Sarkar, M., Burnett, M., Carrière, S., Cox, L. V., Dell, C. A., Gammon, H., Geller, B., Koren, G., Lee, L., Midmer, D., Mousmanis, P., Schuurmans, N., Senikas, V., Soucy, D., & Wood, R. (2009). Screening and recording of alcohol use among women of child-bearing age and pregnant women. The Canadian Journal of Clinical Pharmacology = Journal Canadien De Pharmacologie Clinique, 16(1)

A woman’s alcohol use during pregnancy is one of the top preventable causes of birth defects and developmental disabilities that are known as fetal alcohol spectrum disorders (FASD). The social and economic burden of FASD is substantial. Lifetime direct tangible costs per individual related to health care, education and social services in Canada have been estimated to be $1.4 million. Screening women of child-bearing age and pregnant women and recording their alcohol consumption is a practical process to identify and evaluate women at-risk and to identify potentially exposed infants. The FASD Advisory Workgroup proposes the following three levels of screenings which should be done on consenting women: Level I screening involves practice-based approaches that can be used by health care providers when talking to women about alcohol use, such as motivational interviewing and supportive dialogue. Level II screening includes a number of structured questionnaires that can be used with direct questioning (TLFB) or indirect /masked screening (AUDIT, BMAST / SMAST, CAGE, CRAFFT, T-ACE, TWEAK). Level III screening includes laboratory-based tools that can be used to confirm the presence of a drug, its level of exposure and determine the presence of multiple drugs. There are challenges and limitations in the use of the screening and assessment tools outlined. For example, the single question about alcohol use and the various questionnaires rely on a woman to provide details about her alcohol use. There is no consensus on the appropriate screening to use across Canada as each provincial / territorial jurisdiction, health care organization and healthcare provider uses a variety of formal and informal screening tool. In addition, there are inconsistent processes across Canada for the recording of the alcohol use in a woman’s chart and the transfer of the information to the infant and the child’s health records. The FASD Advisory Workgroup proposes eleven recommendations to improve the screening and recording processes for alcohol use in women of child-bearing age and pregnant women.

Scheeres, J. J., & Chudley, A. E. (2002). Solvent abuse in pregnancy: A perinatal perspective. Journal of Obstetrics and Gynaecology Canada : JOGC = Journal d”Obstetrique Et Gynecologie Du Canada : JOGC, 24(1)

OBJECTIVE: To review the scope and sequelae of solvent abuse in women presenting to a Manitoba teaching hospital. METHODS: Fifty-six patient charts with a diagnosis of solvent abuse in pregnancy were identified through computer search in the medical records of Winnipeg Health Sciences Centre, General Hospital. These charts were reviewed and data obtained from birthing records and associated pediatric charts. RESULTS: Renal tubular acidosis was diagnosed in three patients (5.3%). Two patients (3.6%) had adverse neurological sequelae. One patient was diagnosed with brain damage, including expressive aphasia. Twelve patients (21.4%) delivered preterm infants. Nine infants (16.1%) had major anomalies. Seven infants (12.5%) had fetal alcohol syndrome (FAS)-like facial features. Six neonates (10.7%) had hearing loss. CONCLUSION: Substance abuse in pregnancy is associated with severe maternal and neonatal sequelae. Physicians must be aware of this increasing problem in the obstetrical population and assistance should be offered to each woman, ideally before a woman becomes pregnant, but at least at the first contact a pregnant woman makes with the health care community.

Scott, S., & Dewane, S. L. (2007). Clinical competencies for professionals working with children and families affected by fetal alcohol spectrum disorder. Journal of Psychological Practice, 14(1), 67-92.

Fetal Alcohol Spectrum Disorder (FASD) is a constellation of physical, behavioral, emotional, and cognitive symptoms that arise as a result of a pregnant mother’s in-utero alcohol consumption. FASD is of serious concern to behavioral health practitioners due to high prevalence rates, soaring economic costs, and lifelong implications of the disorder. National prevalence rates for Fetal Alcohol Syndrome (FAS) range from 0.2 to 1.5 per 1,000 live births; prevalence rates for FASD were reported to occur approximately three times as often (Centers for Disease Control, 2004). It is critical that practitioners working with children and families are aware of FASD and are prepared to screen for the disorder. This article provides a comprehensive overview of FASD including diagnostic processes, relevant clinical applications, and vital preventative interventions. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)

Senikas, V. (2009). Three national programs address fetal alcohol spectrum disorder. Journal of Obstetrics and Gynaecology Canada : JOGC = Journal d’Obstétrique Et Gynécologie Du Canada : JOGC, 31(2), 172-186.

