SPONSORED: Alcohol can cause harm at all stages of pregnancy. Health professionals play a key role in supporting all mothers-to-be to avoid harm.
General practitioners, as keystone providers of antenatal care, are a vital source of information and advice about drinking alcohol during pregnancy. Patients who are pregnant or trying to conceive want their GPs to provide clear and consistent advice about alcohol as early as possible in pregnancy.
The latest available evidence that underpins the National Health and Medical Research Council’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol (the Guidelines) states that women who are pregnant or planning a pregnancy should not drink alcohol.
The teratogenic effects of alcohol can impact all stages of a pregnancy, including fertilisation, implantation, development of the placenta and its ongoing functioning and development of the embryo and fetus.
While alcohol can cause harm throughout the whole pregnancy, the potential risks are greatest in the first three to eight weeks post conception when rapid cell division and differentiation is taking place.
Drinking alcohol during pregnancy can:
- Increase the risk of miscarriage and stillbirth.
- Increase the risk of premature birth, the baby being small for gestational age or of low birth weight, and
- Disrupt fetal development resulting in an array of outcomes collectively known as Fetal Alcohol Spectrum Disorder (FASD).
FASD is a lifelong neurodevelopmental condition that is the leading non-genetic development disability in Australia. It can involve:
- Physical and emotional developmental delay
- Impaired speech and language development
- Learning problems, and
- Difficulty controlling behaviour.
People with FASD are also at risk of a range of long-term health problems, including cardiovascular, metabolic and immune problems.
FASD is diagnosed by assessing the degree of deficit on ten neurodevelopmental domains using the Australian Guide to the diagnosis of FASD. FASD presentations are diverse due to the wide range of paternal, maternal and child factors that influence prenatal development, coupled with differences in the dose and timing of prenatal alcohol exposure.
Despite the risks, consumption of alcohol during pregnancy is common in Australia. The last National Drug Strategy Household survey found that:
- One in two women drink alcohol early in pregnancy, before they are aware that they are pregnant, and
- One in seven continue to drink alcohol after becoming aware of their pregnancy.
Alcohol use during pregnancy can occur in any or all populations – across social demographics and cultural backgrounds. Much of this is likely due to the mixed messages that still abound in the community about drinking alcohol during pregnancy.
Research shows that women want clear and consistent advice about alcohol as early as possible in pregnancy. General practitioners play an important role in providing this advice, that aligns with the Guidelines: that women who are pregnant or planning a pregnancy should not drink alcohol.
FASD can be prevented if women are supported by health professionals to remain alcohol-free during pregnancy.
A small proportion of your patients will have an alcohol use disorder and need additional support. It is important to know the referral pathways for specialist antenatal care and alcohol and other drug treatment. Withdrawal management in pregnant women should occur under medical supervision and may require hospital admission.
There are opportunities to ask about alcohol consumption during preconception care, early in pregnancy and throughout the pregnancy. Regular check-ins including assessment of risk using a validated tool such as Audit-C is recommended.
Using a framework for motivational interviewing, such as the ‘Five-As’ – ask, assess, advise, assist and arrange – can be helpful.
New training for health professionals to help support alcohol-free pregnancies will be launched in late 2022 as part of the Foundation for Alcohol Research and Education’s Every Moment Matters campaign.
Find out more and download resources for health professionals at: www.everymomentmatters.org.au.
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