Skip to main content
Top
Published in: Archives of Public Health 1/2023

Open Access 01-12-2023 | Fetal Alcohol Spectrum Disorder | Research

The role of general practitioners in Reunion in detecting alcohol use in pregnant women and identifying fetal alcohol spectrum disorder: a qualitative study

Authors: Sébastien Leruste, Louise Delfarguiel, Bérénice Doray, Coralie Loubaresse, Laetitia Sennsfelder, Thierry Maillard, Catherine Marimoutou, Michel Spodenkiewicz

Published in: Archives of Public Health | Issue 1/2023

Login to get access

Abstract

Background

Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of non-genetic intellectual disability and social maladjustment in children. International guidelines recommend abstinence from alcohol during pregnancy. Réunion is the most affected of all French regions with an estimated Fetal Alcohol Spectrum (FAS) prevalence of 1.2‰ births. General practitioners (GPs) are at the forefront of identifying patients with FASD. Objective: To understand how GPs identify FASD.

Methods

Qualitative study using a grounded theory approach, through semi-structured face-to-face interviews with GPs. Interviews were conducted with the aim of reaching theoretical saturation. These were transcribed verbatim and then analyzed by four researchers to ensure triangulation of the data.

Results

GPs reported barriers to the identification of FASD: challenges in overcoming social taboos and paradoxical injunctions, the influence of limited knowledge and experience, non-specific and highly variable symptoms, ambiguous classification and method of diagnosis involving the mobilization of a multidisciplinary team and lengthy consultations. Conversely, they felt competent to identify neurodevelopmental disorders of any cause, but were concerned about the long waiting time to access specialized care. From the perspective of GPs, it is crucial to prioritize promotion and training aimed at improving the identification and coordination of care pathways for children diagnosed with neurodevelopmental disorders, such as FASD.
Appendix
Available only for authorised users
Literature
1.
go back to reference Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ Can Med Assoc J. 2005;172(5 Suppl):S1-21.CrossRef Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ Can Med Assoc J. 2005;172(5 Suppl):S1-21.CrossRef
2.
go back to reference Popova S, Lange S, Shield K, Mihic A, Chudley AE, Mukherjee RAS, et al. Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. Lancet. 2016;387(10022):978–87.CrossRefPubMed Popova S, Lange S, Shield K, Mihic A, Chudley AE, Mukherjee RAS, et al. Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. Lancet. 2016;387(10022):978–87.CrossRefPubMed
6.
go back to reference Rostand A, Kaminski M, Lelong N, Dehaene P, Delestret I, Klein-Bertrand C, et al. Alcohol use in pregnancy, craniofacial features, and fetal growth. J Epidemiol Community Health. 1990;44(4):302–6.CrossRefPubMedPubMedCentral Rostand A, Kaminski M, Lelong N, Dehaene P, Delestret I, Klein-Bertrand C, et al. Alcohol use in pregnancy, craniofacial features, and fetal growth. J Epidemiol Community Health. 1990;44(4):302–6.CrossRefPubMedPubMedCentral
9.
go back to reference Popova S, Lange S, Burd L, Urbanoski K, Rehm J. Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada. BMC Public Health. 2013;13(1):570.CrossRefPubMedPubMedCentral Popova S, Lange S, Burd L, Urbanoski K, Rehm J. Cost of specialized addiction treatment of clients with fetal alcohol spectrum disorder in Canada. BMC Public Health. 2013;13(1):570.CrossRefPubMedPubMedCentral
10.
go back to reference Banakar MK, Kudlur NS, George S. Fetal alcohol spectrum disorder (FASD). Indian J Pediatr. 2009;76(11):1173–5.CrossRefPubMed Banakar MK, Kudlur NS, George S. Fetal alcohol spectrum disorder (FASD). Indian J Pediatr. 2009;76(11):1173–5.CrossRefPubMed
11.
go back to reference Popova S, Lange S, Probst C, Gmel G, Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(3):e290-9.CrossRefPubMed Popova S, Lange S, Probst C, Gmel G, Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health. 2017;5(3):e290-9.CrossRefPubMed
12.
go back to reference Laporal S, Demiguel V, Cogordan C, Barry Y, Guseva I, Goulet V, et al. Surveillance des troubles causés par l’alcoolisation foetale: analyse des données du programme de médicalisation des systèmes d’information en France entre 2006 et 2013. [Synthèse] Saint-Maurice: Santé publique France, coll. Données de surveillance. 2018;16p. Laporal S, Demiguel V, Cogordan C, Barry Y, Guseva I, Goulet V, et al. Surveillance des troubles causés par l’alcoolisation foetale: analyse des données du programme de médicalisation des systèmes d’information en France entre 2006 et 2013. [Synthèse] Saint-Maurice: Santé publique France, coll. Données de surveillance. 2018;16p.
