Article Review: Protective Factors for Child Development

Protective factors for child development at age 2 in the presence of poor maternal mental health: Results from the All Our Babies (AOB) pregnancy cohort 

Authors: Sheila McDonald, Heather Kehler, and Suzanne Tough                                  Journal: BMJ Open

What is this study about? This study looked at what combination of factors were most protective of developmental delay at age two among children exposed to poor maternal health.

Who are the participants? The study team recruited a cohort of 3000 pregnant women. Two years later, 1596 mother-child dyads completed questionnaires. Of these 1596 pairs, 305 mothers (27%) were determined to be high risk for having poor mental health. The results we describe below are based on information from these 305 mother-child pairs from the Calgary area.

Why is this study important? The authors explain that maternal depression…

View original post 721 more words

Fetal Alcohol Spectrum Disorder: A Significant Global Problem

fetal-acohol-spectrum-disorder-minA study of the global prevalence of fetal alcohol spectrum disorder (FASD) estimates that it affects as many as 8 out of 10,000 children, highlighting the need to improve public education about the potential harm of drinking alcohol during pregnancy.

Drinking alcohol during pregnancy may harm the developing fetus. A wide range of resulting health problems have been observed including defects of the heart, kidneys or bones, problems with brain development, low IQ, and hyperactivity. This group of conditions is known as fetal alcohol spectrum disorder (FASD). Affected children may have mild to severe health problems. However, it is not possible to predict the severity from the amount or timing of their mother’s alcohol consumption. There is no safe amount or safe time of alcohol consumption for a pregnant woman.

It is important to know the prevalence of a condition in order to look at patterns of occurrence.  This helps to direct the focus of resources for prevention and treatment. Researchers in Toronto have completed a comprehensive analysis of the available data on FASD to estimate its global prevalence in children and young people. They recently published their findings in JAMA Pediatrics.

The research team reviewed the medical literature to identify high-quality studies that reported the prevalence of FASD among children and youth in the general population. A total of 24 studies including 1,416 children and youth (0-16 years) were included in the analysis.

They found that the global prevalence of FASD among children and youth in the general population was estimated to be around eight affected children per 1000 people. The WHO European Region had the highest prevalence, approximately 20 per 1000 people, and the WHO Eastern Mediterranean Region had the lowest, approximately 0.1 per 1000 people. At a country level, South Africa had the highest prevalence of FASD (111 per 1000 population), followed by Croatia (55.3 per 1000 population), and Ireland (47 per 1000 population).

Using selected studies, the team also looked at the prevalence of FASD amongst special populations, compared to the general population. They estimated that FASD was 15.6-24.6 times higher in Aboriginal populations, 5.2-67.7 times higher among children in care, 30.3 times higher in a correctional population, 23.7 times higher in a population with low socioeconomic status and 18.5 times higher among a population in psychiatric care.

The estimates of the global prevalence of FASD show that it is a significant health problem. It has an impact on large numbers of children and youth and a high cost of health services. Fetal alcohol spectrum disorder is a largely preventable condition. The researchers suggest there is a need for wider public education about the potential harm of drinking during pregnancy. They also suggest a screening system to identify problem drinking before and during pregnancy. These strategies could be widely implemented at relatively little cost.

Written by Julie McShane, Medical Writer


Lange S, Probst C, Gmel G, et al. Global prevalence of fetal alcohol spectrum disorder among children and youth. A systematic review and meta-analysis. JAMA Pediatrics, published online August 21, 2017. Doi:10.1001/jamapediatrics.2017.1919.

Retrieved from:

Your developing baby: Building the brain is like building a house

Your baby’s growth and development is guided by the brain. Brain development begins during pregnancy and continues into the adult years. In the developing embryo, neurons start to form by 6 weeks of pregnancy. By 16 weeks of pregnancy, 250,000 neurons are being created every minute.

Building the brain is like building a house:

In a house…

  • The structure is built starting on the ground.
  • The base or foundation is set, the walls are built and the electrical system is wired—all in an exact order.
  • The electrical wiring allows all parts of the house to work together.
  • A strong foundation supports everything that is built on top of it.

In the brain…

  • The brain’s basic structure forms during pregnancy.
  • The ‘wiring’ of the brain starts as the brain’s neurons begin to connect with each other.
  • Connections in the brain continue to develop through an ongoing process until the early adult years.
  • These connections are how the brain communicates. Communication happens between neurons in the brain, and between the brain and the rest of the nervous system.
  • Early brain development lays the foundation for future learning, behaviour and health.

