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J FAS Int 2005;3:e3 - Jan. 2005
Attitudes and Approaches of Canadian Providers to Preconception Counselling and the Prevention of Fetal Alcohol Spectrum Disorders


Background
Health care providers play an important role in the prevention of fetal alcohol spectrum disorders (FASD).

Objective
To determine the attitudes and approaches of Canadian providers to preconception counselling and the prevention of FASD.

Methods
Between October 2001 and May 2002, a survey was mailed to a national random sample of paediatricians, psychiatrists, obstetricians and gynaecologists, family physicians, and midwives in Canada, who were current members of professional organisations (N=5361).

Results
Overall response rate was 41.3%. There were significant differences (p<0.05) across provider group in several areas. Ninety-four percent of providers agreed fetal alcohol syndrome (FAS) was an identifiable syndrome; 54% felt prepared to care for pregnant women who were alcohol dependent/abusing while 70% were prepared to access resources for these patients. Less than 50% of providers frequently discussed smoking, alcohol use, or addiction history with women of childbearing age. Less than 15% inquired about a history of sexual or emotional abuse. Once women were pregnant, 94% of family physicians, midwives, and obstetricians inquired about alcohol use. Time was the primary barrier to discussing adverse effects of alcohol prior to conception (58%). Approximately 60% of respondents agreed a registry of consultation specialists, clinical practice guidelines for diagnosis of FAS, and referral resources for women with alcohol problems would be helpful supports in their clinical practice.

Discussion
There are missed opportunities in preconception screening which would identify women at risk for preventable, adverse pregnancy outcomes related to alcohol consumption. Provider training in identification of women at risk would allow for increased access to appropriate resources.

Key Words: Fetal alcohol spectrum disorders; fetal alcohol syndrome; prevention and control; physician?s practice patterns; professional practice; prenatal care; alcohol consumption; directive counseling ;risk factors

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