Research Update

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

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5.2 Recommendations and Implications

As in previous section, the research recommendations are aimed at improving data collection efforts and identifying valuable research questions so that a better understanding of the characteristics of women who use alcohol during pregnancy and the circumstances of their use can be determined. The outlined policy and program implications aim to do the same. Many of the research recommendations made in the prior section also apply here.

Data Collection

• Increase research attention on the characteristics and circumstances of women who consume alcohol while pregnant and the contexts in which they drink (e.g. influential role of partners and peers). This can be achieved through both survey data and more qualitative, representative small-scale studies.
• Do not concentrate studies only on currently over-represented sub-populations (e.g. poor, young women, Aboriginal women). For example, the CCHS and US studies suggest that women with the highest incomes and in the oldest age group are more likely to drink alcohol during pregnancy.
• Continue to collect data and conduct further analyses on women who binge drink during pregnancy (in particular young women) and those who are alcohol dependent, as these forms of consumption present the greatest potential harm to the fetus.
• Develop well-designed, multi-site, multi-year qualitative studies that can gather in-depth information on the women's characteristics and circumstances of women who drink at varying levels and frequency during pregnancy.
• Conduct further studies on women who have given birth to FAS-diagnosed children to learn more about the risk factors for drinking during pregnancy and/or the reasons for stopping or reducing their use.
• Several the data recommendations on women's use of alcohol during pregnancy are also applicable here, including the development of research environments in which women are comfortable in discussing their lives, adoption of a womancentred approach to data collection, analysis of existing data, implementation of longitudinal studies, publicly release of results in a timely manner, and the collection and analysis of data by province and territory.

Research Questions

• What are the associations between alcohol use and the use of other substances (e.g. illicit drugs, tobacco, caffeine, prescription and non-prescription drugs) during pregnancy and for women of childbearing age?
• Do women view alcohol use during pregnancy as a high-risk behaviour (and how does it compare with other behaviours, such as injection drug use)?
• Why are younger and older women the most frequent drinkers? What do they have in common, if anything, to explain this?
• Why are younger women more likely to binge drink during pregnancy? What is the association between binge drinking and income?
• What are the associations between life factors identified as contributing to women's use of alcohol while pregnant, with particular emphasis on the influence of her partner?
• How does women's use of alcohol during pregnancy relate to co-occurring disorders in her life, such as depression?
• What are the unique needs and services required by pregnant women who are alcohol dependent, compared with those who are binge drinkers and, if applicable, women who use alcohol occasionally during pregnancy?
• What contributes to the reported higher rates of alcohol use during pregnancy among women in Quebec and lower rates in the Atlantic Provinces? Are there methodological and/or cultural explanations for these differences?

Policy and Program Implications

• Increase resources for pre- and postnatal care for women at risk, such as women drinking heavily during pregnancy.
• Identify evidence-based interventions that help women reduce or stop their use of alcohol during pregnancy, in particular those interventions that use a variety of strategies to reach different sub-populations of women.
• Design and evaluate campaigns to succinctly convey to the Canadian public the well-documented risks associated with drinking while pregnant, and tailor the information to specific audiences. For example, an abstinence-based message may not be the best means to reach some audiences (in particular women who currently drink at heavy levels while pregnant). Consider including information on general behaviours that contribute to a healthy pregnancy (e.g. nutrition) as well as those that are harmful (e.g. smoking).
• Support perinatal and substance use treatment services that address the factors in women's lives that surround their substance use.
• Raise awareness and sensitivity among all agencies and persons who work within the addictions field about the unique risks of the female population they serve, as the women who are accessing treatment may be pregnant or become pregnant.
• Provide training to agencies and human service workers in follow-up services on asking women about their alcohol use during pregnancy. Careful consideration also must be given to the positions of the people who are asking the questions, as they may be perceived to be in positions of power (e.g. child welfare).
• prenatal alcohol use problems.

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