13.
go back to reference Allen J, Gay B, Crebolder H et al. La définition européenne de la médecine générale. Médecine de famille. WONCA Europe 2002. Allen J, Gay B, Crebolder H et al. La définition européenne de la médecine générale. Médecine de famille. WONCA Europe 2002.
14.
go back to reference Howlett H, Mackenzie S, Strehle EM, Rankin J, Gray WK. A Survey of Health Care Professionals’ Knowledge and Experience of Fetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy. Clin Med Insights Reprod Health. 2019;13:1179558119838872.CrossRefPubMedPubMedCentral Howlett H, Mackenzie S, Strehle EM, Rankin J, Gray WK. A Survey of Health Care Professionals’ Knowledge and Experience of Fetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy. Clin Med Insights Reprod Health. 2019;13:1179558119838872.CrossRefPubMedPubMedCentral
15.
go back to reference Peadon E, O’Leary C, Bower C, Elliott E. Impacts of alcohol use in pregnancy–the role of the GP. Aust Fam Physician. 2007;36(11):935–9.PubMed Peadon E, O’Leary C, Bower C, Elliott E. Impacts of alcohol use in pregnancy–the role of the GP. Aust Fam Physician. 2007;36(11):935–9.PubMed
16.
go back to reference Adebiyi BO, Mukumbang FC, Cloete LG, Beytell AM. Exploring service providers’ perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study. BMC Public Health. 2018;18(1):1238.CrossRefPubMedPubMedCentral Adebiyi BO, Mukumbang FC, Cloete LG, Beytell AM. Exploring service providers’ perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study. BMC Public Health. 2018;18(1):1238.CrossRefPubMedPubMedCentral
17.
go back to reference Mété D. Fiscalité des rhums traditionnels en outre-mer et santé publique : l’exemple de l’île de La Réunion [Taxation of traditional rums in French overseas territories and public health: The example of Reunion Island]. Rev Epidemiol Sante Publique. 2017 Nov;65(6):443-452. French. https://doi.org/10.1016/j.respe.2017.06.003. Epub 2017 Oct 27. PMID: 29110959. Mété D. Fiscalité des rhums traditionnels en outre-mer et santé publique : l’exemple de l’île de La Réunion [Taxation of traditional rums in French overseas territories and public health: The example of Reunion Island]. Rev Epidemiol Sante Publique. 2017 Nov;65(6):443-452. French. https://​doi.​org/​10.​1016/​j.​respe.​2017.​06.​003. Epub 2017 Oct 27. PMID: 29110959.
19.
go back to reference ARS La Réunion. Evaluation du processus du Plan d'action de prévention et de prise en charge de l'ensemble des troubles causés par l'alcoolisation foetale à La Réunion - Rapport final d'évaluation. 2020. ARS La Réunion. Evaluation du processus du Plan d'action de prévention et de prise en charge de l'ensemble des troubles causés par l'alcoolisation foetale à La Réunion - Rapport final d'évaluation. 2020.
21.
go back to reference Pourchez L. L’alcoolisme au féminin à l’île de la Réunion. Ethnol Francaise. 2002;32(4):689–97.CrossRef Pourchez L. L’alcoolisme au féminin à l’île de la Réunion. Ethnol Francaise. 2002;32(4):689–97.CrossRef
24.
go back to reference Crawford-Williams F, Steen M, Esterman A, Fielder A, Mikocka-Walus A. “If you can have one glass of wine now and then, why are you denying that to a woman with no evidence”: Knowledge and practices of health professionals concerning alcohol consumption during pregnancy. Women Birth. 2015;28(4):329–35.CrossRefPubMed Crawford-Williams F, Steen M, Esterman A, Fielder A, Mikocka-Walus A. “If you can have one glass of wine now and then, why are you denying that to a woman with no evidence”: Knowledge and practices of health professionals concerning alcohol consumption during pregnancy. Women Birth. 2015;28(4):329–35.CrossRefPubMed
25.
go back to reference Burns E, Gray R, Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review. Addict Abingdon Engl. 2010;105(4):601–14.CrossRef Burns E, Gray R, Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review. Addict Abingdon Engl. 2010;105(4):601–14.CrossRef
26.
go back to reference Pilowsky DJ, Wu LT. Screening instruments for substance use and brief interventions targeting adolescents in primary care: A literature review. Addict Behav. 2013;38(5):2146 53.CrossRefPubMed Pilowsky DJ, Wu LT. Screening instruments for substance use and brief interventions targeting adolescents in primary care: A literature review. Addict Behav. 2013;38(5):2146 53.CrossRefPubMed
29.
go back to reference Floyd RL, Ebrahim SH, Boyle CA. Observations from the CDC: Preventing Alcohol-Exposed Pregnancies among Women of Childbearing Age: The Necessity of a Preconceptional Approach. J Womens Health Gend Based Med. 1999;8(6):733–6.CrossRefPubMed Floyd RL, Ebrahim SH, Boyle CA. Observations from the CDC: Preventing Alcohol-Exposed Pregnancies among Women of Childbearing Age: The Necessity of a Preconceptional Approach. J Womens Health Gend Based Med. 1999;8(6):733–6.CrossRefPubMed
