{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:35:15Z","timestamp":1792586115349,"version":"4.5.0"},"reference-count":85,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T00:00:00Z","timestamp":1616716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1184466"],"award-info":[{"award-number":["1184466"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Understanding the factors that contribute to women\u2019s alcohol use in pregnancy is critical to supporting women\u2019s health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada\u2019s Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women\u2019s alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health.<\/jats:p>","DOI":"10.3390\/ijerph18073445","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T06:59:42Z","timestamp":1616741982000},"page":"3445","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["\u201cThe Problem Is that We Hear a Bit of Everything\u2026\u201d: A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy"],"prefix":"10.3390","volume":"18","author":[{"given":"Vivian","family":"Lyall","sequence":"first","affiliation":[{"name":"Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4584-6494","authenticated-orcid":false,"given":"Lindsay","family":"Wolfson","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Women\u2019s Health, Vancouver, BC V6H 3N1, Canada"},{"name":"Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9813-5613","authenticated-orcid":false,"given":"Natasha","family":"Reid","sequence":"additional","affiliation":[{"name":"Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Poole","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Women\u2019s Health, Vancouver, BC V6H 3N1, Canada"},{"name":"Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen M.","family":"Moritz","sequence":"additional","affiliation":[{"name":"Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia"},{"name":"School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD 4072, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Egert","sequence":"additional","affiliation":[{"name":"Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette J.","family":"Browne","sequence":"additional","affiliation":[{"name":"School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3943-620X","authenticated-orcid":false,"given":"Deborah A.","family":"Askew","sequence":"additional","affiliation":[{"name":"Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia"},{"name":"Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e290","DOI":"10.1016\/S2214-109X(17)30021-9","article-title":"Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: A systematic review and meta-analysis","volume":"5","author":"Popova","year":"2017","journal-title":"Lancet Glob. 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