Stade, B., Ali, A., Bennett, D., Campbell, D., Johnston, M., Lens, C., Tran, S., & Koren, G. (2009). The burden of prenatal exposure to alcohol: REVISED measurement of cost. Canadian Journal of Clinical Pharmacology, 16(1)

In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. Only one study has examined the cost of FASD in Canada. In that study we did not include prospective data for infants under the age of one year, costs for adults beyond 21 years or costs for individuals living in institutions. Objective To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level. Methods Cross-sectional study design was used. Two-hundred and fifty (250) participants completed the study tool. Participants included caregivers of children, youth and adults, with FASD, from day of birth to 53 years, living in urban and rural communities throughout Canada participated. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs for each in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD. Results Total adjusted annual costs associated with FASD at the individual level was $21,642 (95% CI, $19,842; $24,041), compared to $14,342 (95% CI, $12,986; $15,698) in the first study. Severity of the individual’s condition, age, and relationship of the individual to the caregiver (biological, adoptive, foster) were significant determinants of costs (p < 0.001). Cost of FASD annually to Canada of those from day of birth to 53 years old, was $5.3 billion (95% CI, $4.12 billion; $6.4 billion). Conclusions Study results demonstrated the cost burden of FASD in Canada was profound. Inclusion of infants aged 0 to 1 years, adults beyond the age of 21 years and costs associated with residing in institutions provided a more accurate estimate of the costs of FASD. Implications for practice, policy, and research are discussed. © 2009 Canadian Society of Pharmacology and Therapeutics. All rights reserved.

Stade, B., Ungar, W. J., Stevens, B., Beyen, J., & Koren, G. (2007). Cost of fetal alcohol spectrum disorder in canada. Canadian Family Physician, 53(8), 1303-1304.

QUESTION: I have heard that thousands of Canadian kids are affected by fetal alcohol spectrum disorders. Has there been any attempt to estimate what it costs our society? ANSWER: In a recent Canadian study, the lifetime cost of fetal alcohol spectrum disorders was estimated at $1 million per case. With an estimated 4000 new cases yearly, this translates to $4 billion annually.

Stade, B. C., Bailey, C., Dzendoletas, D., Sgro, M., Dowswell, T., & Bennett, D. (2009). Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. Cochrane Database of Systematic Reviews (Online), (2)

BACKGROUND: It is estimated that more than 20% of pregnant women worldwide consume alcohol. Current research suggests that alcohol intake of seven or more standard drinks (one standard drink = 13.6 grams of absolute alcohol) per week during pregnancy places the baby at risk of serious, lifelong developmental and cognitive disabilities. Psychological and educational interventions may help women to reduce their alcohol intake during pregnancy. OBJECTIVES: To determine the effectiveness of psychological and educational interventions to reduce alcohol consumption during pregnancy in pregnant women or women planning pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (August 2008), CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE (1966 to November 2007), EMBASE (1980 to November 2007), CINAHL (1982 to November 2007), Counsel.Lit (1980 to November 2007), PsycLIT (1974 to November 2007) and PsycINFO (1967 to November 2007) and checked cited references from retrieved articles. SELECTION CRITERIA: Randomized controlled trials examining the effectiveness of psychological and educational interventions for reducing consumption of alcohol among pregnant women, or women planning for pregnancy. DATA COLLECTION AND ANALYSIS: At least two review authors independently extracted information from the results sections of the included studies. MAIN RESULTS: Four studies met the inclusion criteria (715 pregnant women), and reported on at least one of the outcomes of interest. We performed no meta-analyses as the interventions and outcomes measured in the studies were not sufficiently similar. For most outcomes there were no significant differences between groups; and results relating to abstaining or reducing alcohol consumption were mixed. Results from individual studies suggest that interventions may encourage women to abstain from alcohol in pregnancy. There was very little information provided on the effects of interventions on the health of mothers and babies. AUTHORS’ CONCLUSIONS: The evidence from the limited number of studies suggests that psychological and educational interventions may result in increased abstinence from alcohol, and a reduction in alcohol consumption among pregnant women. However, results were not consistent, and the paucity of studies, the number of total participants, the high risk of bias of some of the studies, and the complexity of interventions limits our ability to determine the type of intervention which would be most effective in increasing abstinence from, or reducing the consumption of, alcohol among pregnant women.

