Assessing maternal alcohol use

The timing, frequency and quantity of prenatal alcohol exposure is linked to the pattern and severity of fetal outcomes.

Brain growth and development occur throughout pregnancy, hence adverse cognitive, behavioural and neurodevelopmental outcomes may result from exposure at any time during pregnancy, and may occur in the absence of facial anomalies, or structural central nervous system abnormalities.

General Practitioners, obstetricians and midwives play an important role in talking to women about having a healthy pregnancy.

They should take any opportunity to ask and advise about alcohol use when planning a pregnancy and during pregnancy. Some women may find it difficult to stop drinking and will require referral to services that assist with addiction problems.

NHMRC Alcohol Guidelines

Resources

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FASD Hub eLearning Modules

Access the FASD eLearning modules to learn about the risks and effects of alcohol use in pregnancy and how to assess alcohol use in pregnancy.

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AUDIT-C

View the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) which provide a standardised method for assessment of maternal alcohol use.

Every Moment Matters Campaign

View resources developed for Health Professionals by the Foundation for Alcohol Research and Education.

Supporting pregnant women who use alcohol or other drugs: a review of the evidence

This resource has been developed by The National Drug and Alcohol Research Centre, UNSW Australia, for Health Professionals supporting pregnant women who use alcohol or other drugs.

A photo of a newborn baby being held while her mum looks at her whilst in the delivery room.

Clinical Guidance for the Management of Substance Use in Pregnancy, Birth and the Postnatal Period

The Clinical Guidance for the Management of Substance Use in Pregnancy, Birth and the Postnatal Period summarises the guiding principles, professional practice and interventions used when working with pregnant women who use substances.

WHO Guidelines for identification and management of substance use and substance use disorders in pregnancy

These guidelines contain recommendations on the identification and management of substance use and substance use disorders for health care services which assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder.

There are many factors that contribute to women drinking alcohol during pregnancy:

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

While poverty and unemployment may be contributing to drinking in some populations, Australian research has found that in mainstream public antenatal care, higher income and tertiary educated women were 2-4 times more likely to drink alcohol throughout pregnancy than women with only secondary school education.

The risk of harm from alcohol is hard to predict and is different for everybody. This is because factors such as the mother’s age, her general health and any medical conditions she may have, her levels of stress, other drug use and smoking, and even her body composition can influence how alcohol is metabolised and therefore the risk of harm to the developing baby. The genetic makeup of mother and baby can also make a difference in this process.

Health Professionals should:

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.

Video Series: GP, Ask the Question

GP Ask The Question’ Video 1: Alcohol in pregnancy is everyone’s business

A pregnant woman faces away from the camera, talking to a GP who sits in her office

GP Ask The Question’ Video 2: Asking questions about alcohol in pregnancy

GP Ask The Question’ Video 3: Recording alcohol use in pregnancy

What is an alcohol use disorder?

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.

What support should be offered?

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.

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Acknowledgement of Country

FASD Hub Australia acknowledges Aboriginal and Torres Strait Islander peoples as the Traditional Custodians of Country throughout Australia, and we recognise their connections to land, water and community. We pay our respect to their elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander peoples.