BACKGROUND: There are myriad long-term health problems for children affected by alcohol exposure during pregnancy. Clinicians cannot identify infants at risk of fetal alcohol spectrum disorder (FASD) based on maternal and neonatal characteristics. There is consensus that early identification of FASD can mitigate or ameliorate the secondary disabilities associated with FASD. Although FASD meets some of the criteria for universal screening, it is unclear if universal screening for prenatal exposures is acceptable to new mothers.
OBJECTIVE: The purpose of this study was to examine conditions under which postpartum mothers in a Canadian urban center would consent to universal screening of their infant's meconium, urine, or hair; and identify the characteristics of mothers who would not consent.
METHODS: Focus groups and a cross-sectional survey. Focus groups were composed of 5 to 15 participants, and open-ended questions on a semistructured interview guide were used to facilitate discussion, which was tape recorded. The survey was developed from results of the focus group, pilot tested, and revised. The survey was administered verbally by trained research assistants on the postpartum unit in 3 hospitals in a large Canadian urban center during a 4-month period (July-October 2003) to eligible women fluent in English who had recently given birth.
ANALYSIS: Themes were identified from transcripts of the focus group and grouped into elements of the Health Belief Model, including perceived susceptibility, severity, threat, benefits, and barriers. Survey data were analyzed in SPSS 12.0, and all tests were 2-sided (where applicable). Bivariate analysis was used to compare willingness to consent by strata of self-reported alcohol use and by maternal characteristics. Categorical data were compared using the chi-square test, and continuous variables were compared by Student t test.
RESULTS: The findings of the focus groups are presented elsewhere; however, justice (testing without discrimination) was a theme identified by the 29 women ranging in age from 18 to 40 years who participated in the focus groups. Of the 1920 women eligible to participate, 1509 (78.4%) agreed to participate, of which 1474 (76.7%) completed the entire questionnaire. Mothers (93.8%) would consent and thought all women should consent (97.6%) if determination of results would lead to effective treatment. Women wanted screening information early in pregnancy. Precursors to screening were: clear knowledge of what would happen with a positive test result, who would have access to the information, how effective medical care would be for the child, and the chance that a baby with a positive test would have a problem. Mothers who would not consent were older, likely to have a college degree, and married; denied alcohol and tobacco use during pregnancy; and had a negative "Tolerance, Annoy, Cut-down, and Eye-opener" alcohol screening.
CONCLUSIONS: Women would support a universal screening program if screening made a difference for the dyad and appropriate resources were available to optimize child development. However, the potential benefit of a screening program remains to be demonstrated.
DISCLOSURE: This work is funded by Alberta Children's Services and the Alberta Heritage Foundation for Medical Research Health Research Fund.