Your newborn’s brain is like a house that has just been built. The walls and doors are up but the wiring isn’t all in place. There are still a lot of changes to come.

Caring for yourself during pregnancy is important because it supports your child’s brain development, which affects all parts of your child’s growth and development.

The quickly developing brain is very sensitive to harmful environments such as too much stress, certain illnesses and being exposed to harmful chemicals.

This site suggests ways to create healthy environments to help your baby’s developing brain during pregnancy. More information on helping to build your child’s brain through the early years.

  • When stress becomes too much

    Everyone has some amount of stress. But some things cause so much stress it can be harmful to your health, and your baby’s developing brain and overall health. If you are going through something stressful that isn’t going away or for which you have no support, it’s important to get help. Talk to your health care provider or call Health Link toll-free in Alberta at 8-1-1.

Retrieved from:

HPHC logo

Discussing alcohol use with women – does the SBIR model need rearranging?


How to discuss alcohol use with women of childbearing age is a topic in women’s health that is getting more attention and focus. Within FASD prevention circles, we have understood that women and their partners may not know about the risks of alcohol consumption during pregnancy or may drink before they realize they are pregnant.  Thus, they benefit from discussion of what they know, what the evidence says and options for action.

Screening, Brief Intervention, and Referral (SBIR) has long been known as an approach to guide clinicians when assessing risky alcohol use. But is the SBIR model the best approach to discussing alcohol with women of childbearing age and their partners? What are the approaches currently used across Canada? How should we discuss alcohol with women and who should do it? What works best according to the evidence?

The Centre of Excellence for Women’s Health (CEWH), the Canadian Centre on Substance Use and Addiction (CCSA), and the University of British Columbia Midwifery Programhave teamed up to answer these questions. The Dialogue to Action on Discussing Alcohol with Women project has three high-level objectives: to identify current approaches; to summarize and share the available evidence; and, to promote best practices.


Nancy Poole of CEWH and Audrey McFarlane of CanFASD and Lakeland Centre for FASD at the Dialogue to Action regional meeting in Edmonton.

In order to meet their first objective, project researchers are currently conducting 12 regional meetings across Canada with physicians, midwives, nurses, and service providers in, sexual health clinics, violence against women services, alcohol and drug services, and Indigenous health services.

They are learning what is already being done and sharing what is known about promising practices and existing resources that can guide discussions and referrals. Participants are suggesting resources and tools – such as webinars, guidelines, policies and programs – that will be helpful in conducting meaningful discussions and support in their communities with women who use legal substances – or soon to be legal, like cannabis.

One early emerging idea arising from this project is that “screening” may be currently placed in the wrong location in the mnemonic list of SBIR.  Starting with brief information sharing and support (the relationship first), followed by screening/referral can be more engaging, trauma-informed, collaborative and person-centred. The rearranged approach prioritizes eliciting and appreciating individual needs and perspectives.

So the list might become BISR or even BISBIRT – repeating the conversation about substance use and ideas for action after screening as well as before it.

This project is one of several projects addressing FASD in Canada being funded by the Public Health Agency of Canada. You can learn more about all the projects here:

Read more:

Conversations on alcohol: Women, their partners, and professionals – April 23, 2017

Preconception Interventions: Trending or Mainstream? – July 21, 2016

Alcohol and FASD: It’s not just about women  – June 6, 2017

Retrieved from:


Text messaging program may help pregnant women kick the smoking habit

quit-for-youWASHINGTON, DC (Oct. 2, 2017) — An intensive text messaging program provides some pregnant women help in fighting the urge to light up a smoke, according to a study out today.

“Our findings show that a text messaging program helped some groups of pregnant women quit smoking during pregnancy,” says lead author Lorien C. Abroms, ScD, MA, an associate professor of prevention and community health at Milken Institute School of Public Health(Milken Institute SPH) at the George Washington University. “The study’s findings suggest a potential new quitting strategy, especially for those later in their pregnancies and older pregnant women.”

The researchers recruited pregnant women who were already enrolled in an established text messaging program called Text4baby. Text4baby has been found to have a positive health impact on alcohol consumption during pregnancy–but not smoking. Abroms and her team wanted to find out if a more intensive mobile phone program called Quit4baby would be more effective. To find out, the team recruited nearly 500 pregnant women, who smoked an average of 7 cigarettes per day and wanted more help to quit.