31.
go back to reference Davis PM, Carr TL, La CB. Needs assessment and current practice of alcohol risk assessment of pregnant women and women of childbearing age by primary health care professionals. Can J Clin Pharmacol. 2008;15(2):e214-22.PubMed Davis PM, Carr TL, La CB. Needs assessment and current practice of alcohol risk assessment of pregnant women and women of childbearing age by primary health care professionals. Can J Clin Pharmacol. 2008;15(2):e214-22.PubMed
32.
go back to reference Brown JM, Bland R, Jonsson E, Greenshaw AJ. The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health. Can J Psychiatry. 2019;64(3):169–76.CrossRefPubMed Brown JM, Bland R, Jonsson E, Greenshaw AJ. The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health. Can J Psychiatry. 2019;64(3):169–76.CrossRefPubMed
33.
go back to reference Kable JA, O’Connor MJ, Olson HC, Paley B, Mattson SN, Anderson SM, et al. Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis. Child Psychiatry Hum Dev. 2016;47(2):335–46.CrossRefPubMed Kable JA, O’Connor MJ, Olson HC, Paley B, Mattson SN, Anderson SM, et al. Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis. Child Psychiatry Hum Dev. 2016;47(2):335–46.CrossRefPubMed
35.
go back to reference Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Ensemble des troubles causés par l’alcoolisation fœtale: lignes directrices canadiennes concernant le diagnostic. CMAJ Can Med Assoc J. 2005;172(5 Suppl):SF1-21.CrossRef Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Ensemble des troubles causés par l’alcoolisation fœtale: lignes directrices canadiennes concernant le diagnostic. CMAJ Can Med Assoc J. 2005;172(5 Suppl):SF1-21.CrossRef
36.
go back to reference Loock C, Conry J, Cook JL, Chudley AE, Rosales T. Identifying fetal alcohol spectrum disorder in primary care. CMAJ Can Med Assoc J. 2005;172(5):628–30.CrossRef Loock C, Conry J, Cook JL, Chudley AE, Rosales T. Identifying fetal alcohol spectrum disorder in primary care. CMAJ Can Med Assoc J. 2005;172(5):628–30.CrossRef
38.
go back to reference Coles CD, Gailey AR, Mulle JG, Kable JA, Lynch ME, Jones KL. A comparison among 5 methods for the clinical diagnosis of fetal alcohol spectrum disorders. Alcohol Clin Exp Res. 2016;40(5):1000–9.CrossRefPubMedPubMedCentral Coles CD, Gailey AR, Mulle JG, Kable JA, Lynch ME, Jones KL. A comparison among 5 methods for the clinical diagnosis of fetal alcohol spectrum disorders. Alcohol Clin Exp Res. 2016;40(5):1000–9.CrossRefPubMedPubMedCentral
43.
go back to reference Popova S, Lange S, Shield K, Burd L, Rehm J. Prevalence of fetal alcohol spectrum disorder among special subpopulations: a systematic review and meta-analysis. Addiction. 2019;114(7):1150–72.CrossRefPubMedPubMedCentral Popova S, Lange S, Shield K, Burd L, Rehm J. Prevalence of fetal alcohol spectrum disorder among special subpopulations: a systematic review and meta-analysis. Addiction. 2019;114(7):1150–72.CrossRefPubMedPubMedCentral
44.
go back to reference Temple VK, Ives J, Lindsay A. Diagnosing FASD in adults: the development and operation of an adult FASD clinic in Ontario Canada. J Popul Ther Clin Pharmacol. 2015;22(1):e96-105.PubMed Temple VK, Ives J, Lindsay A. Diagnosing FASD in adults: the development and operation of an adult FASD clinic in Ontario Canada. J Popul Ther Clin Pharmacol. 2015;22(1):e96-105.PubMed
45.
go back to reference Pelletier-Fleury N, Le Vaillant M, Szidon P, Marie P, Raineri F, Sicotte C. Preventive service delivery: a new insight into French general pratice. Health Policy. 2007;83:268–76.CrossRefPubMed Pelletier-Fleury N, Le Vaillant M, Szidon P, Marie P, Raineri F, Sicotte C. Preventive service delivery: a new insight into French general pratice. Health Policy. 2007;83:268–76.CrossRefPubMed
46.
go back to reference Chaput H, Monziols M, Fressard L, Verger P, Ventelou B, Zaytseva A. Deux tiers des médecins généralistes libéraux déclarent travailler au moins 50 heures par semaine. DREES Études et Résultats. 2019;1113:1–2. Chaput H, Monziols M, Fressard L, Verger P, Ventelou B, Zaytseva A. Deux tiers des médecins généralistes libéraux déclarent travailler au moins 50 heures par semaine. DREES Études et Résultats. 2019;1113:1–2.
Metadata
Title
The role of general practitioners in Reunion in detecting alcohol use in pregnant women and identifying fetal alcohol spectrum disorder: a qualitative study
Authors
Sébastien Leruste
Louise Delfarguiel
Bérénice Doray
Coralie Loubaresse
Laetitia Sennsfelder
Thierry Maillard
Catherine Marimoutou
Michel Spodenkiewicz
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Archives of Public Health / Issue 1/2023
Electronic ISSN: 2049-3258
DOI
https://doi.org/10.1186/s13690-023-01221-0

Other articles of this Issue 1/2023

Archives of Public Health 1/2023 Go to the issue