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International Foetal Alcohol Spectrum Disorder Awareness Day

Foetal alcohol spectrum disorders are lifelong physical, behavioural, and cognitive disabilities caused by foetal exposure to alcohol. Prevention is simple on paper: women should not drink during pregnancy. But we know that in practice there are numerous reasons why pregnant women may drink (or continue to drink), including: having pre-existing problems with alcohol; not knowing they are pregnant; not being aware of the risks of drinking during pregnancy; and being under the impression that drinking during the early weeks of gestation is ‘harmless’.

For agencies and professionals whose role is to communicate risk, there remains a lack of evidence about “exactly how much alcohol is linked to increased risk”. Weighing this against the severe problems that children can develop when exposed to alcohol before birth, official UK guidelines have opted to advise that the safest option for women who are pregnant or could get pregnant is not to drink at all.
• The British Medical Association’s recommendation for women who are pregnant, or considering a pregnancy, is that “the safest option is not to consume any alcohol”.
• The Royal College of Obstetricians and Gynaecologists advises that “The safest approach is not to drink alcohol at all if you are pregnant, if you think you could become pregnant or if you are breastfeeding”.
• Guidelines from the Chief Medical Officer state that “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum”. However, “The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy”.

For International Foetal Alcohol Spectrum Disorder Awareness Day, Drug and Alcohol Findings is revisiting the evidence base about how to effectively address the problem of alcohol-exposed pregnancies – organised under the headings of (1) brief intervention, (2) prevention, and (3) spending. In the commentaries of the analyses we link to below, we discuss the social and policy considerations around disseminating “consistent and clear” guidance on alcohol consumption in pregnancy.

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Highlights from the Effectiveness Bank

1. BRIEF INTERVENTION The British Medical Association states that healthcare professionals should be given sufficient time and resources to ensure that any woman who is pregnant, or who is planning a pregnancy, and who is identified as drinking at low-to-moderate levels, is offered brief intervention counselling. This should occur at the earliest possible stage and be considered part of routine antenatal care.

‘Going off script’: screening and brief advice in Scottish antenatal care
Highly skilled and practiced at having difficult conversations, midwives play an important role in screening for and giving brief advice about drinking alcohol in pregnancy. Based on the Scottish antenatal experience, are midwives following the standardised approach, and how important is it that they do?

‘How have infertility treatments affected your drinking?’
Problems with fertility can be caused or exacerbated by substance use, and in the reverse direction, women can lean on drinking and drug use to cope with the emotional and physical toll of infertility treatment. Enquiring about drug and alcohol problems may be an ‘ethical and medical duty’ for reproductive specialists, but can screening, brief intervention, and referral to treatment be successfully integrated into their routine practice?

2. PREVENTION Many pregnancies are unplanned, and women may continue drinking into their first and sometimes second trimesters unaware that they are pregnant. One approach is to simultaneously address risky drinking and ineffective use of contraception. Targeting interventions at women before they become pregnant could shift the focus in clinical practice from treatment of substance-exposed pregnancies to prevention of a major (and costly) public health concern.

Preventing alcohol- and tobacco-exposed pregnancies
In the USA the CHOICES Plus trial tested a bundle of ‘pre-conception’ services for risky drinking, smoking, and ineffective contraception. Significant reductions in the risk of pregnancies exposed to alcohol and tobacco suggest the package may be feasible and effective, but would it transfer to the UK context?

3. SPENDING In Britain, there is currently no nationwide strategy for, or clinical guideline on, the prevention, diagnosis, and treatment of foetal alcohol spectrum disorders. Furthermore, the full extent of harm caused by drinking during pregnancy has not been accounted for, and the societal and financial costs are unclear.

Compelling argument for spending more on prevention
Foetal alcohol spectrum disorder is a preventable condition with a significant cost to society. Yet, in North America only a very small proportion of the total costs of foetal alcohol spectrum disorders is used to fund research and prevention. Looking to established models of prevention in Canada and the United States, review asks whether there is a strong financial justification for investing further in prevention, and if so what the optimal path to prevention would be.

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The Drug and Alcohol Findings Effectiveness Bank offers a free mailing list service updating subscribers to UK-relevant evaluations of drug/alcohol interventions. Findings is supported by the Society for the Study of Addiction and Alcohol Change UK, and advised by the National Addiction Centre.