Connecting Internationally at the 7th European FASD Alliance Conference

We had the opportunity to share and discuss the work being undertaken on FASD in a number of countries last week at the EUFASD conference in Madrid. It was so interesting to hear of the successes and challenges that other countries are facing in prevention work. In this blog, we highlight some of the interesting international work we heard about at the conference.

South Africa (SA) – Dr. Leana Olivier is the CEO of the Foundation for Alcohol Related Research (FARR) which, among other interesting work, offers a perinatal support program called Healthy Mother Healthy Baby (HMHB) in communities across South Africa. Similar to Canadian efforts, FARR is concerned with increasing screening and brief support efforts by health care providers so that referral to the HMHB program is made possible for women who need support to reduce/stop drinking when pregnant. Dr. Olivier presented on the challenge of using the AUDIT-C screening tool when looking to identify at-risk drinking by women who live in communities where heavy drinking is a norm, as is common in SA. Their research found that some questions in the AUDIT-C were producing misleading results, impacting the identification of women who are drinking in a harmful way and the referral and diagnosis pathways. The result was that  only 21% of women were identified as high risk by the AUDIT-C tool when actually 62.5% of women were engaging in binge drinking. The question “Has anyone expressed concern about your drinking” was a key example resulting in under identification. It is well known that women’s substance use is often influenced by partners, including in contexts of coercive control, and thus expressions of concerns about a woman’s drinking are unlikely to be made. Additionally, the norm of heavy drinking may also impact the likelihood of concerns being expressed about drinking in pregnancy. Dr. Olivier’s presentation underlined how it is key: to validate screening tools with women and subpopulations of women taking into consideration the realities of women’s lives, to broaden our view to take into consideration community norms, and to pair screening with conversations by health and social care providers who can more adequately explore risk and make referrals.

Finland – The Federation of Mother and Child Homes and Shelters of Finland shared information about the ‘Holding Tight’ model that includes 6 live-in Mother and Child Homes and 8 outpatient units designed to support substance using pregnant women and families with babies. Their aim is to support mothers’ efforts to stay abstinent during pregnancy, as well as to support early parenting and healthy development. The live-in treatment period lasts from pregnancy to several months postpartum, after which there is an open care period, lasting from several months to about 2-3 years. They see the success of this holistic model as linked to: a period of treatment that is sufficient in length of time, intensive support provided for parenthood and abstinence, confidential and warm relationships with staff, and treatment that offers respect and peer support.

US – A group at New York University are in the process of conducting a study of a hybrid intervention called Safe Start, with OB-GYN clinics serving low income women in Texas (in a state where reproductive health outcomes are less than optimal) to determine its contribution to reducing alcohol use in pregnancy. The intervention includes a self paced computer-delivered alcohol reduction intervention designed to increase knowledge and motivation, a nurse delivered component to reinforce the computer delivered content and to address women’s questions, and booster sessions at 2 follow-up visits. They are hoping to recruit 600 women to this study.

UK – Researchers from Bristol looked at questions and topics raised by women accessing an online parenting forum (Mumsnet) over a 10-year period (2002 to 2022). They were interested in knowing how the topics aligned with the changes in UK guidance on alcohol. The most common topic thread involved concerns about alcohol consumption before pregnancy recognition. Another frequent topic was seeking advice about the safety of alcohol consumption during pregnancy and the use of non-alcoholic products. The authors concluded that online discussions within the UK parenting forum indicate that users were often unclear on guidance and risks associated with prenatal alcohol, and used the platform to seek information and reassurance from peers.  

We presented on the digital handbook about wraparound programming that built on the findings of the Co-Creating evidence study. Many conference attendees followed up to express their interest and appreciation for this relatively advanced work and our leadership in the field. Through poster presentations we also offered lessons about the role of alcohol policy in FASD prevention efforts and the need for information and support in the preconception period, highlighting the development of our booklet for those planning a pregnancy.

Beyond prevention, the conference included sessions on research that described current efforts to advance diagnosis and evidence-based interventions with individuals with FASD and their families.  It is clear that we are in early stages of understanding and acting on what needs to be done to prevent FASD and support those who live with it. Many countries discussed the challenge of addressing stigma and norms around alcohol use, and garnering government support. Having the opportunity to connect internationally with others in the field inspires the further necessary work!