Drinking Alcohol During Pregnancy Whats the Message

1
Drinking Alcohol During Pregnancy Whats the
Message?

• Christopher Griffiths
• Consultant Nurse Learning Disabilities
• Abertawe Bro Morgannwg University NHS Trust

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Drinking Alcohol During Pregnancy Conflicting
Guidance

• Department of Health - women trying to conceive
  or who are pregnant should avoid alcohol.
• Royal College of Obstetricians and Gynaecologists
  there is no evidence of harm if a woman drinks
  one or two units a week.
• National Institute for Health and Clinical
  Excellence women should avoid alcohol in the
  first 3 months in particular, because of the
  increased risk of miscarriage.

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What is a Unit of Alcohol?

• One unit of alcohol approximates to
• Half pint of ordinary strength beer, lager or
  cider
• A small pub measure of spirit
• There are 1.5 units in a small (125ml) glass of
  ordinary strength wine or a standard (35ml) pub
  measure of spirit.

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Low, Moderate and Heavy Drinking

• Low to moderate drinking is considered to be less
  than one drink a day (1.5 units)
• The Office of National Statistics (ONS) defines
  heavy drinking as
• 8 or more units for men and
• 6 or more units for women on at least one day in
  the week
• British Medical Association, 2007

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Binge Drinking

• Traditional thinking
• Current thinking
• Binge drinking refers to heavy drinking during
  the course of an evening
• The DoH uses the ONS definition of heavy drinking
  as a proxy for binge drinking
• The Prime Ministers Strategy Unit (PMSU) defines
  binge drinking as over twice the recommended
  guidelines for daily drinking.

(BMA, 2007)
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Historical View of Alcohol and Pregnancy

• During the gin epidemic a RCP report, noted in
  1725, that weak, feeble and distempered children
  were the result
• In 1834 a parliamentary report remarked that
  children tend to be born starved, shrivelled and
  imperfect in form

EMIS, 2007
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Foetal Alcohol Spectrum Disorder

• Foetal Alcohol Syndrome (FAS)
• Partial Foetal Alcohol Syndrome (PFAS)
• Alcohol Related Birth Defects (ARBD)
• Alcohol Related Neurodevelopmental Disorders
  (ARND)

Reproduced with kind permission of FASAware UK
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Foetal Alcohol Syndrome (FAS)

• Facial anomalies
• Growth retardation
• Central Nervous System abnormalities

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Facies in Fetal Alcohol Syndrome
Discriminating Features
In the young child
Streissguth, 1994
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Risk Factors

• Maternal consumption of alcohol during pregnancy
• There is no safe time to drink during pregnancy
• Heavy drinking and binge drinking are special
  risks
• Genetic make up of the mother and foetus
• Factors such as malnutrition, smoking and other
  drug use increase risk

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Drinking During Pregnancy

• Most women change their behaviour during
  pregnancy.
• Unplanned pregnancy is common
• First 4-8 weeks important developmental period
• If pregnant, STOP drinking

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Learning disabilities and FAS

• Severe developmental disabilities
• Below average I.Q.
• Attention deficits
• Memory problems

• Impulsiveness
• Inappropriate behaviour
• Poor adaptive behaviour
• Poor fine motor control

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Summary

• Drinking heavily and regularly during pregnancy
  can result in severe mental and physical
  developmental delay in the child.
• Foetal Alcohol Syndrome is a leading cause of
  learning disabilities
• The neurological and cognitive problems
  associated with FAS can be lifelong
• FAS is preventable.

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Thank you

• References and Further Reading
• British Medical Association (2007) Fetal Alcohol
  Spectrum Disorders. A guide for healthcare
  professionals. London.
• Department of Health (2008) Safe, Sensible,
  Social Consultation on further action. London
  Department of Health (2008) Safe, Sensible,
  Social - Consultation on further action. Impact
  Assessments. London
• FASawareUK (2003). Foetal Alcohol Spectrum
  Disorder. A resource for professionals United
  Kingdom Version 2003. Saskatchewan Institute on
  Prevention of Handicaps.
• Mukherjee RA, Hollins S, Abou-Saleh MT, et al
  (2005) Low level alcohol consumption and the
  fetus. BMJ. 2005 Feb 19 330(7488) 375-6
• Plant ML and Plant MA (2001) Heavy drinking by
  young British women gives cause for concern.
  British Medical Journal 323 1183
• Prime Ministers Strategy Unit (2004) Alcohol
  harm reduction strategy for England. London
  Prime Ministers Strategy Unit.
• Riley EP (2008) FASD Not Just Another Pretty
  Face The effects of prenatal alcohol on brain
  and behaviour. Presentation. England
• The Information Centre (2006) Statistics on
  alcohol England
• Special thanks to
• Professor Edward Riley, Center for Behavioural
  Teratology and Department of Psychology, San
  Diego State University
• Gloria Armisted, FASawareUK