Review of the questionnaries used to detect alcohol consumption during pregnancy and the Green Page. / Revisión de los cuestionarios utilizados para la detección del consumo de alcohol durante el embarazo y la Hoja Verde.

Alcohol consumption during pregnancy is a leading cause of fetal alcohol spectrum disorder (FASD). Maternal reporting in childbearing women or pregnant women is the standard for the early detection of alcohol consumption. The Green Page (GP) is a screening questionnaire of environmental health which includes the alcohol intake record during pregnancy and/or lactation period. The aim of this paper is to review the features of the different questionnaires for the detection of alcohol consumption during the gestation period and the GP, as well as to make a comparison between them. Review of the scientific literature published over the last 10 years of indexed articles in Medline. Combined searching strategy with MeSH descriptors: 'pregnancy, alcohol drinking, surveys and/or questionnaires. AUDIT, AUDIT-C and SURP-P are mainly self-administered and do not require training. SURP-P and 4P´s are validated in pregnant women. Others detect quantity and frequency of exposure, need specific training and are administered face to face: TLFB, RD, ACOG antepartum record and the GP. ACOG antepartum record and GP are specific for pregnant population. GP detects alcohol consumption at the beginning of pregnancy in both women and their partner on a holistic and global environmental health approach. A careful face-to-face recording of alcohol exposure with trained staff, with an integrative and global environmental health focus throughout pregnancy, may help improve prevention and screening of pregnancy at risk for FASD.

El consumo de alcohol en el embarazo es la causa del trastorno del espectro alcohólico fetal (TEAF). La información aportada por las mujeres en edad fértil o embarazadas es el estándar para la detección temprana del consumo de alcohol. La Hoja Verde (HV) es una herramienta de cribado de salud medioambiental que incluye el registro de la ingesta de alcohol durante el embarazo y/o lactancia. El objetivo del presente trabajo es revisar las características de los distintos cuestionarios de detección del consumo de alcohol durante la gestación y de la HV, así como hacer una comparación entre ellos. Revisión de la literatura científica publicada en los últimos 10 años de los artículos indexados en Medline. Estrategia de búsqueda combinada con los descriptores MeSH: 'pregnancy, alcohol drinking, surveys and/or questionnaires'. AUDIT, AUDIT-C y SUPR-P se realizan mayoritariamente autoadministrados y no requieren entrenamiento. SUPR-P y 4P´s Plus están validados en embarazadas. Otros detectan cantidad y frecuencia, requieren entrenamiento previo y se realizan cara a cara: TLFB, RD, ACOG antepartum record y la HV. ACOG antepartum record y la HV son específicos para embarazadas. La HV detecta el consumo de alcohol al inicio del embarazo tanto en la gestante como en su pareja con un enfoque holístico y global de la salud medioambiental. Un cuidadoso registro de la ingesta de alcohol de forma presencial, con profesionales entrenados y con un enfoque holístico y global de la salud medioambiental durante el embarazo ayudaría a mejorar la prevención y cribado de embarazos en riesgo de TEAF.

Sociocultural aspects of drug dependency during early pregnancy and considerations for screening: Case studies of social networks and structural violence.

OBJECTIVE: To contribute in closing the current gap in literature that holistically examines sociocultural influences on perinatal drug dependency. This article draws from social network theory and structural violence to qualitatively consider the contextual components of addiction and substance use during pregnancy, which purposefully moves away from situating this issue from solely being within the contexts of pathologized disorders or products of social inequalities. DESIGN: Face-to-face semi-structured interviews with drug-dependent pregnant women identified during a reproductive environmental health consultation. SETTING: Interviews were conducted at a university hospital in southeastern Spain between October 2015 and June 2016. PARTICIPANTS: 10 pregnant women with confirmed perinatal substance use and/or drug dependency. FINDINGS: The sociocultural perspective offers a useful lens by which providers can understand the reasons for initial substance use and progress of multi-drug dependency as way of individually tailoring intervention strategies for expecting mothers. This perspective draws from the frameworks of social network analysis (SNA) and structural violence to dialectically examine drug dependency in this unique patient population not to be solely an individual occurrence, but rather a combination of macro and micro-level factors at play. KEY CONCLUSIONS: The sociocultural approach in examining maternal health allows for the holistic exploration of the already taboo and symbolically paradoxical phenomenon of drug dependency in pregnant women. IMPLICATIONS FOR PRACTICE: The "Hoja Verde" and similar perinatal screening methods that comprehensively assess for the potential of environmental risks can be a key instrument in the practice of preventing developmental issues of children as early as pregnancy and into adolescence.

Case control study of periconceptional folic acid intake and nervous system tumors in children.

PURPOSE: Since 1992, the Centers for Disease Control and Prevention recommends that women of childbearing age consume 400 µg of folic acid per day to reduce the risk of neural tube defects (NTD). It has been speculated that both NTD and nervous system tumors (NST) may share common mechanisms of altered development. It examines the association between folic acid supplementation and the risk for childhood NST. METHODS: Incident cases of children with cancer in Spain registered between 2004 and 2006 were identified through the MACAPE Network Group. Tumors were classified as tumors derived from the neuroectoderm (cases) and those with a mesoderm origin (controls). In a second analysis, NST were further divided into central nervous system tumors (CNST) and sympathetic nervous system tumors (SNST). We compared folic acid supplementation between the groups. RESULTS: Overall, folic acid supplementation any time during pregnancy was similar between cases and controls (odds ratio (OR)=1.05; 95% confidence interval (CI) 0.92-1.20). However, supplementation before the 21st and 36th days of gestation resulted in significantly lower NST than in children with mesoderm tumors (OR=0.34; 95% CI 0.17-0.69 and OR=0.58; 95% CI 0.37-0.91, respectively). Preconceptional intakes of folic acid were also lower in NST although marginally nonsignificant (OR=0.44; 95% CI 0.10-1.02). When NST were divided into CNST and SNST, significant differences between tumors of mesoderm origin were only found for CNST. CONCLUSIONS: Our results support the hypothesis that folate supplementation reduces the risk of childhood NST, especially CNST. The specific mechanism and cellular role that folate may play in the development of CNST have yet to be elucidated.