title: Clinical practice characteristics and preconception counseling strategies of health care providers who recommend alcohol abstinence during pregnancy.
abstract: OBJECTIVE
  National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies.
  
  
  METHODS
  A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy.
  
  
  RESULTS
  Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05).
  
  
  CONCLUSIONS
  It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation."
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada. suzanne.tough@calgaryhealthregion.ca
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Tough
authors.forename: Margaret
authors.initials: M
authors.lastname: Clarke
authors.forename: Matt
authors.initials: M
authors.lastname: Hicks
authors.forename: Sterling
authors.initials: S
authors.lastname: Clarren
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D037001:Directive Counseling / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D016017:Odds Ratio; D016742:Preconception Care / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D013695:Temperance / Q000706:statistics & numerical data