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Mothers of children with FASD have high rate of inadequate prenatal care: U of M study

February 19, 2019 — 

More than 40 per cent of Manitoba women who gave birth to a child with fetal alcohol spectrum disorder (FASD) received inadequate or no prenatal care, a University of Manitoba study has found.

The study of health data looked at 700 Manitoba births over a 28-year period, from 1984 to 2012. It is one of the first studies in the world, and the largest, to investigate the rate of prenatal care among mothers of children diagnosed with FASD.

“Our findings show that these women are not receiving an important health-care service that is critical to monitoring their health and that of their baby, and could help to reduce their alcohol consumption during pregnancy,” said the study’s lead author, Dr. Deepa Singal, a postdoctoral fellow at the Manitoba Centre for Health Policy (MCHP) in the Max Rady College of Medicine, Rady Faculty of Health Sciences.

FASD is a neurodevelopmental disorder that can occur when a baby is exposed to alcohol in the womb. It can have lifelong effects that include physical, mental, behavioral and learning disabilities. About 10 per cent of women around the world report consuming alcohol during pregnancy.

Singal’s study, Prenatal care of women who give birth to children with fetal alcohol spectrum disorder in a universal health care system, has been published by the Canadian Medical Association Journal (CMAJ) Open online journal.

“Our research suggests that screening and intervention programs in prenatal care settings may be missing an extremely high-risk population for alcohol use during pregnancy,” Singal said. “If pregnant women who have issues with alcohol use or dependence don’t venture into a doctor’s office, or do so rarely, they are not being reached by programs or supports offered there.”  

The study found that mothers of children with FASD have higher rates of social complexities, including poverty, single parenthood and mental health disorders. It’s likely that these complexities pose barriers to accessing prenatal care, Singal said. Pregnant women who consume alcohol may be reluctant to seek health care, she added, because they may fear stigma, judgment and losing their children to child welfare services.

“Outreach efforts to make contact with at-risk women should be incorporated into FASD prevention strategies,” the researcher said.

“More broadly, we need programs across sectors to address the social determinants of health – factors such as poverty, low educational attainment, unemployment, stress and addiction – in order to increase the rate of prenatal care among vulnerable women who consume alcohol.”

Nearly 60 per cent of women in the study who gave birth to children with FASD did receive adequate prenatal care, yet still consumed enough alcohol to affect the fetus. This indicates a need for additional research to better understand the role of physicians in reducing alcohol use during pregnancy.

The study recommends that doctors routinely screen for alcohol use in pregnancy, make referrals to treatment and support programs, and link patients to community resources.

The researchers conducted the study by analyzing anonymous health information stored in a data repository at the MCHP. They used FASD diagnoses in children to identify a study cohort of 700 mothers.

They traced these mothers’ contacts with the health-care system both before and after the birth of a child with FASD, comparing them with a group of 2,100 mothers whose children did not have FASD. They found that 41 per cent of mothers in the FASD group received inadequate or no prenatal care, compared with 15 per cent of mothers in the comparison group.

The study is part of a larger research project by the same team, the Manitoba Mothers and Fetal Alcohol Spectrum Disorder Study. It is looking at the life circumstances of women who have given birth to a child diagnosed with FASD in the province.

The study received funding from Research Manitoba and the Evelyn Shapiro Award for Health Services Research.



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