Here’s a brief summary on the some of the latest research published on fetal alcohol spectrum disorder (FASD).
Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: analysis of prenatal secondary outcomes in an ongoing randomized controlled trial (Open-Access)
Previous studies from the U.S. have shown that pairing public health nurses with families has been beneficial for child mental health and cognitive development, as well as maternal health. Researchers studied the impact of pairing public health nurses with socioeconomically disadvantaged, expecting families in B.C. on the rates of substance use. They found that:
- There were relatively low rates of alcohol consumption before 28 weeks gestation, with 5.7% of participants reported having drunk alcohol in the previous month.
- There is no evidence that having a Nurse-Family Partnership in this community will significantly reduce the rates of prenatal alcohol exposure in this community compared to other public health initiatives.
- Rates of cigarette use and cannabis use during pregnancy were high before 28 weeks (25.6% and 25.6% respectively).
- A Nurse-Family Partnership combined with existing services was effective at reducing cannabis use during pregnancy (researchers saw an 8.5% reduction) compared to just existing services (4.7% reduction).
- Nurse-Family Partnerships were effective at reducing the participants’ cigarette count but did not significantly effect the rates of prenatal cigarette use in this population.
Key Takeaway: Nurse-Family Partnerships show promise at reducing some types of prenatal substance exposure in socioeconomically disadvantaged communities when combined with other harm reduction approaches. These partnerships are not anticipated to be an effective solution for reducing the rates of prenatal alcohol exposure.
Catherine, N.L.A., Boyle, M., Zheng, Y., McCandless, L., Xie, H., Lever, R., Sheehan, D., Gonzalez, A., Jack, S.M., Gafni, A., Tonmyr, L., Marcellus, L., Varcoe, C., Cullen, A., Hjertaas, K., Riebe, C., Rikert, N., Sunthoram, A., Barr, R., MacMillan, H. & Waddell, C. (October 27, 2020). Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: analysis of prenatal secondary outcomes in an ongoing randomized controlled trial. CMAJ Open. 8(4). doi: 10.9778/cmajo.20200063
More Prevention Research
Early diagnosis of fetal alcohol spectrum disorder (FASD) can improve outcomes for children. Researchers surveyed 20 adults with FASD who were diagnosed between 1 and 11 years old prior to the study to determine if diagnosis in adulthood had the same benefits as it does in childhood. They found that:
- The average age of diagnosis for the participants was 25.4, but it ranged anywhere from 18 to 45 years.
- All of the participants followed through with at least one of the recommendations outlined in the diagnostic assessment process and 75% followed up with 2 or more.
- Participants reported that receiving a diagnosis was beneficial. It gave them some relief, self-acceptance, and a greater understanding of themselves. It also helped them better understand the supports they need.
- There were high rates of mental health problems (55%), unemployment (85%), and unstable housing (10%), which is consistent with other research. However, because of the limitations of the study, the rates of challenges in this population are expected to be higher than stated.
- At the time of diagnosis, only 10% of participants were receiving disability income support. However, by the time of follow up, that number rose to 90%. Likewise, before diagnosis, only 15% were eligible for developmental supports, which rose to 85% after diagnosis.
- When asked, participants were most proud of their job, school, or volunteer work, their family accomplishments, and/or their improved lifestyle. For example, as one participant said: “It may not sound like a lot but I’m really happy to be back on my feet. I’ve been clean and off drugs for the past 7 years. I volunteer at a rescue shelter.”
Key Takeaway: An FASD diagnosis is beneficial for adults as well as children. A diagnosis can help to improve access to financial supports and physical services, and can improve individuals’ personal understanding and self-awareness.
Valerie K. Temple, Sonal Prasad, Svetlana Popova & Ann Lindsay. (2020). Long-term outcomes following Fetal Alcohol Spectrum Disorder (FASD) diagnosis in adulthood. Journal of Intellectual & Developmental Disability. DOI: 10.3109/13668250.2020.1824612
More Diagnosis Research
People exposed to alcohol and/or tobacco prenatally may experience increased mental health challenges. The authors of this study used data from 1168 Australian mother-child pairs to see if there was an association between prenatal alcohol and tobacco exposure and an increase in depressive symptoms in offspring. The researchers found that:
- Prenatal exposure to six or more standard drinks per week increased the risk of depressive symptoms in offspring.
- Prenatal exposure to tobacco increased the risk of depressive symptoms in offspring at the age of 17.
- The risk of depressive symptoms increased as exposure to alcohol and tobacco increased.
- Early screening and identification of prenatal and tobacco exposures could potentially reduce depressive symptoms.
