Study ties FASD to lack of prenatal care By:  Alexandra Paul Posted: 7:00 PM CST Tuesday, Feb. 19, 2019

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This article was published 18/02/2019 (1892 days ago), so information in it may no longer be current.

More than 40 per cent of Manitoba women who gave birth to a child with fetal alcohol spectrum disorder received little or no prenatal care, despite recommendations that all women should be screened for drinking and substance abuse, a new provincial study has found.

The University of Manitoba study, the largest of its kind in the world, surprised even the researchers who summarized the findings.

“I was quite startled (with) the primary finding that was 41 per cent of women who went on to have an FASD birth didn’t have adequate or any prenatal care,” said the study’s lead author, Deepa Singal, a post-doctoral fellow at the Manitoba Centre for Health Policy, which is part of the U of M’s Max Rady College of Medicine.

The study was posted online in the Canadian Medical Association Journal last week and publicized Tuesday by the U of M.

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“When you look at the general population, the agencies in Canada report that 95 per cent of women have access to prenatal care. That’s a shocking difference with our study,” Singal said.

The study is based on provincial health data that looked at 700 Manitoba births over a 28-year period, from 1984 to 2012. The researchers then identified birth mothers by linking the FASD data base to Manitoba’s population research data base, which draws on the province’s health care records. The study went on to compare their findings with a group of 2,097 women with babies who did not have FASD.

FASD is a brain injury that can occur when an unborn baby is exposed to alcohol. It’s a lifelong disorder that can include physical, mental, behavioural and learning disabilities.

The study is significant in Manitoba because of links to the child welfare system, where 97 per cent of the 11,000 children in care are Indigenous. The system has come under heavy criticism for removing Indigenous children from their mothers, often within days of birth, under a controversial system known as “flagging” birth mothers, which includes mothers who abuse intoxicants.

Three weeks ago, a live stream of a baby removed from a mother at St. Boniface General Hospital blew up on Facebook, followed by court documents from child welfare authorities which indicated a history of addictions motivated their actions. The controversial case was too recent to be included in the study but it’s timely.

The study said women need a safe space and they need to be able to trust their doctors if they are ever to feel comfortable about disclosing addictions issues and getting the help they need.

“The real issue is how do we get the moms into the physicians’ offices in the first place.” – Deepa Singal, a post-doctoral fellow at the Manitoba Centre for Health Policy

“These women are missing this important health care service, a health care service that could reduce their alcohol consumption during pregnancy and help reduce the rate of fetal alcohol,” Singal said.

The study found that mothers of children with FASD are more likely to be single parents, living in poverty with three or more other children. More than 82 percent were coping with mental health issues, with nearly 34 per cent diagnosed with mood and anxiety disorders.

Pregnant women who drink may be reluctant to seek care because they fear stigma, judgment and losing their children to child welfare authorities, the study said.

“The real issue is how do we get the moms into the physicians’ offices in the first place. Our research shows these women have a high rate of . . poverty, single parenthood and mental health issues. It’s likely that with these things — along with the stigma and the fear of losing their children to child welfare — they’re not even accessing the services they need,” Singal said.

“They’re scared: Is their physician going to report them to the authorities?” Singal said.

“It speaks to the need for developing policy and reducing the stigma and educating women who need these services, that this is not a criminal proceeding. They do have patient-doctor confidentiality and physicians do want to help them," she said.

“The important piece there is some women aren’t sure (about disclosure). They may think there is no doctor-patient confidentiality and that these physicians could report if women openly say they’re using alcohol or there’s illicit drug use during pregnancy,” she said.

The study found that 60 per cent of women receive prenatal counselling and some of them consumed alcohol anyway, a finding that suggests doctors may not have the tools they need to counsel women or help them find addictions services they need. Close to 10 per cent of women around the world report drinking during their pregnancies. One in 100 births worldwide is a baby with FASD.

alexandra.paul@freepress.mb.ca