Author Archives: edmontonfetalalcoholnetwork

Science Daily: Women with intellectual and developmental disabilities have almost double the rate of repeat pregnancy

sd-logoWomen with intellectual and developmental disabilities have nearly double the rate of having another baby within a year of delivering compared to women without such disabilities, according to a new study published in CMAJ (Canadian Medical Association Journal).

Rapid repeat pregnancy within one year of a previous live birth is associated with smaller babies, preterm birth, neonatal death and other adverse effects. It also indicates a lack of access to reproductive health care, such as pregnancy planning and contraception.

About one in 100 adults have an intellectual or developmental disability, such as autism-spectrum disorder, Down syndrome, fetal alcohol syndrome and other nonspecific conditions that cause intellectual and developmental limitations.

Researchers analyzed data on 2855 women with intellectual and developmental disabilities compared with 923 367 women without such disabilities who had a live birth between 2002 and 2013. They found that 7.6% of women with these disabilities had another baby within a year, compared to 3.9% of women without these disabilities.

“Women with intellectual and developmental disabilities are more likely than those without such disabilities to be young and disadvantaged in each marker of social, health, and health care disparities. They experience high rates of poverty and chronic physical and mental illness, and have poor access to primary care,” says Hilary Brown, an adjunct scientist at Institute for Clinical Evaluative Sciences (ICES) and lead author of the study.

Rapid repeat pregnancies in women with intellectual and developmental disabilities ended in induced abortion (49%), live birth (33%) and pregnancy loss (18%) compared with induced abortion (59%), pregnancy loss (22%) and live birth (19%) in women without these disabilities.

“This study shows that current efforts to promote reproductive health might not be reaching women with intellectual and developmental disabilities and that there is a lot more we can do to educate and support these women in relation to pregnancy planning and contraception,” adds Brown.

The study was conducted by researchers from University of Toronto; Women’s College Research Institute; ICES; St. Michael’s Hospital and Centre for Addiction and Mental Health, Toronto, Ontario.

It was funded by the Province of Ontario through its research grants program.

Journal Reference:

  1. Hilary K. Brown, Joel G. Ray, Ning Liu, Yona Lunsky, Simone N. Vigod. Rapid repeat pregnancy among women with intellectual and developmental disabilities: a population-based cohort study. Canadian Medical Association Journal, 2018; 190 (32): E949 DOI: 10.1503/cmaj.170932

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Research: Maternal hair testing to disclose self-misreporting in drinking and smoking behavior during pregnancy



Drinking and smoking behavior were assessed during pregnancy through maternal hair analysis.

Ethyl glucuronide and nicotine were measured in maternal hair as biomarkers.

Gestational drinking was significantly more misreported than tobacco smoking.

Maternal hair analysis revealed an alarming misreported prevalence of alcohol use during pregnancy.


This study aimed to objectively verify smoking and drinking behavior during pregnancy and to disclose self-misreporting through maternal hair analysis. A total of 153 women attending a university hospital in Barcelona (Spain) were selected and interviewed after delivery, on their smoking and drinking habits during pregnancy.

A 9-cm hair strand was collected and analyzed by liquid chromatography tandem mass spectrometry for the presence of nicotine (NIC) and ethyl glucuronide (EtG) as biomarkers of tobacco andalcohol consumption, respectively. Concentrations of EtG <7 pg/mg hair and ≥30 pg/mg hair in the 0–3-cm hair segment have been used to assess, respectively, total abstinence and chronic excessive consumption in the previous 3 months, with repetitive moderate drinking lying in the interval 7–30 pg EtG per mg hair. Hair NIC less than 1 ng/mg hair indicates non-exposure to tobacco smoke while hair NIC indicates daily active smoking.

In the interview, 28.1% of women declared to have smoked occasionally during gestation, while only 2.6% stated to have consumed alcohol on more than one occasion during pregnancy. Hair testing of smoking biomarkers disclosed that 7.2% of women remained active smokers during the whole pregnancy (hair NIC: 3.21–56.98 ng/mg hair), 16.3% were passive non-smokers or occasional smokers (hair NIC: 1.04–2.99 ng/mg hair), while 76.5% were not exposed to any cigarette smoke (hair NIC < limit of quantification – 0.91 ng/mg hair).

Conversely, alcohol hair biomarkers showed that only 35.3% of women were totally abstinent during gestation (hair EtG: 3.89–6.73 pg/mg hair), while 62.7% drank a non-negligible amount of alcohol during pregnancy (hair EtG: 7.06–26.57 pg/mg hair), and 2% were chronic excessive drinkers (hair EtG: 35.33–47.52 pg/mg hair). Maternal hair analysis has shown to be significantly more sensitive than interviews in revealing an alarming misreported prevalence of alcohol use during pregnancy.

