Letters
Women's health
Volume 187 - Issue 5

A review of policies on alcohol use during pregnancy in Australia and other English-speaking countries, 2006

Authors:  Colleen M O’Leary, Louise M Heuzenroeder, Elizabeth J Elliott and Carol I Bower

Med J Aust 2007; 187 (5): 315-316. || doi: 10.5694/j.1326-5377.2007.tb01257.x
Published online: 3 September 2007
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In reply: Morley and colleagues and Miers raise a number of interesting discussion points. As we reported in our policy review, the Canadian, United Kingdom and Australian guidelines have similar intent but differ in emphasis.1 Health Canada’s policy position is that, although abstinence is the prudent choice, fetal risk is relative to the amount of alcohol consumed and is minimal with low levels of maternal alcohol intake. Australian policy addresses the same issues, with less emphasis on abstinence and more on avoiding intoxication and ensuring low-level alcohol consumption. Since our review was published, UK guidelines have been reframed to emphasise abstinence, but their message has not changed — they now place more weight on avoiding alcohol during pregnancy.2

We strongly agree with Morley and colleagues that screening for alcohol should be routine in all pregnant women, and that standardised items should be included in a core dataset.3 If this were implemented, Australia would be in a unique position to make a valuable contribution to alcohol and pregnancy research.

Miers comments that research into the impact of low to moderate alcohol exposure during pregnancy should not be a priority, because it may direct “attention and dollars away from the urgent need for diagnosis and management of fetal alcohol spectrum disorder”. Although we agree that specialised clinical services are important — and lacking — in Australia, it is short-sighted to suggest that there is no need for further research to establish the true risks from low to moderate alcohol consumption. Rates of alcohol consumption in Australia are high: about 80% of women report alcohol consumption in the 3 months before pregnancy, 14% report binge drinking, while 47% report that pregnancy was unplanned.4 Many fetuses may thus be exposed to alcohol before women are aware they are pregnant. Unfortunately, many women are unable to stop drinking and may expose their babies to high alcohol levels. Health professionals need to have a true estimate of risk to the fetus and know what additional factors (eg, genetics and nutrition) may alter risk, and women deserve to be well informed. The need for research is well articulated by Morley et al.

Research evidence in humans does not clearly indicate a risk to the fetus from low levels of alcohol consumption, and this has led to inconsistent policy.5,6 As we point out, the potential for harm from an abstinence message should be considered when Australian alcohol guidelines are reframed. Whatever the policy, it needs to be widely disseminated, in a “digestible” format, to health professionals and the community. Research being conducted at the Telethon Institute for Child Health Research is evaluating educational materials for health professionals about alcohol and pregnancy.

Authors

  • Colleen M O’Leary1,2
  • Louise M Heuzenroeder3
  • Elizabeth J Elliott4
  • Carol I Bower1,2
  • 1. Department of Population Sciences, Telethon Institute for Child Health Research, Perth, WA.
  • 2. Centre for Child Health Research, University of Western Australia, Perth, WA.
  • 3. Mental Health Research and Outcomes, Central Northern Adelaide Health Service, Glenside Campus, Adelaide, SA.
  • 4. Discipline of Paediatrics and Child Health, and Australian Paediatric Surveillance Unit, University of Sydney, Children's Hospital at Westmead, Sydney, NSW.

Correspondence: colleeno@ichr.uwa.edu.au

References

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