Risky Drinking by Women
of Child-Bearing Age:
Trends and Implications
Courtney R. Green, PhD
Manager of Research Development
Canada FASD Research Network
[email protected]sd.ca
For this Symposium
 Understanding FASD
Courtney Green
 Trends and patterns of
women’s drinking
Gerald Thomas
 Preventing FASD and
promoting women’s health
Nancy Poole
– Effects of Prenatal Alcohol
– Prevalence, Incidence, Costs
 What we know and need to
 Universal FASData Form
 Relevance to Public Health
Fetal Alcohol Spectrum Disorder (FASD)
FASD represents a constellation
of adverse effects resulting
from prenatal exposure to
Prenatal alcohol exposure
 Can affect the face
 Can cause birth defects
 Can affect the brain
(structure and function)
 Behaviour
CMAJ, 1981
Critical Periods of Fetal Development
Alcohol affects every area of the brain
Brain stem
Limbic system
Cerebrum (left
temporal lobe)
 Frontal lobes
 Multiple locations
 Whole brain
Regulation of state
Motor Skills coordination /balance
Speech and language
Executive functioning
Learning, memory, cognition
Adaptive skills and applications
Clarren, 2010
Common behaviours associated with FASD
Poor co-ordination/motor control
Developmental delay
Learning problems
Memory problems
Socially engaging
Why Diagnose FASD?
 Key to access to supports and services
 Diagnosis before age 6 is a critical factor for
improving outcome
 Must be done by a trained multidisciplinary team
Speech-Language Pathologist
Occupational Therapist
Others (mentor, addiction worker, social worker,
psychiatrist, etc)
 FASD has been traditionally used an identification and
not a diagnosis
 FASD is an umbrella term that has included:
Fetal Alcohol Syndrome (FAS)
partial FAS (pFAS)
Alcohol-related Neurodevelopmental Disorder (ARND)
Alcohol-Related Birth Defects (ARBD)
 These categories differ based on the presence/absence
of facial features and confirmed prenatal alcohol
 FASD: Canadian Guidelines for Diagnosis were
published in 2005.
Diagnosis: 2014 Revisions
 Nomenclature
– FASD with sentinel facial features
– FASD with sentinel facial features, provisional
– FASD without sentinel facial features
 Growth Restriction: No longer required
 Neurodevelopmental assessment: changes/clarifications
to the domains of interest (10 domains)
Motor Skills
Academic Achievement
– Executive Function
- Neuroanatomy/Neurophysiology
- Language
- Memory
- Adaptive behaviour, social skills and
social communication
- Anxiety, Depression and Mood
Common myths
 One or two drinks a week
when pregnant are harmless
 Mothers of children with
FASD chose to drink during
pregnancy and did not care if
they damaged their children
 Behavioural problems linked
to FASD are the result of
poor parenting.
 Children affected by FASD
will grow out of it as they age
 FASD is an Aboriginal issue.
 Children with FASD can’t
learn, making it a hopeless
 Findings are mixed as to the impact
of low levels of consumption –
alcohol is a teratogen
 Continued drinking at risky levels in
pregnancy is associated with
serious histories of trauma and
related health and social challenges
 Behaviour problems are related to
brain injury, with life long
 Women of all races and income
levels are vulnerable to drinking in
 Early diagnosis can improve
outcomes and maximize potential.
 No National statistics
• Yukon: 46/1000 (Asante et al., 1985)
• Northwest BC: 25/1000 (Asante et al., 1985)
 Prevalence of FAS is at least 2 to 7 per 1,000
in the US (May et al., 2009)
– Prevalence of FASD in populations of younger
school children may be as high as 2-5% in the US
and some Western European countries (May et al.,
 Canada
– Manitoba: 7.2/1000 (but could be as high as
14.8/1000) (Williams et al., 1999)
– Saskatchewan: 0.515/1000 for 1973-77;
0.589/1000 for 1988-92 (Habbick et al., 1996)
Cost of FASD
 Estimated annual cost of $7.6 billion in Canada
(Thanh and Jonsson, 2009).
– Total direct health care cost of acute care, psychiatric care, day
surgery, and emergency department services associated with
FAS in Canada in 2008-2009 is ~$6.7 million (Popova et al.,
 At the individual level, the total adjusted annual
cost associated with FASD is ~ $21,642 (Stade et
al, 2009).
 An FASD evaluation requires 32 to 47 hours,
which costs $3,110 to $4,570 per person
(Popova et al., 2013).
What we know
 Children’s neurodevelopmental disorders are
a significant issue in Canada
– Effect quality of life for children and their families
– Strain health, social services, education,
corrections and education sectors
 Children with neurodevelopmental disorders
often present with patterns of abnormalities
and co-occurring conditions
– Influences the presenting deficits, treatment
recommendations and potential outcomes.
What we would like to know
 Specific functional deficits and/or clusters of
deficits that are specific to individuals with
– Important for developing successful, accessible
and cost-effective programs
 This data is available in the diagnostic clinics,
but needs to be collected succinctly using a
standardized process.
The Universal FASData Form
 CanFASD recently developed and piloted the
universal FASData form for capturing data from the
FASD population
 Provides a structure for active communication and
collaboration among all clinical programs in Canada
that provide FASD diagnoses
 Provides real-time information on the difficulties,
challenges and needs of those who present for an
FASD-related diagnosis
 Captures type of diagnosis, recommendations for
interventions, specifics of assessments and
Implications for the FASDataform
 Provide an accurate measure of the spectrum
of functional diagnoses and actual treatment
plans for FASD
 Support the development of more specific
and effective educational/vocational
 Produce national prevalence data for FASD
Progress to date
 Engaged 41 diagnostic clinics across Canada in the
pilot study
 Collected standardized data that was stored in a
centralized database
 Captured 400+ files in the complete data set
Findings in functional profiles
 The top three functional deficits were in the areas of:
– Adaptive behaviour
– Executive function and abstract reasoning
– Social Communication
 The top clusters of functional deficits were:
– Academic achievement, Executive function,
– Cognition, Executive function and Adaptive
 The majority of individuals did not have the facial
features associated with FASD but did have
significant neurodevelopmental deficits
FASD summary
 FASD is the leading known cause of preventable
developmental disability among Canadians.
– ~9.1 per 1000 live births or 1% of the population (Health
Canada 2006).
 FASD is characterized by learning, behaviour and
emotional problems.
 FASD is a life-long disability.
 Most people living with FASD do not have facial
 Early diagnosis can improve outcomes and maximize
 People living with FASD can live a normal life if they
are well supported.
Importance for Public Health
 FASD is a disorder that requires the attention and
coordination of multiple health and allied health
 Awareness of the disability and of patterns and
influences on women’s drinking are important, on the
part of all those working in public health
 A range of mutually reinforcing alcohol awareness,
health promotion, treatment and policy interventions
are needed to prevent FASD and promote women’s

1 - Canadian Public Health Association