These findings stress the need to use objective measures to assess alcohol exposure and to consider the inclusion of targeted actions to reduce alcohol consumption in maternal-child health policies.

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    Have you read: A Handbook For Beautiful People

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    When twenty-two-year-old Marla finds herself unexpectedly pregnant, she wishes for a family, but faces precariousness: an uncertain future with her talented, exacting boyfriend, Liam; constant danger from her roommate, Dani, a sometime prostitute and entrenched drug addict; and the unannounced but overwhelming needs of her younger brother, Gavin, whom she has brought home for the first time from deaf school. Forcing her hand is Marla’s fetal alcohol syndrome, which sets her apart but also carries her through.

    When Marla loses her job and breaks her arm in a car accident, Liam asks her to marry him. It’s what she’s been waiting for: a chance to leave Dani, but Dani doesn’t take no for an answer. Marla stays strong when her mother shows up drunk, creates her own terms when Dani publicly shames her, and then falls apart when Gavin attempts suicide. It rains, and then pours, and when the Bow River finally overflows, flooding Marla’s entire neighbourhood, she is ready to admit that she wants more for her child than she can possibly give right now. Marla’s courage to ask for help and keep her mind open transforms everyone around her, cementing her relationships and proving to those who had doubted her that having a fetal alcohol spectrum disorder does not make a person any less noble, wise or caring.

    About the author:

    Jennifer Spruit grew up in Lloydminster, AB/SK, alongside pump jacks, farm machinery, and its endless, sparkling winter sky. Her affair with writing began with a Grade One story about a tractor, but she has since become engaged in writing about people. She studied Creative Writing at UBC and now lives in Courtenay, on Vancouver Island, where she enjoys playing folk and bluegrass, teaching kids, and rowing a blue canoe. Her work has appeared in Arc, The Antigonish Review, Prairie Fire Magazine, and SubTerrain Magazine, among others. A Handbook for Beautiful People is her debut novel. She is currently at work on a second novel.


    “…there is a lot going on in A Handbook for Beautiful People, much of it very good. Spruit’s chapter titles (“Ravioli” “Eggplant” “Honeydew”) allude to the growing fetus in a creative way. Marla’s fetal alcohol syndrome manifests itself in myriad behaviours and decisions, something the condition is said to do. It makes her both unpredictable and believable, a good combination. Spruit’s use of point-of-view, which shifts fluidly between different characters, is impressive and regularly means we’ll see scenes unfold in different ways for different people, as we do at a Christmas dinner that takes place in a Chinese restaurant. The novel’s techniques are consistently intriguing.”

    “Wonderful, heartfelt, heartbreaking–I can’t recommend this novel highly enough.”
    –Annabel Lyon, author of The Sweet Girl

    Click here for purchase and ordering information


    Mental Health for Life


    Mental health is key to our well-being. We can’t be truly healthy without it. It involves how we feel, think, act, and interact with the world around us. Mental health is about realizing our potential, coping with the normal stresses of life, and making a contribution to our community. It may be more helpful to think of good mental health as thriving. Good mental health isn’t about avoiding problems or trying to achieve a ‘perfect’ life. It’s about living well and feeling capable despite challenges. Mental well-being is bigger than the presence or absence of a mental illness. People who live with a mental illness can and do thrive, just as people without a mental illness may experience poor mental health.

    Each of our paths to mental well-being will be unique. We all have our own goals, our own challenges, our own talents, and our own supports. But good mental health is in everyone’s reach. Below, find tips and activities to help you take a look at your own well-being, discover your strengths, and take action.

    Build a healthy self-esteem

    Self-esteem is more than just seeing your good qualities. It is being able to see all your abilities and weaknesses together, accepting them, and doing your best with what you have. Self-esteem means recognizing your unique talents and abilities, and using that confidence to follow your goals and interests without comparing yourself to others.

    Activity: Build confidence

    Take a good look at your good points. What do you do best? Where are your skills and interest areas? How would a friend describe you? Now, look at your weak points. What do you have difficulty doing? What things make you feel frustrated? Now, which list was easier to write? Remember that all of us have our positive and negative sides. We build confidence by developing our weaker areas and regularly reminding ourselves of the things we’re comfortable with and proud of.

    Build positive support networks

    Good relationships take effort, whether it’s relationships with family members, friends, or other important supporters. It takes courage to reach out and time to build trust. But social support is a very important part of mental health. People in our networks can offer many different kinds of support, like emotional support, practical help, and alternate points of view. Support can come from family and friends, neighbours, co-workers or classmates, faith communities, clubs or support groups for specific problems.

    Activity: Make time

    Make time just to be with important people in your life. Make time for simply having fun and enjoying each other’s company, and time for serious conversations.

