Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis

The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.

https://journals.sagepub.com/doi/pdf/10.1177/0269881112444324

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

https://e-lactancia.org/media/papers/DrogadiccionBF-ProtocoloABM21-BM2015-EN.pdf

ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015

Study question Does surgical treatment of endometriomas impact on the ovarian reserve as evaluated with antral follicle count (AFC)? Summary answer This meta-analysis of published data shows that surgery for endometrioma does not significantly affect ovarian reserve as evaluated by AFC. What is known already Surgical excision of an ovarian endometrioma significantly affects ovarian reserve evaluated with anti-Mullerian hormone (AMH) levels. Data for other reliable markers of ovarian reserve, such as AFC, have not been pooled in meta-analyses. Study design, size, duration A systematic review with electronic searches of PubMed, MEDLINE and Embase up to April 2014 was conducted to identify articles evaluating AFC before and after surgery for ovarian endometriomas, or before or after surgery for the affected versus the contralateral ovary. Participants/materials, setting, methods Of the 24 studies evaluated in detail, 13 were included for data extraction and meta-analysis, including a total of 597 patients. The primary outcome at pooled analysis was AFC (mean and SD) for affected ovaries before and after surgery. Secondary outcomes were AFC for the affected ovary versus the contralateral ovary before surgery, and AFC for the operated versus the contralateral ovary after surgery. The data were pooled using the RevMan software by the Cochrane Collaboration. Heterogeneity between studies was based on the results of the χ(2) and I(2) statistics. A random-effect model was used for the meta-analysis because of high heterogeneity between studies. Main results and the role of chance AFC for the operated ovary did not change significantly after surgery (mean difference 0.10, 95% CI -1.45 to 1.65; P = 0.90). Lower AFC for the diseased ovary compared with the contralateral one was present before surgery, although the difference was not significant (mean difference -2.79, 95% CI -7.10 to 1.51; P = 0.20). After surgery, the operated ovary showed a significantly lower AFC compared with the contralateral ovary (mean difference -1.40, 95% CI -2.27 to -0.52; P = 0.002). Limitations, reasons for caution Heterogeneity among the selected studies was high; therefore, limiting the conclusions of the present systematic review. Wider implications of the findings Ovarian reserve evaluated with AFC is not reduced after surgical treatment of an endometrioma. A lower AFC is present for the affected ovary both before and after surgery. Recently, concerns have been raised as to the reliability of AMH as a marker of ovarian reserve. Based on the present findings, surgical treatment of an endometrioma may be considered safer for the ovarian reserve than previously thought. Study funding/competing interests No external funding was sought or obtained for this study. No conflicts of interest are declared.

The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis

Over the past 40 years, a significant body of animal and human research has documented the teratogenic effects of prenatal alcohol exposure (PAE). Neurobehavioral Disorder associated with PAE is proposed as a new clarifying term, intended to encompass the neurodevelopmental and mental health symptoms associated with PAE. Defining this disorder is a necessary step to adequately characterize these symptoms and allow clinical assessment not possible using existing physically-based diagnostic schemes. Without appropriate diagnostic guidelines, affected individuals are frequently misdiagnosed and treated inappropriately (often to their considerable detriment) by mental health, educational, and criminal justice systems. Three core areas of deficits identified from the available research, including neurocognitive, self-regulation, and adaptive functioning impairments, are discussed and information regarding associated features and disorders, prevalence, course, familial patterns, differential diagnosis, and treatment of the proposed disorder are also provided.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis

