouth of a newborn could reveal the extent of damage caused by early pregnancy alcohol exposure.”

Last fall, research out the the University of North Carolina found that a significantly greater number of children probably suffer from fetal alcohol spectrum disorder than anyone ever suspected. Earlier this year, Professor Peter Hepper from Queen’s University Belfast broke the news that even drinking a half of a glass of wine with dinner could damage a baby’s brain, an earlier Inquisitr article detailed.

Some earlier research indicated that proper maternal intake of folate, choline, and vitamin A might offer some protection to unborn babies against the effects of fetal alcohol exposure.

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Reaching and engaging women: What works and what’s needed

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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Web-Based Preconception Interventions to Prevent FASD


Katherine Flannigan, PhD and Nancy Poole, PhD


It is estimated that between 10-15% of Canadian women consume alcohol during pregnancy, and up to 5% of infants are born each year with Fetal Alcohol Spectrum Disorder (FASD).1 In response, researchers are exploring evidence-informed approaches for reducing prenatal alcohol exposure (PAE), and improving birth outcomes and the health of parents-to-be. One approach is through preconception health (PCH) interventions, which have the potential to optimize the health and wellbeing of women, men, and children.


FASD is characterized by physical, cognitive, social-emotional, and behavioural difficulties as a result of PAE.2 When adequate supports are not put into place, FASD can be associated with negative long-term outcomes including problems with school and employment, confinement, mental health and substance use difficulties, and trouble with the law.3 Researchers, policy makers, and service providers spend considerable effort to identify best practices and develop policies for FASD diagnosis, intervention, and prevention.

In the FASD prevention field specifically, many initiatives have been undertaken to support women to reduce or abstain from alcohol during pregnancy. One of the strategies in this work involves improving the health of women before they conceive, to maximize the chances of positive pregnancy outcomes and improve women’s overall health. These PCH interventions typically include evaluation and education around risk factors, and support for healthy decision-making before, during, and after pregnancy. Web-based programs are emerging as an effective way to increase preconception awareness and willingness to discuss PCH with service providers,4 as well as a promising avenue for PCH intervention to change behaviours. These initiatives are important, as they have the potential to provide feasible, cost-effective, and accessible support to a wide range of individuals.

Web-Based Preconception Health Interventions

One of the first web-based PCH interventions to be evaluated was a self-guided change tool focused on reducing the number of alcohol-exposed pregnancies among women at risk.5 The intervention was delivered both through the mail and online, and supported self-guided change through four modules covering current drinking patterns, decision-making, goal setting and planning, and overcoming barriers. After the intervention, over half (58%) of the women who completed were deemed no longer at risk for alcohol-exposed pregnancies, but there was no difference in the rate of risk reduction whether the women completed the web-based or mail-based version. However, women in the web-based group were more likely to complete all modules at follow-up, and educated women were more likely to complete the intervention.

The Gabby System is another online interactive agent developed to engage women in discussing PCH with the ultimate goal of reducing a range of risk factors.6 Research results indicate that women find the Gabby System to be user-friendly, useful, an appropriate length, and that Gabby is easy to talk to, trustworthy, and provides useful information.6.7 Moreover, after having completed the Gabby System intervention, a majority of women reported they had taken some action to resolve risk factors.6,7

A third web-based intervention was recently developed to improve knowledge and behaviours related to adverse pregnancy outcomes in women planning to become pregnant.8 Women in this study were provided with individually-tailored information to identify risk factors, and invited to schedule a preconception visit with a health care provider, bringing the information package along. Among women who responded to follow-up, the greatest reductions were seen in alcohol consumption, followed by folic acid supplementation, and susceptibility to hepatitis B and rubella, and most women had attended a preconception visit.

Importantly, researchers have also highlighted the father’s role in reducing preconception risk factors, and emphasized that intervention efforts should involve both parents to be most effective in promoting healthy pregnancies.9,10 The web-based platform, Smarter Pregnancy, involves personalized coaching on nutrition and lifestyle factors for couples who are planning to become, or are already pregnant.10 This intervention has shown positive results at 6 months follow-up, with the majority of participants reporting high usability, and persistent reductions in nutritional inadequacies and alcohol and tobacco use among both mothers and fathers.