    Get involved

    Being involved in things that really matter to us provides a great feeling of purpose and satisfaction. You make a difference, no matter how big or small your efforts. Getting involved connects you with others in your community who share similar interests or values and connects you to groups of people you might not normally meet. It can help you learn new skills, build confidence, and see your own experiences in a different way.

    Activity: Volunteer

    Be a volunteer. Read to children at your local library, visit people in a hospital or care facility, serve on a committee or board of your favourite charity, clean up your favourite park or beach, or simply help a neighbour.

    Build resiliency

    Resiliency means coping well with problems, stress, and other difficult situations. Problems and stress are a normal part of life. Situations like accidents or illness, unexpected life changes, and conflict happen to everyone. Resiliency is what helps you look at the situation realistically, take action when you can make changes, let go of things you can’t change, and recognize the helpful supports in your life. Your resiliency toolkit might include skills like problem-solving, assertiveness, balancing obligations and expectations, and developing support networks. While some people learn these skills during treatment for mental health problems, we should really think of them as skills for everyone. You can learn more about these skills online, in books, through community organizations, or through your health care provider.

    Activity: Build your own toolkit

    Set aside time to think about the resiliency tools you already have. This might include skills like structured problem-solving or people who can help you during difficult situations. Remember to include strategies that have worked for you in the past. Keep your list on hand and use it as a reminder when you need help. It’s also a good way to see where you might want to build new skills or supports.

    Recognize your emotions

    Emotional well-being is not about being happy all the time. Feeling sad, angry, and anxious at times is part of being human. Emotional well-being involves expressing our emotions in a way that respects everyone. Bottling up our feelings doesn’t respect our own experiences, just as lashing out because we feel angry may not respect others. Emotional well-being also includes recognizing what influences our emotions, discovering how our emotions affect the way we think or act, taking action when our emotional response isn’t helpful, and learning to accept our emotions—even the difficult ones.

    Activity: Identify and deal with your moods

    Find out what makes you happy, sad, joyful or angry. What calms you down? Learn ways to deal with your moods. Share joyful news with a friend, and find support when you feel sad. Physical exercise can help you deal with your anger or anxiety. Keep a stack of your favourite funny cartoons, stories, or videos for times when you need to laugh. And don’t forget the power of music to lift you up or calm you down.

    Take care of your spiritual well-being

    Spiritual well-being means getting to know ourselves, discovering our values, and learning to be at peace with who we are. It also involves finding and connecting to something bigger than ourselves and living with purpose. Spirituality can give us meaning and solace, help us overcome challenges, and help us build connections with others. This may mean religion for some, but it doesn’t have to—it’s really about how we feel on the inside.

    Activity: Connect with yourself

    Set aside quiet, quality time to be totally alone. Try a breathing exercise: count your breaths from one to four, and then start at one again. Or do something you love to do, like dancing, going to a baseball game, building a bird house, going for a hike, or whatever works for you!

    Do you need more help?

    Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area.

    Founded in 1918, The Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.



    New Book, Mothers, Addiction and Recovery: Finding Meaning Through the Journey


    This anthology is a collection of personal accounts, research, treatment approaches and policy commentary exploring women’s experiences of mothering in the context of addiction. Individual chapters focus on a variety of addictions during pregnancy or mothering including misuse of substances, food and smartphones.

    A central theme of the book is the meaning of women’s maternal identity as key to recovery. Part I focusses on women’s lived experiences of mothering through their addiction and recovery. The chapters in part II report findings from studies that have prioritized the perspective of mothers living with addiction. In Part III of this collection, we expand our view of addiction and turn to approaches for supporting mothers of daughters with eating disorders and prevention of smartphone addiction. In part IV, contributors expand on the themes of harm reduction and restorative, healing approaches to the treatment of mothers’ addictions that have echoed throughout the chapters of this book. The anthology concludes with a gendered analysis and critique of addiction programs and policy.

    “Mothers, Addiction and Recovery: Finding Meaning Through the Journey” is a timely and innovative book, which provides a significant exploration of the topic of addiction. The book effectively highlights mothers’ unique experiences of addiction from their own voices, provides a comprehensive overview of current scholarly research and theorization on addiction, and offers a critical discussion of addiction treatment and recovery programs and practices. The authors provide invaluable insight into the various ways that women mother in the context of addiction, the challenges and struggles they encounter, and the strengths and capacities they demonstrate despite the difficulties and stigmatizations that they face. This book should be read by policy makers, academics, service providers, the wider general public, and anyone who seeks to gain a greater understanding of the unique experience of mothering in the context of addiction.”
    —CAROLINE MCDONALD-HARKER, Professor, Department of Sociology & Anthropology, Mount Royal University, Calgary, Alberta

    Purchase details can be found here

    Environmental toxins are seen as posing risks during pregnancy


    Leading up to and during pregnancy, women are told to avoid alcohol and cigarettes, to make sure they get enough folate and omega-3 fatty acids, and to get adequate sleep and exercise. Most are told little or nothing about reducing their exposure to chemicals despite evidence suggesting that ingredients in plastics, vehicle exhaust and cosmetics additives can have profound impacts on babies’ health.

