Optimizing well-pregnancy care on Prince Edward Island

While pregnancy is a normal, transitional life event many women experience, the need exists for competent, holistic health care during this time in their lives. On Prince Edward Island, 90% of perinatal care is administered by obstetricians following a medical model of care; this is 30% greater than the national average (Public Health Agency of Canada [PHAC], 2009). Pregnancy outcomes on P.E.I., in regards to folic acid supplementation, high pre-pregnancy and pregnancy body mass indexes (BMI), overweight or obese expectant mothers, substance use, and breastfeeding consistently fall outside national averages (P.E.I. Reproductive Care Program [P.E.I. RCP], 2008; PHAC, 2009, 2012). An initiative to implement nurse practitioner-led perinatal care for healthy pregnant women can help to address these outcomes by ensuring appropriate ongoing physical assessment, addressing psychosocial needs, and increasing perinatal education to women and their families during the preconception, prenatal, and postpartum periods. The initiative will include communication to key stakeholders, and a timeline of planned activities and will follow the PHAC’s (2001) Project Evaluation to assess success of the project

Incidence of prenatal alcohol exposure in Prince Edward Island

Background: Fetal alcohol spectrum disorder (FASD) is a leading preventable cause of neurodevelopmental disability in North America. The stigma associated with alcohol use and abuse during pregnancy makes it difficult to obtain information on prenatal alcohol use through self-reporting. We assessed the incidence of prenatal alcohol exposure in Prince Edward Island to facilitate future public health initiatives addressing FASD. Methods: Prenatal alcohol exposure was examined via population-based collection of meconium and analysis of fatty acid ethyl esters (FAEEs). Fatty acid ethyl esters are nonoxidative metabolites of ethanol that are produced in the fetus. Meconium FAEE concentrations of 2.0 nmol/g or greater are indicative of frequent prenatal alcohol exposure during the last 2 trimesters of pregnancy. Samples were collected from 1307 neonates between Nov. 8, 2010, and Nov. 8, 2011, in hospitals in PEI, or from those born to mothers who resided in PEI but gave birth in Halifax, Nova Scotia. Samples were frozen and shipped for analysis. Fatty acid ethyl esters were analyzed by gas chromatography–mass spectrometry and quantified by means of deuterated internal standards. Results: Of the 1307 samples collected, 1271 samples were successfully analyzed. Positive results for FAEEs were obtained in 3.1% (n = 39) of samples collected within the first 24 hours after birth. Interpretation: Not all neonates exposed to heavy prenatal alcohol in utero will exhibit FASD; based on current estimates of predictive value for disease by exposure, our findings suggest that 1.3% of neonates born in PEI during this 1-year period will have FASD. In its application to an entire provincial birth cohort, this study successfully implemented a public health–centred approach for evaluating population-based risk of FASD, with implications for practice across Canada