Quit4baby is targeted to smoking cessation and sends more text messages–between 1 and 8 per day aimed at bolstering a pregnant woman’s resolve to quit. The messages help educate the women about the health risks associated with smoking and they are interactive–allowing a woman to text back for more help if she is experiencing a craving or goes back to smoking.

After three months, 16 percent of the women who were enrolled in both Text4baby and Quit4baby had quit compared with just 11 percent of women getting just Text4baby. However, the difference between the two groups did not reach statistical significance, the authors say.

The more intensive intervention did seem to help two subgroups quit smoking at least in the short run, Abroms says. The combo of Text4baby and Quit4baby helped women age 26 and older and those in the second and third trimester of pregnancy quit through the delivery date and in some cases beyond. However, the researchers found that the resolve to quit seemed to disappear postpartum as many of these women started smoking again.

Very little help is provided to pregnant smokers who want to quit so the study’s findings are important, especially if the strategy can be adjusted to be more effective, Abroms says. Despite the health risks, about 10 percent of women smoke throughout their pregnancy in the United States.

Additional studies must be done to find out if Quit4baby can be paired with other smoking cessation tools in order to provide long-term help for pregnant women who want to kick their smoking habit for good, she says.

The study, “A Randomized Trial of Text Messaging for Smoking Cessation in Pregnant Women,” was published October 2 in the American Journal of Preventive Medicine.

Retrieved from:

Evidence Is ‘Sparse’ That Light Drinking In Pregnancy Is Risky, But So Is Evidence That It’s Safe



No question, the evidence that heavy drinking during pregnancy is risky is incontrovertible.

Fetal alcohol spectrum disorders (FASDs), which affect babies born to mothers who drank heavily while pregnant, involve physical as well as behavioral and learning problems. Organizations such as the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics say there is no safe amount of alcohol to drink while pregnant.

But what does the scientific evidence actually say about drinking an occasional glass of wine or bottle of beer while pregnant?

Not much, according to a recent paper in the journal BMJ Open. The authors reviewed 24 studies about light drinking in pregnancy and pooled their results.

Evidence about the effects of drinking the equivalent of two pints of beer or two small glasses of wine per week is “sparse,” the researchers concluded. “Our extensive review shows that this specific question is not being researched thoroughly enough.”

But, as the authors of the paper note, absence of evidence is not the same as evidence of absence. In other words, just because scientists haven’t investigated whether light drinking in pregnancy is risky doesn’t mean that it isn’t. After all, there’s no evidence that it’s safe, either.”Ours was a very comprehensive systematic review of all the high-quality studies on this topic, and we didn’t find any evidence of a beneficial effect,” co-author Luisa Zuccolo, a senior research fellow in epidemiology at the U.K.’s University of Bristol, told me. “If anything, there was some evidence of harm for outcomes such as being born small for gestational age and being born preterm.”

“Ours was a very comprehensive systematic review of all the high-quality studies on this topic, and we didn’t find any evidence of a beneficial effect,” co-author Luisa Zuccolo, a senior research fellow in epidemiology at the U.K.’s University of Bristol, told me. “If anything, there was some evidence of harm for outcomes such as being born small for gestational age and being born preterm.”

Until recently, though, U.K. guidelines advised women to avoid drinking alcohol while trying to conceive or during the first trimester but didn’t proscribe it altogether, even though animal studies have shown that the fetal brain is susceptible to the effects of alcohol at virtually every stage of development. The guidelines, published in 2008, advised women not to drink more than the equivalent of one or two glasses of wine or bottles of beer in a week.

But in January 2016, the U.K. Department of Health published new alcohol guidelines that state the safest approach for women who are considering getting pregnant or are pregnant is not to drink alcohol at all.

Zuccolo called such advice “spot on.”

“Most countries follow the precautionary principle when advising on fetotoxic substances,” she said. “The reason is that we don’t know what levels are safe, plus, they are likely to differ from baby to baby, so no point in risking it. The only surely safe level is no alcohol.”

I asked Zuccolo why scientists haven’t conducted more research into the effects of drinking small amounts of alcohol during pregnancy. “I think many studies have been published that look at the whole spectrum of drinking, not just light drinking, and some looked at light and moderate drinking combined, but very few focused on the dose we were interested in, which is very small amounts.”

Meanwhile, despite the solid evidence about the risks of drinking heavily while pregnant, some women still do, researchers reported recently in the journal Reproductive Toxicology. Based on a comprehensive search of the scientific literature for quantitative research about binge-drinking during pregnancy, they estimated how common it was in different countries.

