The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies
2. Materials and Methods
2.1. Identification of Current Practices in Screening for Alcohol Use in Clinical and Surveillance Contexts
2.2. Identification of Data Collected in the Research Context
3.1. Current Approaches to Screening for Alcohol Use in Clinical and Surveillance Contexts
3.1.1. Structured Screening Tools to Identify Risky Drinking in General and with Pregnant Women
- How often do you have a drink containing alcohol? This is scored (0) Never; (1) Monthly or less; (2) 2 to 4 times a month; (3) 2 to 3 times a week; and (4) 4 or more times a week
- How many standard drinks containing alcohol do you drink in a typical day? This is scored (0) 1 or 2; (1) 3 or 4; (2) 5 or 6; (3) 7 to 9; and (4) More than 10
- How often do you have six or more drinks on one occasion? This is scored (0) Never; (1) Less than monthly; (2) Monthly; (3) Weekly; and (4) Daily or Almost Daily
3.1.2. Questions Used for Surveillance of Alcohol Use by Pregnant Women in Canada
3.2. Summary of Information Asked about Alcohol Use in the Pregnancy Cohorts
3.2.1. Occurrence of Alcohol Use
3.2.2. Frequency of Alcohol Use
3.2.3. Quantity of Alcohol Use
3.2.4. Heavy Alcohol Use
3.2.5. Quit Date
- Asking about frequency of use using standardized categories, such as those in the AUDIT-C ((0) Never (1) Monthly or less (2) 2 to 4 times a month (3) 2 to 3 times a week (4) 4 or more times a week). This allows for a comparison across cohorts, and with other studies that employ the commonly used AUDIT-C, and corrects the problem that some cohorts had the lowest response category of “one or less” or “less than once a month”; i.e., it did not allow for the separation of no drinking, and low-level drinking.
- Asking about the quantity of alcohol consumption using standardized categories such as those in the AUDIT-C which are (0) 1 or 2 (1) 3 or 4 (2) 5 or 6 (3) 7 to 9 (4) more than 10, or a continuous number that can be re-categorized as necessary. The use of visual tools that picture what comprises a standard drink has been found to be helpful when asking about quantity, as many women do not know about standard drink sizes . These tools show pictures of standard amounts of various types of alcohol, which can help women see that any type of alcohol may affect the fetus, given that misconceptions prevail about the benefits of some types of alcohol (e.g., red wine). Using both low and high examples of the number of drinks, such as is in the AUDIT categories, makes room for those who do drink at risky levels to see that researchers are interested in, and can handle, hearing that more than 10 is a possibility.
- Asking about the number of drinks consumed on an occasion, as this has a bearing on the risk of adverse effects on the fetus, as well as on women’s health. It is recommended that “more than 3 drinks on an occasion” be used (or “4 or more”) to align with what is considered risky for all women in Canada’s Low Risk Alcohol Drinking Guidelines (LRDGs). In this way women will be able to see the consistency of any questions about alcohol that are being asked when they are accessing health care services generally, to those asked about consumption before, during and after pregnancy in the context of the pregnancy cohort studies. Learning about these LRDGs and reporting on alcohol consumption, referring to LRDGs guidance, is being recommended in alcohol screening with all men and women.
- Asking about alcohol consumption before pregnancy (using the same standardized response categories for frequency and quantity described above), changes in use since pregnancy recognition, and quit date are also important information that could be gathered uniformly in the pregnancy cohorts. This information is important to understand for several reasons. When linked to birth outcomes, it can provide critical information to understanding risk, for example, the risk associated with any heavy preconception use.
- It is also recommended that, no matter in what context that questions are asked about alcohol use, that this be done in a trauma informed and culturally sensitive way, and in a way that makes it safe for women to report harm reduction efforts, and not only abstinence. Women who have experienced trauma are more likely to drink during pregnancy , and experience more mental health issues . Trauma-informed approaches are based in safety and collaboration , and culturally safe, strengths-based and wellness -oriented approaches are foundational to any discussions of alcohol with Indigenous girls and women [50,51]. Clinical guidelines on the topic of pregnancy and substance use are now making specific recommendations about using trauma informed, equity informed and culturally safe approaches, and such approaches are relevant for the research context as well .
Conflicts of Interest
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|Cohort||Prior to Pregnancy||During Pregnancy||Postpartum|
|Occurrence||Frequency||Quantity||Heavy Drinking||Occurrence||Frequency||Quantity||Heavy Drinking||Occurrence||Frequency||Quantity||Heavy Drinking|
|ABC 2||-||X||-||-||-||X||X||X *||-||X||-||-|
|APrON 4||X||X||X||X *||X||X||X||X *||X||X||X||X *|
|GESTE 7||-||-||-||-||X||-||X||X *||-||-||-||-|
|MIROS C 8||-||-||-||-||X||X||X||-||-||X||-||X|
|Oak 10||-||-||-||-||X||X||X||X *||-||-||-||-|
|Occurrence||N/A||N/A||Alcohol consumption after pregnancy recognition||N/A||During the past week, did you drink alcohol?||Have you had any alcoholic drinks in the last 3 months?||Have you consumed alcohol over the past 3 months?|
|Frequency||Since pregnant, number drink - days/week?|
Since pregnant, number drink - total number days?
|Number of drinks (during pregnancy)||Once you knew you were pregnant, how many days did you drink alcohol (on average)?||During this pregnancy, how often do you drink alcohol in a month?||During the past year/since last meeting, how often do you drink alcohol?||If yes (you had any alcoholic drinks in the last 3 months), number of alcoholic drinks per week? Beer/Spirit/Wine||Over the past 3 months, how often did you drink alcohol?|
|Quantity||On the days that you drank, since you have become pregnant, how many drinks did you usually have?||During pregnancy, how often do you have a drink of beer, wine, liquor, or any other alcoholic beverage?||How many drinks would you typically have when you drank (on average)?||N/A||In the last month, how often did you drink alcohol?||If yes (you had any alcoholic drinks in the last 3 months), quantity (mL) per drink on average? Beer/Spirit/Wine||Currently, during your pregnancy, how many drinks did you have on average during a typical week?|
Over the past 3 months, on average, how many drinks did you have during a typical week?
|Heavy use||Since pregnant, 5 or more drinks - days/week?|
Since pregnant 5 or more drinks - days/month?
|[See quantity]||Since becoming pregnant (including before you knew you were pregnant), did you ever drink 5 or more drinks on any one occasion?||During this pregnancy, have you consumed at least 5 or more drinks of alcohol in a day?|
During this pregnancy, how many time have you consumed at least 5 or more drinks of alcohol in a day?
|During the past year/ since last meeting, how often did you have more than 5 drinks at one time?||N/A||Currently, during your pregnancy, how often did you have four or more drinks at the same sitting or occasion?|
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Poole, N.; Schmidt, R.A.; Bocking, A.; Bergeron, J.; Fortier, I. The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies. Int. J. Environ. Res. Public Health 2019, 16, 2019. https://doi.org/10.3390/ijerph16112019
Poole N, Schmidt RA, Bocking A, Bergeron J, Fortier I. The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies. International Journal of Environmental Research and Public Health. 2019; 16(11):2019. https://doi.org/10.3390/ijerph16112019Chicago/Turabian Style
Poole, Nancy, Rose A. Schmidt, Alan Bocking, Julie Bergeron, and Isabel Fortier. 2019. "The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies" International Journal of Environmental Research and Public Health 16, no. 11: 2019. https://doi.org/10.3390/ijerph16112019