Together, these studies indicate that web-based interventions are a promising avenue for reducing pregnancy risk factors and promoting PCH, reaching a wide range of individuals. These interventions are perceived by users to be understandable, useful, and accessible, and individually tailored feedback and interactivity appear to be particularly important components.


  • Canadian research on web-based PCH interventions is lacking, and studies are needed to explore the unique factors that might influence how web-based interventions may be best implemented with a range of women and men in Canada.
  • It will be important to identify and reach subgroups of women who may be in greater need of prenatal education and support. Those who are socially disadvantaged may need to be provided with cell phones or access to computer kiosks in public health clinics in order to benefit from web-based interventions.
  • Because of limited access to the Internet, individuals in rural and isolated communities represent another hard-to-reach group and may require creative and innovative approaches to benefit from web-based interventions.
  • Fathers are important contributors to PCH and should be involved and engaged in our efforts to promote healthy families.
  • There exist several websites related to PCH health in Canada, such as Alberta’s Ready or Not ( and Ontario’s Best Start( to be linked to new web-based interventions.



  1. Popova, S., Lange, S., Probst, C., Parunashvili, N., & Rehm, J. (2017). Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States. European Journal of Medical Genetics, 60(1), 32-48. doi:10.1016/j.ejmg.2016.09.010
  2. Chudley, A. E., Conry, J., Cook, L. L., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal Alcohol Spectrum Disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal, 172(5), S1-S21. doi:10.1503/cmaj.1040302
  3. Streissguth, A. P., Bookstein, F. L., Barr, H. M., Sampson, P. D., O’Malley, K., & Young, J. K. (2004). Risk factors for adverse life outcomes in Fetal Alcohol Syndrome and Fetal Alcohol Effects. Journal of Developmental and Behavioral Pediatrics, 25(4), 228-238. doi:10.1097/00004703-200408000-00002
  4. Batra, P., Mangione, C. M., Cheng, E., Steers, W. N., Nguyen, T. A., Bell, D., .Kuo, A. A., & Gregory, K. D. (2017). A cluster randomized controlled trial of the MyFamilyPlan online preconception health education tool. American Journal of Health Promotion, 890117117700585. doi:10.1177/0890117117700585
  5. Tenkku, L. E., Mengel, M. B., Nicholson, R. A., Hile, M. G., Morris, D. S., & Salas, J. (2011). A web-based intervention to reduce alcohol-exposed pregnancies in the community. Health Education & Behavior, 38(6), 563-573. doi:10.1177/1090198110385773
  6. Gardiner, P., Hempstead, M. B., Ring, L., Bickmore, T., Yinusa-Nyahkoon, L., Tran, H., Paasche-Orlow, M., Damus, K., & Jack, B. (2013). Reaching women through health information technology: The Gabby preconception care system. American Journal of Health Promotion, 27(3), ES11-ES20.
  7. Jack, B., Bickmore, T., Hempstead, M., Yinusa-Nyahkoon, L., Sadikova, E., Mitchell, S., Gardiner, P., Adigun, F., Penti, B., Shulman, D., & Damus, K. (2015). Reducing preconception risks among African American women with conversational agent technology. Journal of the American Board of Family Medicine, 28(4), 441-U141. doi:10.3122/jabfm.2015.04.140327
  8. Agricola, E., Pandolfi, E., Gonfiantini, M. V., Gesualdo, F., Romano, M., Carloni, E., Mastroiacovo, P., & Tozzi, A. E. (2014). A cohort study of a tailored web intervention for preconception care. BMC Medical Informatics and Decision Making, 14. doi:10.1186/1472-6947-14-33
  9. Agricola, E., Gesualdo, F., Carloni, E., D’Ambrosio, A., Russo, L., Campagna, I., Pandolfi, E., & Tozzi, A. E. (2016). Investigating paternal preconception risk factors for adverse pregnancy outcomes in a population of Internet users. Reproductive Health, 13. doi:10.1186/s12978-016-0156-6
  10. Van Dijk, M. R., Huijgen, N. A., Willemsen, S. P., Laven, J. S., Steegers, E. A., & Steegers-Theunissen, R. P. (2016). Impact of an mHealth platform for pregnancy on nutrition and lifestyle of the reproductive population: A survey. JMIR mHealth and uHealth, 4(2), e53. doi:10.2196/mhealth.5197

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