Research Update

Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue

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2 Methodology

A systematic analysis of existing, published data on women's use of alcohol during pregnancy was undertaken. The data were collected from available literature spanning the medical and social science disciplines.^viii The primary inclusion criteria were post-1995,^ix Canadian, peerreviewed literature on women's use of alcohol during pregnancy. When Canadian literature was lacking, as it was particularly with respect to evaluated responses, the international (primarily US) literature was consulted. Also, the applicable FAS and FASD literature was more heavily drawn upon in the response section.^x For all sections, research reports, reviews, discussion documents and personal communication with field experts were drawn on when limited evidence-based literature was located.^xi Although no attempt was made to rate studies for this update, the greatest attention was paid to experimental and quasi-experimental studies. For the most part, the review of patterns of women's alcohol use during pregnancy and their characteristics and circumstances is confined to published survey data and localized case file review and qualitative studies. Every attempt was made to account for the most recent Canadian data from the growing number of Canadian data sources.

The research update proceeds from a review of the epidemiology of women's use of alcohol, particularly in relation to pregnancy, to a review of the literature on effective responses. The literature on responses to women's use of alcohol during pregnancy is dominated with the prevention of FASD. This review reflects this and gives priority to peerreviewed studies that used an experimental and quasi-experimental design. The responses sections use the framework proposed by the Institute of Medicine,26 distinguishing between universal, selective and indicated prevention of prenatal alcohol use problems. Training and professional development, and policy and legal responses are also discussed. Because there are few peer-reviewed Canadian evaluation studies, most of the empirical literature is US-based. Although it was beyond the scope of this report to identify all relevant non-peerreviewed Canadian literature, an attempt was made to identify key Canadian evaluation reports and other documents that reflect recommended practices.

viii. The following databases were searched for (English-only) literature: Arts and Humanities Citation Index; Canadian Centre on Substance Abuse Library Collection Database; Centre for Addiction and Mental Health Library Database; Criminal Justice Abstracts; Digital Dissertations; DrugScope; ETOH Archival Database (Alcohol and Alcohol Problems Science); ERIC; MEDLINE; PsycINFO; Sociological Abstracts; and Social Science Citation Index. The key words used in the search were alcohol, alcohol use, drug, substance, pregnancy, alcohol warning label, prenatal, and addiction. Additional terms and their derivations were used to access the literature specific to responses, such as treatment and prevention. These terms were searched in a variety of ways depending on the database and were not searched together. For instance, terms were searched as a “topic” in the Arts and Humanities Citation Index, whereas they were searched as “keywords” in Sociological Abstracts. Over 100 articles were selected for review.

The following Web sites were searched for (English-only) literature:

Alberta Alcohol and Drug Abuse Commission (AADAC); Best Start: Ontario's Maternal Newborn and Early Child Development Resource Centre; Canadian Institute for Health Information (CIHI); Canadian Institute of Health Research (CIHR); Canadian Mental Health Association (CMHA); Canadian Paediatric Society (CPS); Canadian Public Health Association (CPHA); Centre of Excellence for Early Childhood Development (CEECD); Centres for Excellence in Women's Health (CEWH); Cochrane Reviews; FAS/E Support Network of BC; FASlink; FASWorld; Fetal Alcohol Syndrome topic page, National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention, USA; Government of Canada; Health Canada; Motherisk; Public Health Agency of Canada (PHAC); SAMHSA Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence; Society of Obstetricians and Gynaecologists of Canada (SOGC); Status of Women Canada (SWC); and The Women's Addiction Foundation. For the majority of Web sites, searches employed the keywords "pregnan*" AND "alcohol." This search string varied slightly from Web site to Web site depending on the sophistication of each Web site's search utility. The majority of Web sites allowed for keyword searches using only one or two terms (pregnan* & alcohol). A limited number of Web sites used “advanced search” options, whereby the entire Web site or the publications/library catalogue could be searched. Advanced search options often allowed for the use of specific subject headings (pregnant, pregnancy, alcohol) in conjunction with date parameters. Therefore, from one Web site to another the effectiveness of the search utility varied greatly. As a result, the most relevant results were found by conducting a broad search for "pregnan*" or "pregnan* AND alcohol" and reviewing the list of results. In addition, Web pages, PDF documents and/or sections of Web sites were scanned for relevant material. Over 50 documents were selected for review.

ix. Pre-1995 articles were included when more recent literature was not located and/or it was a significant document.

x. This document, therefore, in some ways can be viewed as an update to Health Canada's 2000 report Best Practices: Fetal Alcohol Syndrome/Fetal Alcohol Effects and the Effects of Other Substance Use During Pregnancy, prepared by Gary Roberts and Jo Nanson.

xi. This method corresponds with Rehm's liberal approach to inclusion criteria for reviews. Rehm, J. (1999). Review papers in substance abuse research. Addiction, 94(2), 173–176.

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