They found that the percentage of pregnant women who had at least one drinking binge, defined as four or more standard alcoholic drinks per occasion, ranged from 0.2% in Singapore and Brunei Darussalam to  13.9% in Paraguay.The United States was closer to Singapore and Brunei Darussalam than to Paraguay, Shannon Lange, the first author of the study and a

The United States was closer to Singapore and Brunei Darussalam than to Paraguay, Shannon Lange, the first author of the study and a PhD candidate at Toronto’s Center for Addiction and Mental Health, told me.

Based on 19 studies, Lange and her collaborators estimated that in the United States, 3.1% of pregnant women binge on alcohol, representing about a fifth of the 14.8% of pregnant women who consume at least one drink. Interestingly, in the United Kingdom, where guidelines until recently didn’t totally ban the practice, approximately 40% of pregnant women have at least one drink, and roughly 8% or 9% of them binge drink, according to Lange’s study.

“The findings of the current study are alarming and have significant long-term implications, as FASD (fetal alcohol spectrum disorders) is a lifelong disability,” Lange and her coauthors wrote.



Retreived from:

Alcohol or Drug Use During Pregnancy


During pregnancy, everything you eat, drink, or take into your body affects you and your growing baby (fetus). Pregnant women often need to make changes to have a healthy pregnancy, such as eating better or exercising. But one of the most important things you can do when you are pregnant is to avoid alcohol and drugs.

Alcohol and drugs can cause problems for you during your pregnancy and when it is time for your baby to be born. They can also affect your baby both before and after he or she is born. They can:

  • Affect your baby’s size.
  • Affect how your baby’s heart, lungs, and brain work.
  • Cause lifelong learning, emotional, and physical problems for your child.

Using alcohol and illegal drugs is not safe for you or your baby.

If you use alcohol or drugs, the best time to stop is before you get pregnant. But sometimes pregnancy is unexpected. Since drugs and alcohol can harm your baby in the first weeks of pregnancy, the sooner you can stop, the better.

Even some over-the-counter and prescription medicines aren’t safe to take when you’re pregnant. Tell your doctor about all the drugs and supplements you take. He or she can help you decide what medicines are safe to take during pregnancy.

How do alcohol and drugs affect pregnancy?

Substance Possible effect on mother Possible effect on fetus, newborn, and child
  • Effects not known
  • Long-term memory problems
  • Learning problems
  • Seizures
  • Addiction, withdrawalsymptoms after birth
  • Breathing problems
  • Small size at birth
  • Physical and mental development problems
  • Life-threatening breathing problems
  • Convulsions or seizures
  • Coma
  • Low birth weight
  • Problems with how bones form
  • Learning problems
  • Low birth weight
  • Heart and lung problems
  • Confusion
  • Delusions
  • Hallucinations
  • Risk of overdose
  • Withdrawalsymptoms after birth
  • Learning problems
  • Emotional problems
  • Behaviour problems

Alcohol or drug misuse: How to stop

You may already know that alcohol and drugs can harm you and your baby. But it can still be hard to stop. Changing your behaviours isn’t easy. Some people need treatment to help them quit using drugs or alcohol. Here are some things you can do:

Take the first step. Admitting that you need help can be hard. You may feel ashamed or have doubts about whether you can quit. But your treatment can be successful only if you make the choice to stay sober. Remember that many people have struggled with these same feelings and have recovered from substance use problems. Quitting now will help you and your baby.

Tell someone. If you can’t stop drinking or using drugs on your own, tell someone that you need help. There are people and programs to help you. Your doctor is a good place to start. He or she can talk to you about treatment options. Your doctor may be able to give you medicines that can ease withdrawal symptoms. Or he or she may be able to find a hospital or clinic that you can go to for treatment.

You might also want to tell a friend or loved one. Having someone on your side that you know well, telling you that you can do this for yourself and your baby, is a very important part of recovery.

Make changes to your life. It can be hard to stop using alcohol or drugs when it has become a part of your life. You may need to make changes to your routine, like not being around certain people, or not going to places where you used to drink or use drugs. Ask friends and family to support your changes.

Consider counselling. Counselling helps you make changes in your life so you can stay sober. You learn to cope with tough emotions and make good choices. You may get counselling in a group or one-on-one.

Join a support group. Groups like Alcoholics Anonymous (AA) and Narcotics Anonymous were formed to help people who want to stop doing things that add no value to their lives. You may have more success quitting if you share your story, hear the stories of those who may be struggling and those who have successfully quit, and find someone to partner with.

Retrieved from:

« Older Entries Recent Entries »