Objective To establish national standards of care for the screening and recording of alcohol use and counselling on alcohol use of women of child-bearing age and pregnant women based on the most up-to-date evidence. Evidence Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in May 2009 using appropriate controlled vocabulary (e.g., pregnancy complications, alcohol drinking, prenatal care) and key words (e.g., pregnancy, alcohol consumption, risk reduction). Results were restricted to literature published in the last five years with the following research designs: systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment (HTA) and HTA-related agencies, national and international medical specialty societies, clinical practice guideline collections, and clinical trial registries. Each simple-article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Values The quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). Sponsor The Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada. Endorsement These consensus guidelines have been endorsed by the Association of Obstetricians and Gynecologists of Quebec; the Canadian Association of Midwives; the Canadian Association of Perinatal, Women's Health and Neonatal Nurses (CAPWHN); the College of Family Physicians of Canada; the Federation of Medical Women of Canada; the Society of Rural Physicians of Canada; and Motherisk. Summary Statements 1.There is evidence that alcohol consumption in pregnancy can cause fetal harm. (II-2) There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. (III) 2.There is insufficient evidence to define any threshold for low-level drinking in pregnancy. (III) 3.Abstinence is the prudent choice for a woman who is or might become pregnant. (III) 4.Intensive culture-, gender-, and family-appropriate interventions need to be available and accessible for women with problematic drinking and/or alcohol dependence. (II-2) Recommendations 1.Universal screening for alcohol consumption should be done periodically for all pregnant women and women of child-bearing age. Ideally, at-risk drinking could be identified before pregnancy, allowing for change. (II-2B) 2.Health care providers should create a safe environment for women to report alcohol consumption. (III-A) 3.The public should be informed that alcohol screening and support for women at risk is part of routine women's health care. (III-A) 4.Health care providers should be aware of the risk factors associated with alcohol use in women of reproductive age. (III-B) 5.Brief interventions are effective and should be provided by health care providers for women with at-risk drinking. (II-2B) 6.If a woman continues to use alcohol during pregnancy, harm reduction/treatment strategies should be encouraged. (II-2B) 7.Pregnant women should be given priority access to withdrawal management and treatment. (III-A) 8.Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for termination of pregnancy. (II-2A)

https://westernhealth.nl.ca/uploads/Addictions%20Prevention%20and%20Mental%20Health%20Promotion/Clinical%20Guidelines.pdf

Alcohol use and pregnancy consensus clinical guidelines.

Objective To establish national standards of care for the screening and recording of alcohol use and counselling on alcohol use of women of child-bearing age and pregnant women based on the most up-to-date evidence. Evidence Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in May 2009 using appropriate controlled vocabulary (e.g., pregnancy complications, alcohol drinking, prenatal care) and key words (e.g., pregnancy, alcohol consumption, risk reduction). Results were restricted to literature published in the last five years with the following research designs: systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment (HTA) and HTA-related agencies, national and international medical specialty societies, clinical practice guideline collections, and clinical trial registries. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Values The quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1). Sponsor The Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada. Endorsement These consensus guidelines have been endorsed by the Association of Obstetricians and Gynecologists of Quebec; the Canadian Association of Midwives; the Canadian Association of Perinatal, Women's Health and Neonatal Nurses (CAPWHN); the College of Family Physicians of Canada; the Federation of Medical Women of Canada; the Society of Rural Physicians of Canada; and Motherisk. Summary Statements 1.There is evidence that alcohol consumption in pregnancy can cause fetal harm. (II-2) There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. (III) 2.There is insufficient evidence to define any threshold for low-level drinking in pregnancy. (III) 3.Abstinence is the prudent choice for a woman who is or might become pregnant. (III) 4.Intensive culture-, gender-, and family-appropriate interventions need to be available and accessible for women with problematic drinking and/or alcohol dependence. (II-2) Recommendations 1.Universal screening for alcohol consumption should be done periodically for all pregnant women and women of child-bearing age. Ideally, at-risk drinking could be identified before pregnancy, allowing for change. (II-2B) 2.Health care providers should create a safe environment for women to report alcohol consumption. (III-A) 3.The public should be informed that alcohol screening and support for women at risk is part of routine women's health care. (III-A) 4.Health care providers should be aware of the risk factors associated with alcohol use in women of reproductive age. (III-B) 5.Brief interventions are effective and should be provided by health care providers for women with at-risk drinking. (II-2B) 6.If a woman continues to use alcohol during pregnancy, harm reduction/treatment strategies should be encouraged. (II-2B) 7.Pregnant women should be given priority access to withdrawal management and treatment. (III-A) 8.Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for termination of pregnancy. (II-2A)

No. 245-Alcohol Use and Pregnancy Consensus Clinical Guidelines.