    In recent years, the field of ­maternal-fetal medicine has started to respond. In 2013, the American College of Obstetricians and Gynecologists issued a committee opinion, reaffirmed this year, “calling for timely action to identify and reduce exposure to toxic environmental agents while addressing the consequences of such exposure.” The International Federation of Gynecology and Obstetrics voiced a similar opinion in 2015, and the following year nearly 50 prominent U.S. doctors and scientists created Project TENDR: Targeting Environmental Neuro-Developmental Risks to call for reducing chemical exposures that can interfere with fetal and children’s brain development.

    Yet, a recent survey suggests that most doctors don’t discuss exposure to pollutants with their pregnant patients.

    “Fetal development is a critical window of human development, and so any toxic exposure during that time, during pregnancy, doesn’t only have a short-term effect at that moment, but really an effect that lasts the entire lifetime,” said Nathaniel DeNicola, who was on the committee that reaffirmed the ACOG opinion.

    In 2011, University of California at San Francisco (UCSF) researcher Tracey Woodruff and colleagues reported finding traces of dozens of harmful chemicals in 99 percent or more of the 268 pregnant women whose urine they analyzed; among them were organochlorine pesticides, perchlorate, phthalates and cancer-causing compounds found in vehicle exhaust and smoke.

    Click here to read full article!

    Drink, drank, drunk: what happens when we drink alcohol in four short videos

    Alcohol is a depressant, a diuretic, and a disinfectant. These generally aren’t pleasant attributes, but people have been drinking alcohol for thousands of years – some of the earliest written texts mention or contain recipes for beer, and pottery shards from China show people may have been making alcohol as far back as 7,000BCE.

    So what is this special chemical that we’ve loved to drink for so long?

    Well, there are many types of alcoholic drinks – fizzy and flat, hot and cold, fermented and distilled – but all of the alcohol we drink as humans is ethanol based.

    The process of how ethanol gets from the glass into your brain is not straight forward. And how quickly it gets to your brain (and whether or not it’s quickly broken down by your liver) is down to a variety of factors, one of which it’s actually very easy for us to control: whether or not we’ve eaten.

    Let’s take a look at what happens after that first sip of alcohol.

    The organ that takes on the biggest burden of processing ethanol in our body is the liver.

    The liver is one of our largest and most important organs and it performs hundreds of functions, including converting the nutrients in food into something our bodies can actually use.

    But there’s a reason we apologise to our livers if we’ve a big night: the liver’s other job is processing any toxic substances we ingest into something harmless, or removing them from the body altogether. Which makes it the perfect organ to deal with ethanol.

    Most – about 90 to 98% – of the ethanol we consume is processed in the liver, with the remainder either removed in our urine, sweat or when we exhale.

    The liver processes alcohol in two distinct steps. The first involves an enzyme called alcohol dehydrogenase (ADH), which breaks down ethanol into a chemical called acetaldehyde. Unfortunately acetaldehyde is actually a toxin, which is why there’s a second stage to the process.

    Another enzyme – aldehyde dehydrogenase (ALDH) – quickly breaks down acetaldehyde into acetate, which is harmless. It’s then either excreted, used to make other molecules or broken down into water and carbon dioxide.

    And it’s while your liver is slowly processing the ethanol in your system (as quickly as it can) that the remainder makes its way to your brain.

    A complicating factor for determining how drunk we’re likely to feel after a certain amount of alcohol is that different people will process alcohol at different speeds.

    There are many things that impact how quickly the body processes alcohol, including your weight, body composition and hormones, the number of drinks you’ve had and how quickly you drank them.

    But roughly, the liver can effectively process about 1 standard drink in an hour, give or take. Women and men do process alcohol at different speeds, which is why alcohol campaigns often suggest women consume fewer drinks in the first hour than men.

    The problems start when you consume more than a standard drink per hour – which is not hard to do, given an average bottle of beer has 1.2 to 1.4 standard drinks, and a restaurant sized glass of wine is about 1.5 standard drinks.

    While it can be hard to match up exactly how many drinks equate to how intoxicated you’ll feel, your blood alcohol concentration (or BAC) gives a pretty good indication of what most people will feel as they ingest escalating amounts of alcohol.

    So what does that actually look like?

    Alcohol makes us feel increasing pleasure and relaxation as we drink more, while simultaneously hampering both our ability to make decisions and even move capably, which can lead to dangerous consequences.

    The actual recommended intake for adults is just two standard drinks a day, which is less than a pint of beer. Realistically, people often drink more than this. So the important thing is to be aware of your limits, plan for how much you intend to drink, eat a meal before you begin drinking, and drink responsibly.

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