An Update on the Evidence: This years’ annotated bibliography of articles published in 2023 just released!

This year’s Annotated Bibliography of Articles Published in 2023 was just released and includes 104 articles from 20 countries.

Each year, researchers associated with the Prevention Network Action Team (pNAT) of the Canada FASD Research Network search the academic literature for articles related to alcohol use in pregnancy and Fetal Alcohol Spectrum Disorder (FASD) prevention. Articles are reviewed for relevancy, identified by topic and country, and the findings are summarized.

Countries with the highest number of articles published were the US (43 articles), Australia (20 articles), Canada (17 articles), South Africa (11 articles) and the UK (8 articles). The findings were organized using a four-part prevention model (below) used by the pNAT to describe the wide range of work that comprises FASD prevention.

Canada’s 4-part prevention model

This year, 32 articles described the prevalence, influences, and factors associated with alcohol use in pregnancy, 11 articles described Level 1 prevention efforts, 24 articles described Level 2 prevention efforts, 18 articles described Level 3 prevention efforts, 13 articles described Level 4 prevention efforts, 9 articles described supportive alcohol and child welfare policy, and 13 articles described stigma, ethical issues, and systemic approaches.

Factors Associated with Alcohol Use in Pregnancy

As with previous years, we continued to see a wide range of structural, informational, stress, social determinants of health, and preconception health related factors that were associated with alcohol use during pregnancy. Many factors, including depression, anxiety, socioeconomic status, education status, preconception substance use, and experiences of violence or trauma continued to be reported this year. However, structural factors, such as the normalization of alcohol use, lack of recreational opportunities, stigma, and inadequate and inequitable access to prenatal care were also identified. These findings are congruent with previous research on Levels 3 and 4 that underscored how social pressure and society’s normalization of alcohol use influence individual decision-making capacity.

Highlights from Level 1 Prevention: Broad awareness building

Several articles from Australia described the implementation process and effectiveness of alcohol warning labels. One study described the process and challenges that Australia and New Zealand experienced when implementing alcohol warning labels. The study described that public health advocacy groups were essential in mobilizing and gathering evidence on the importance of alcohol warning labels, testing consumer messaging, and gathering community and political support.

Highlights from Level 2 Prevention: Discussions of alcohol use with all women of childbearing years

Research on Level 2 prevention, like previous years, emphasized the importance of universal screening for alcohol use in the preconception and perinatal periods, as well non-stigmatizing, patient-oriented brief interventions. Early screening for alcohol use was found to reduce the incidence of FASD, particularly when paired with healthcare provider education and targeted support for women with substance use concerns.

Highlights from Level 3 and 4 Prevention: Specialized, holistic support from pregnant and postpartum women experiencing alcohol and other health and social issues

There was a larger emphasis on trauma-informed practice in this year’s literature. Effective strategies for integrating trauma-informed approaches into support for pregnant and postpartum women included training for staff, collaboration across service providers, peer support, and an emphasis on building relationships and trust in women’s substance use responses.

Supportive Alcohol and Child Welfare Policies

Last year, we added a new category on supportive alcohol and child welfare policies. In this new category, several studies described the relationship between alcohol policies and pregnant women’s substance use treatment. One study found that when alcohol was women’s primary substance, mandatory reporting was associated with greater substance use treatment admissions. However, alcohol warning labels were associated with fewer treatment admissions. Other research pointed to how policies and public perspectives on policies to specifically address prenatal alcohol use were more punitive compared to other substance use. This research emphasizes the need for approaches that support, rather than further stigmatize, women.

The annual literature search is intended to provide an update on the current evidence to those involved in FASD prevention in Canada, to inform practice and policy. The members of the pNAT also have the opportunity to discuss the implications of the findings for their work in monthly web meetings.

You can access the annotated bibliography here, and view previous annotated bibliographies here.