Today’s post is about the Women Want to Know program on alcohol and pregnancy and the role of health professionals.
Did you know that 97 percent of Australian women have said they wanted to be asked about their alcohol use in pregnancy? Most women visit a health professional when they’re pregnant for advice on a range of topics, alcohol being one. These visits present the ideal opportunity to discuss alcohol consumption and reinforce that not drinking during pregnancy is the safest option.
However, some health workers are reluctant to discuss alcohol with pregnant women, concerned that the woman may feel uncomfortable. Or they’re unsure what advice to provide and where to refer if necessary. A new national campaign, Women Want to Know, aims to overcome these barriers by educating health professionals on the effects of alcohol consumption during pregnancy to ensure that women are fully informed. Conversations about alcohol with women who are pregnant or planning pregnancy can assist women to stop or reduce their alcohol use and prevent adverse consequences. Alcohol consumption during pregnancy is known to cause birth defects,, and is also linked to miscarriage, premature birth, low birthweight and Foetal Alcohol Spectrum Disorders (FASD). FASD is a lifelong disability primarily associated with brain damage caused by prenatal alcohol exposure. People with FASD also experience growth restriction, developmental delay and social, emotional and behavioural deficits.
So how much alcohol is safe during pregnancy?
Despite numerous studies, the safe level of alcohol during pregnancy has not been determined and there is no known level of alcohol or time during pregnancy where damage to the foetus will not occur,. For these reasons Australia’s National Health and Medical Research Council (NHMRC) recommends that ‘for women who are pregnant or planning a pregnancy, not drinking is the safest option.’
What is the role of health professionals in educating women about alcohol consumption?
As a health professional you can positively influence a woman’s choices about their alcohol consumption by initiating conversations. Australian women consider health professionals to be the best source of information regarding alcohol during pregnancy and many are willing to make changes if advised to do so. However many women do not ask about alcohol as they expect all important issues to be raised by the health worker.
As part of Women Want to Know, pregnant women and new mothers were asked about the information they’d like to receive on alcohol and pregnancy. Here’s a short interview of Verity providing her views.
One easy way to discuss alcohol with women is to use the 5As, an evidence-based framework that lets you structure a conversation appropriate to the person. The 5As are: ASK all women of child-bearing age and pregnant women about their alcohol use.
ASSESS and record the woman’s alcohol consumption using tools such as AUDIT-C.
ADVISE all women that:
- No alcohol is the safest option when pregnant or planning pregnancy; and
- No safe level of alcohol consumption during pregnancy has been determined.
This advice is consistent with the NHMRC’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Women who have already consumed alcohol in pregnancy can be advised that:
- The level of risk to the foetus is hard to predict but is likely to be low if small amounts of alcohol have been consumed; and
- Stopping drinking at any time in the pregnancy will reduce the risk to the foetus.
ASSIST women to stop or reduce alcohol consumption through:
- Positive reinforcement for women who are already abstaining
- Advising on the consequences of alcohol exposure to the foetus;
- Encouraging women to seek the support of their partner and loved ones in abstaining; and
- Conducting brief intervention or motivational interviewing to support women to abstain or, where that’s not possible, to reduce alcohol intake and avoid intoxication.
ARRANGE for further support by planning additional consultations or by referral to specialist services.
To see these steps in action, watch this video of a health professional discussing alcohol use with a pregnant woman.
Here’s a health professional outlining why discussions about alcohol are important.
To learn more about the Women Want to Know campaign and order free print materials, visit www.alcohol.gov.au
Free accredited online training is also available through:
- Australian College of Midwives;
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists; and
- Royal Australian College of General Practitioners;
- Royal Australasian College of Physicians
Women Want to Know has been developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with the Australian Government Department of Health, the Royal Australian College of General Practitioners (RACGP), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Australian College of Midwives (ACM), the Australian Medical Association (AMA), the Australian Medicare Locals Alliance (AMLA) and the Maternity Coalition.
 Hard, M., Einarson, T. and Koren, G. (2001). The role of acetaldehyde in pregnancy outcome after prenatal alcohol exposure. Therapeutic Drug Monitoring 23 (4), 427-434. http://journals.lww.com/drug-monitoring/Abstract/2001/08000/The_Role_of_Acetaldehyde_in_Pregnancy_Outcome.18.aspx
 Denkins, Y., Woods, J., Whitty, J. and Hannigan, J. (2000). Effects of gestational alcohol exposure on fatty acid composition of umbilical cord serum in humans. The American Journal of Clinical Nutrition 71 (1):300-306 http://ajcn.nutrition.org/content/71/1/300s.abstract?sid=5f923c79-5671-4dc3-8eab-495fca1f5003
Siler-Khodr, T., Yang, Y., Grayson, M., Henderson, G. and Lee, M. (2000). Effects of ethanol on thromboxane and prostacyclin production in the human placenta. Alcohol 21(2):169- 80. http://www.ncbi.nlm.nih.gov/pubmed/10963940
 O’Leary, C., Nassar, N., Kurinczuk, J. and Bower, C. (2009). The effect of maternal alcohol consumption on fetal growth and preterm birth. BJOG: An International Journal of Obstetrics and Gynaecology 116: 390-400
 Henderson, J., Gray, R,.Brocklehurst, P. (2007). Systematic review of the effects of low-moderate prenatal alcohol exposure on pregnancy outcomes. BJOG: An International Journal of Obstetrics and Gynaecology 114 (3): 243-252. Alcohol and Pregnancy Project (2009). Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder: a Resource for Health Professionals. Telethon Institute for Child Health Research, Perth.