The Manitoba mothers and fetal alcohol spectrum disorder study: a retrospective population-based cohort study using linked administrative data
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Date
2017
Authors
Singal, Deepa
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Abstract
Background: Identifying maternal risk factors associated with giving birth to children with Fetal Alcohol Spectrum Disorder (FASD) is integral to the development of effective prevention strategies, however, there are no Canadian data in this area. The objective of this dissertation was to utilize population-based linked data to generate a large, representative sample of mothers whose children were diagnosed with FASD to investigate: (1) maternal risk factors associated with giving birth to children with FASD; (2) maternal physical and health outcomes; and (3) maternal usage of health services of the study population.
Methods: A cohort of mother-infant dyads from a population of all children born in Manitoba between April 1, 1984 and March 31, 2012 who had an FASD diagnosis from the Manitoba FASD Centre from April 1, 1999 to March 31 2012, with follow-up until December 1, 2013 (study group: n=702). A control group (n=2097) matched 1:3 on date of birth of index child, region of residence, and socioeconomic status was generated to compare exposures and outcomes. Logistic regression analyses were run to determine maternal risk factors for giving birth to children with FASD, and adjusted relative rates for all mental and physical health outcomes, as well as rate of prenatal care, were calculated using generalized estimating equations with a Poisson or Negative Binomial distribution.
Results: The following maternal characteristics were identified as having a statistically significant association with giving birth to children with FASD: history of teen pregnancy, being a single mother at birth of the index child, higher gravidity and parity, having a psychiatric disorder and/or physical health disorder up to three years before the birth of the child, and having inadequate prenatal care. Women who gave birth to children with FASD were also more likely to
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be involved with the child welfare system and the justice system, and to take antidepressants during pregnancy. Study group women had higher adjusted rates of substance use disorder, personality disorder, and mood and anxiety disorders before pregnancy, as well as higher adjusted rates of maternal psychological distress during pregnancy and postpartum, and antidepressant prescriptions before, during, and after pregnancy. Adjusted rates were higher among the study group for suicide completion, number of women attempting suicide, and number of attempts after the birth of the child until the end of the study period, as well as for inadequate and low prenatal care.
Conclusion: Women giving birth to children with FASD face significant social complexity, as well as a high psychiatric burden, increased risk of suicide, and are at risk for inadequate prenatal care. FASD prevention strategies are needed that address these maternal risk factors to help reduce the incidence of FASD.
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Keywords
Administrative data, prenatal alcohol use, prenatal care, suicide, mental health, fetal alcohol spectrum disorder
Citation
Singal, D., Brownell, M., Chateau, D., Hanlon-Dearman, A., Longstaffe, S., & Roos, L. L. (2017). The Psychiatric Morbidity of Women Who Give Birth to Children with Fetal Alcohol Spectrum Disorder (FASD): Results of the Manitoba Mothers and FASD Study. Can J Psychiatry, 62(8), 531-542. doi: 10.1177/0706743717703646
Singal, D., Brownell, M., Chateau, D., Wall-Wieler, E., Longstaffe, S., Hanlon-Dearman, A., & Roos, L. L. (2017). Suicide and suicide attempts among women in the Manitoba Mothers and Fetal Alcohol Spectrum Disorder cohort: a retrospective matched analysis using linked administrative data. CMAJ Open, 5(3), E646-E652. doi: 10.9778/cmajo.20160127
Singal, D., Brownell, M., Hanlon-Dearman, A., Chateau, D., Longstaffe, S., & Roos, L. L. (2016). Manitoba mothers and fetal alcohol spectrum disorders study (MBMomsFASD): protocol for a population-based cohort study using linked administrative data. BMJ Open, 6(9), e013330. doi: 10.1136/bmjopen-2016-013330
Singal, D., Brownell, M., Chateau, D., Wall-Wieler, E., Longstaffe, S., Hanlon-Dearman, A., & Roos, L. L. (2017). Suicide and suicide attempts among women in the Manitoba Mothers and Fetal Alcohol Spectrum Disorder cohort: a retrospective matched analysis using linked administrative data. CMAJ Open, 5(3), E646-E652. doi: 10.9778/cmajo.20160127
Singal, D., Brownell, M., Hanlon-Dearman, A., Chateau, D., Longstaffe, S., & Roos, L. L. (2016). Manitoba mothers and fetal alcohol spectrum disorders study (MBMomsFASD): protocol for a population-based cohort study using linked administrative data. BMJ Open, 6(9), e013330. doi: 10.1136/bmjopen-2016-013330