• lack of knowledge about the effects of alcohol on the fetus
• lack of convincing evidence that the occasional drink is harmful
• having a partner or friend who drinks
• opinions from family and friends who drank in pregnancy with apparently healthy children
• peer pressure, particularly about drinking on special occassions such as birthdays, weddings, new years eve
• lack of support from partner, friends and family
• living in a family or community tolerant of heavy drinking
• social isolation & living in remote communities
• poverty
• unemployment
• stress, domestic violence, loneliness which may result in self-medicating
• women who have FASD themselves

Health professionals have an important role to support women not to drink alcohol when planning a pregnancy and during pregnancy. They should:

• Ask about their alcohol use.
• Assess and record the level of risk of the alcohol consumption.
• Advise women that alcohol use may harm the developing fetus and therefore the NHRMC Alcohol Guidelines state that ‘To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol.’
• Assist women to stop or reduce alcohol consumption through positive reinforcement; talking about the consequences of alcohol exposure to the fetus; and conducting brief interventions with the aim of supporting the woman to abstain, and where this is not possible, to reduce alcohol use.
• Arrange for further support by planning additional consultations or referral to specialist services and support groups.

A non-judgmental approach is important when taking a history of alcohol consumption in pregnancy. Questions about alcohol should be asked in the context of optimising outcomes in pregnancy, together with other questions such as smoking, diet, stress and exercise.

Alcohol use disorder is usually seen as problematic drinking that results in a range of situations such as:

• drinking more or for a longer period of time
• spending a lot of time recovering from the after effects of alcohol
• craving or thinking about wanting to drink
• continuing to drink even though it is causing problems with family members, friends, education or work
• continuing to drink even when it is causing health problems such as trouble sleeping, heart palpitations, anxiety, memory loss
• putting yourself and others at risk by drinking and driving; drinking and operating machinery; drinking and engaging in unsafe sex

Alcohol use disorders can range from mild to severe, with the most severe being alcohol dependence.

There is a lack of highly trained professionals and appropriate services for pregnant women with alcohol use problems. Research conducted at the National Drug and Alcohol Research Centre (NDARC) confirms:

• all pregnant women who screen positively for alcohol-use disorders should be offered access to treatment that matches the severity of the disorder. Treatment may include inpatient admission for detoxification if necessary.
• all pregnant women who are alcohol dependent should be offered extended hospitalisation after their child’s birth for additional help and support. Women and children should also be followed-up through the child’s formative years to provide assistance with healthcare, social services, housing and parenting.
• treatment of pregnant women who are alcohol dependent should be undertaken by a multidisciplinary team. This includes alcohol and other drug services, obstetric care and a GP.

Health professionals working with women with alcohol use disorders need to be FASD informed when providing treatment and support as some of their clients may also have FASD.