Stade, B. C., Stevens, B., Ungar, W. J., Beyene, J., & Korean, G. (2006). Health-related quality of life of canadian children and youth prenatality exposed to alcohol. Health and Quality of Life Outcomes, 4

Background: In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. Objective: To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. Methods: A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with FASD were calculated. A one-sample t-test was used to compare mean HRQL scores of children and youth with FASD to those from the Canadian population. Results: Mean HRQL score of children and youth with FASD was 0.47 (95% CI: 0.42 to 0.52) as compared to a mean score of 0.93 (95% CI: 0.92 to 0.94) in those from the general Canadian population (p < 0.001). Children demonstrated moderate to severe dysfunction on the single-attributes of cognition and emotion. Conclusion: Children and youth with FASD have significantly lower HRQL than children and youth from the general Canadian population. This finding has significant implications for practice, policy development, and research. © 2006 Stade et al; licensee BioMed Central Ltd.

Thanh, N. X., & Jonsson, E. (2009). Costs of fetal alcohol spectrum disorder in alberta, canada. Canadian Journal of Clinical Pharmacology, 16(1)

Although many programs targeting fetal alcohol spectrum disorder (FASD) are implemented, the province of Alberta is still lacking information on costs of FASD. Objectives To estimate the costs of FASD in Alberta based on available US and Canadian research on costs of FASD, and Alberta data. Methods Two types of costs were estimated. The annual long-term economic cost of FASD, which referred to a projected amount of money incurred by lives of the cohort of children born with FASD each year, was estimated by multiplying the lifetime cost of caring for each child born with FASD with the number of children born with FASD each year. The annual short-term economic cost of FASD, which referred to the amount of money incurred by people who are presently living with FASD, was estimated by using a FASD cost calculator online at http://www.online-clinic.com. Both were societal costs adjusted to 2008 Canadian dollars. Results The annual long-term economic cost from the disorders rose from $130 to $400 million each year for the Alberta economy. The annual short-term economic cost for FASD in Alberta was from $48 to $143 million, and the daily cost for FASD in Alberta was from $105 to $316 thousand. Conclusion These numbers suggest a need for a provincial FASD prevention strategy. The costs of FASD can be used to evaluate the benefits of prevention programs to society. © 2009 Canadian Society of Pharmacology and Therapeutics. All rights reserved.

Tough, S., Clarke, M., & Cook, J. (2007). Fetal alcohol spectrum disorder prevention approaches among canadian physicians by proportion of Native/Aboriginal patients: Practices during the preconception and prenatal periods. Maternal and Child Health Journal, 11(4), 385-393.

Objective: To examine if physician knowledge and practices related to fetal alcohol spectrum disorders (FASD) and its prevention vary based on the proportion of Native/Aboriginal patients served. Methods: A questionnaire was mailed to a national random sample of Canadian physicians between October 2001 and May 2002. The main outcome measure was responses regarding knowledge about and prevention of FASD. Bivariate analysis was used to compare practice patterns and knowledge between those who cared for a higher proportion (?10%) and a lower proportion (<10%) of Native/Aboriginal patients. Results: The overall response rate was 39.4% (1,700/4,313), and 21.4% of physicians reported that ?10% of their clinical practice was comprised of Native/Aboriginal patients. Those caring for a greater proportion of Native/Aboriginal patients were significantly (p <0.05) more likely to discuss sexual and emotional abuse (approximately 20% vs. 10%) and a history of addictions (52% vs. 44%) with women of childbearing age. In prenatal interviews, they were also significantly (p <0.05) more likely to routinely include a history of addictions treatment (70% vs. 62%) and drinking prior to pregnancy awareness (91% vs. 85%), as well as more likely to ask about evidence of alcohol related defects in other children (50% vs. 37%), and discuss the drinking pattern of the patient’s partner (25% vs. 18%). Conclusions: Physicians who had a higher proportion of Native/Aboriginal patients appeared to be more attuned to the issues of FASD and to assess risk in a more comprehensive manner. However, support for improved identification of women at risk and referral opportunities is warranted. © Springer Science+Business Media, LLC 2007.