Research Update

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

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4.2 Recommendations and Implications

The following research recommendations are aimed at improving data collection efforts and identifying valuable research questions so that a better understanding of the patterns of women's use of alcohol during pregnancy can be determined.

Data Collection

Implement systematic surveillance practices to monitor women's use of alcohol and other drugs during pregnancy in all provinces and territories.^xxi This should include the development of more valid and reliable measures of substance use during pregnancy, taking into account current experiences with surveys, interviews and screening instruments. For example, standardize the use of gender-appropriate definitions of heavy drinking on surveys (e.g. binge drinking as 4 or more drinks on one occasion for women and 5 or more for men), and relate alcohol-specific questions only to the period of each respondent's pregnancy. Attention should also be given to ongoing methodological problems, such as small sample sizes of pregnant women and the under-use of qualitative methodologies.

1. In conjunction with the implementation of systematic surveillance practices to monitor women's use of alcohol and other drugs during pregnancy, develop research environments and relationships that are respectful, non-judgmental, sensitive and acknowledge the reasons why women use alcohol in pregnancy. These conditions may facilitate openness and comfort for women to provide more candid information.

2. Adopt a woman-centred approach to data collection. Such an approach would facilitate understanding in addressing women's use of alcohol in pregnancy. Although there is no agreement on an overarching definition of a women-centred approach to research, it is commonly understood to be research that contributes to the improvement of individual and group conditions for women and men, stemming from social, political and economic improvement for women.

3. Avoid selection bias in studies. Attempts should be made to compile a random sample of pregnant women and avoid focusing only on women who access services for their drinking.

4. Use tailed methods for collecting information on sub-populations and marginalized groups (e.g. street-involved girls and young women, sex trade workers). It is necessary to approach such studies by fully accounting for the range of risk factors the women face and the influence of these on their alcohol consumption.

5. Analyze existing national datasets and publish regular and timely reports on women's use of alcohol during pregnancy and the use of alcohol by women of childbearing age. Substance use trends should continue to be documented for pregnant women using the NLSCY and CCHS. The analysis of data on women of childbearing age is important, given the frequency and levels of alcohol use documented for this population together with the prevalence of unplanned pregnancies.

6. Conduct longitudinal studies on alcohol use, starting with girls/young women who are of childbearing age. This is important because of the high rates of heavy drinking in this population.

7. Make available and accessible diagnostic services in Canadian communities to determine incidence and prevalence rates of FASD.

Research Questions

8. Under what conditions are women able to reduce or stop alcohol consumption once pregnancy has occurred? What contributes to pregnant women's continued use during pregnancy and/or after delivery?

9. What factors are underlying increased rates of alcohol use among adolescent girls and young women as well as increased levels of consumption?

10. Is the apparent decline in the rate of alcohol consumption during pregnancy from the mid to late 1990s accurate, and if so, why? How does this relate to 2000 rates in Canada?

11. What health risks do women pose to their bodies, physically, socially, mentally and spiritually, when they drink alcohol while pregnant? In addition to FAS/FASD, how do these risks potentially negatively influence pregnancy outcome?

12. Although the number of women who report using alcohol during pregnancy are generally low, as are the reported levels of use, there are still women using and some at high levels. Are there co-existing conditions in the lives of these women that have not been identified or fully examined?

13. What combinations of alcohol and other substances (e.g. benzodiazepines^xxii), alcohol and life circumstances (e.g. trauma), and alcohol and other harmful behaviours (e.g. poor nutrition) are common among women of childbearing age?

xxi. The Canadian Perinatal Surveillance System (CPSS), as part of the Public Health Agency of Canada, is launching a Maternity Experiences Survey to monitor important indicators during pregnancy, such as alcohol and drug use. This survey will be the first of its kind in Canada. The target population is all women who have had a live birth in the months prior to the survey. Phase I was completed in January 2001 with the testing of sampling strategies and the data collection instrument. Health Canada and CPSS are currently developing the National Survey.

xxii. Benzodiazepines are central nervous system depressants.

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