- Among participants assessed, 5% were prenatally exposed to alcohol and 20% were prenatally exposed to tobacco.
Key Takeaway: Young adults prenatally exposed to alcohol have a greater risk of depressive symptoms than unexposed youth. Early identification and prevention of prenatal substance exposures could potentially mitigate depression in young adults.
Duko, B., Pereira, G., Betts, K., Tait, R., Newnham, J., & Alati, R. (2020). Prenatal alcohol and tobacco use and the risk of depression in offspring at age of 17 years: findings from the Raine Study. Journal of Affective Disorders. DOI: https://doi.org/10.1016/j.jad.2020.10.030
More Intervention Research
Many parents in the child welfare system have substance use challenges, which means that their children may be at risk for prenatal exposure to substances. Researchers in the U.S. conducted a literature review of papers published from 2006 to 2018 to find out if child welfare agencies had policies and procedures that outlined steps to take when working with this population. They found that:
- Over 22 years only 32 articles were published that fit the criteria. 16 were research/evaluation articles and 16 were policy/practice articles.
- 75% of research studies addressed both prenatal alcohol and prenatal drug use. Of the 16 policy articles, 6 addressed alcohol exposure only and 6 addressed both drug and alcohol exposure.
- 68.8% of research articles looked at newborns (<1 year).
- There was no policy/practice literature addressing child welfare staff training or understanding of prenatal substance exposures.
- There was very little research on child welfare policies and practices about identifying and caring for children with prenatal substance exposures.
Key Takeaway: Children with prenatal substance exposures experience increased challenges in the child welfare system and need specialized supports. However, in the U.S., there is very little evidence-based literature that outlines best practices for child welfare agencies to identify and support these individuals.
Tammy Richards , Jacquelyn Bertrand, Sharon Newburg-Rinn , Heather McCann, Erin Morehouse & Erin Ingoldsby (2020): Children prenatally exposed to alcohol and other drugs: what the literature tells us about child welfare information sources, policies, and practices to identify and care for children. Journal of Public Child Welfare. DOI: 10.1080/15548732.2020.1814478
More Child Welfare Research
Comparing Outcomes of Children and Youth with Fetal Alcohol Spectrum Disorder (FASD) in the Child Welfare System to those in Other Living Situations in Canada: Results from the Canadian National FASD Database
This report provides a complete overview of the Saskatoon Mental Health Strategy (MHS) Court, an initiative that coordinates treatment for justice-involved people with mental health issues, cognitive issues, or FASD, and diverts them from the traditional court system. Although no people with FASD were identified in this data set, the results suggest that this initiative is beneficial for people with mental health challenges and cognitive difficulties.
Zidenberg, A., Kerodal, A. G., Jewell, L. M., Mathias, K., Smith, B., Luther, G., & Wormith, J.S. (2020). Evaluation of the Saskatoon Mental Health Strategy (MHS) Court: Outcome and cost analysis. Centre for Forensic Behavioural Science and Justice Studies – University of Saskatchewan, Saskatoon, SK.
More Justice Publications
To ensure that research is relevant and beneficial to the FASD community, community members need to be involved in discussions about research priorities. Researchers surveyed a sample of Australians to understand priority areas for research about FASD and alcohol use during pregnancy. They found that:
- 7 of the top 10 priorities identified for Aboriginal and non-Aboriginal community members were the same.
- The top 10 priorities identified could be grouped into three overarching themes, which often intersected with one another:
- Understanding influences on prenatal alcohol exposure (PAE)
- Preventing PAE and promoting maternal and child health
- Improving FASD diagnosis and management
- Priorities for Aboriginal communities highlight:
- The role of families and communities in supporting pregnant women and people with FASD
- The image of intergenerational trauma
- The need for a holistic approach to supporting healthy pregnancies
- Priorities for non-Aboriginal communities highlight:
- The diagnosis and management of FASD
- The role of the healthcare system
Key Takeaways: There is a need for community participation in the identification of priority areas for research on FASD, alcohol and pregnancy.
Finlay-Jones, A., Elliott, E. J., Mayers, D., Gailes, H., Sargent, P., Reynolds, N., Birda, B., Cannon, L., Reibel, T., McKenzie, A., Jones, H., Mullan, N., Tsang, T. W., Symons, M. and Bower, C. (2020) “Community Priority setting for Fetal Alcohol Spectrum Disorder Research in Australia”, International Journal of Population Data Science, 5(3). doi: 10.23889/ijpds.v5i3.1359.
This blog is intended to provide a summary of some of the recent literature on FASD. For a more complete and nuanced understanding of these findings, please read the full research papers. Please note that this is not a comprehensive list of all research published on FASD in October 2020.