Resume Objectif Etablir, en fonction des donnees les plus a jour, des normes de diligence nationales pour ce qui est du depistage et de la consignation de la consommation d'alcool, ainsi que du counseling a offrir aux femmes en âge de procreer et enceintes en ce qui concerne la consommation d'alcool. Resultats La litterature publiee a ete recuperee, en mai 2009, par l'intermediaire de recherches menees dans PubMed, CINAHL et la Cochrane Library au moyen d'un vocabulaire controle (p. ex. pregnancy complications, alcohol drinking, prenatal care) et de mots cles (p. ex. pregnancy, alcohol consumption, risk reduction) appropries. Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles. Aucune restriction n'a ete imposee quant a la langue. Les recherches ont ete mises a jour de facon reguliere et leurs resultats ont ete incorpores a la directive clinique jusqu'en mai 2010. La litterature grise (non publiee) a ete identifiee par l'intermediaire de recherches menees dans les sites Web d'organismes s'interessant a l'evaluation des technologies dans le domaine de la sante et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et aupres de societes de specialite medicale nationales et internationales. Chacun des articles a ete analyse afin d'en determiner la pertinence et son texte integral a ete acquis, le cas echeant. Les resultats obtenus ont ete analyses et evalues par les membres du groupe de travail specialise etabli par la Societe des obstetriciens et gynecologues du Canada. La qualite des resultats a ete evaluee et les recommandations ont ete formulees conformement aux lignes directrices elaborees par le Groupe d'etude canadien sur les soins de sante preventifs. Valeurs La qualite des resultats a ete evaluee au moyen des criteres decrits par le Groupe d'etude canadien sur les soins de sante preventifs (Tableau 1). Commanditaires Agence de la sante publique du Canada et Societe des obstetriciens et gynecologues du Canada. Approbation La presente directive clinique de consensus a ete approuvee par l'Association des obstetriciens et gynecologues du Quebec, la Federation des femmes medecins du Canada, l'Association canadienne des sages-femmes, l'Association canadienne des infirmieres et infirmiers en perinatalite et en sante des femmes (CAPWHN) (anciennement connue sous le nom de AWHONN-Canada), le College des medecins de famille du Canada, la Societe de la medecine rurale du Canada et Motherisk. Declarations sommaires 1.Nous disposons de donnees indiquant que la consommation d'alcool pendant la grossesse peut causer des torts au fœtus. (II-2) Nous ne disposons pas de donnees suffisantes pour affirmer que la consommation de faibles niveaux d'alcool pendant la grossesse s'avere sure ou nocive pour le fœtus (III). 2.Nous ne disposons pas de donnees suffisantes pour definir quelque seuil que ce soit pour ce qui est de la consommation de faibles niveaux d'alcool pendant la grossesse (III). 3.L'abstinence constitue le choix prudent pour une femme enceinte ou qui pourrait le devenir (III). 4.Des interventions intensives et adaptees sur les plans de la culture, du sexe et de la famille doivent etre mises a la disposition des femmes qui connaissent une consommation problematique et/ou une dependance a l'alcool (II-2). Recommandations 1.Le depistage universel de la consommation d'alcool devrait etre mis en œuvre periodiquement aupres de toutes les femmes enceintes et de toutes les femmes en âge de procreer. Idealement, la consommation entrainant des risques pourrait etre identifiee avant la grossesse, ce qui en permettrait la modification (II-2B). 2.Les fournisseurs de soins de sante devrait creer, pour leurs patientes, un milieu sur favorisant le signalement de la consommation d'alcool (III-A). 3.Le public devrait etre avise que le depistage de la consommation d'alcool et l'offre d'un soutien aux femmes exposees a des risques font partie des soins de sante qui sont systematiquement offerts aux femmes (III-A). 4.Les fournisseurs de soins de sante devraient prendre connaissance des facteurs de risque associes a la consommation d'alcool chez les femmes en âge de procreer (III-B). 5.Les interventions de courte duree sont efficaces et devraient etre mises en œuvre par les fournisseurs de soins de sante aupres des femmes qui presentent une consommation risquee d'alcool (II-2B). 6.Lorsqu'une femme continue a consommer de l'alcool pendant la grossesse, la mise en œuvre de strategies de reduction des torts / de traitement devrait etre favorisee (II-2B). 7.Les femmes enceintes devraient se voir accorder un acces prioritaire aux services de prise en charge du sevrage et de traitement (III-A). 8.Les fournisseurs de soins de sante devraient aviser les femmes du fait qu'une faible consommation d'alcool aux debuts de la grossesse ne constitue pas une indication d'interruption de grossesse (II-2A).

Pascal Croteau

Papers

Alcohol use and pregnancy consensus clinical guidelines.

No. 245-Alcohol Use and Pregnancy Consensus Clinical Guidelines.

No 245-Directive clinique de consensus sur la consommation d’alcool et la grossesse.