Consistency of alcohol education during pregnancy ‘absolutely crucial’

Pregnant women want their healthcare provider to advise them on alcohol consumption, but some doctors are hesitant due to the ‘perceived sensitivity’ of the issue.
 
That was the finding of a panel of experts at a 19 May hearing for an ongoing Senate inquiry into effective approaches to prevention and diagnosis of fetal alcohol spectrum disorder (FASD).
 
Terms of Reference of the inquiry, launched last year, include strategies for optimising life outcomes for people with FASD, supporting carers, and the prevalence and management of FASD, including in vulnerable populations, the education system, and the criminal justice system, as well as to assess the effectiveness of the National FASD Action Plan 2018–28, including gaps in ensuring a nationally coordinated response and adequacy of funding.
 
Curtain University Associate Professor Nyanda McBride, co-author of the National Drug Research Institute’s submission to the inquiry, said at the hearing that despite national guidelines advising that there is no safe level of drinking during pregnancy, some women are not being informed by their healthcare providers.
 
She believes more training is needed to ensure GPs, doctors and midwives deliver appropriate advice about the risks of drinking while pregnant.

‘It is extremely important for healthcare professionals to initiate conversations about drinking with all their pregnant patients and their partners, not just those they consider at risk,’ Associate Professor McBride told newsGP.
 
‘Research reports that women want a clear understanding of current research to guide their decisions about alcohol use during pregnancy, and healthcare professionals are in a prime position to provide this advice.’
 
However, Associate Professor McBride identified in her research that some GPs may have reservations due to potential impact on the patient–doctor relationship.
 
‘Asking about alcohol could appear judgmental and GPs want to maintain good rapport so that women continue to attend antenatal care,’ she said.
 
‘Some GPs noted that they lacked the skills and resources to raise the issue of alcohol consumption during pregnancy and were concerned about not having the right information on hand.
 
‘It is particularly important to reinforce to women that not drinking is the safest option for the fetus, and for healthcare professionals to have detailed understanding of the area, and to recognise that their advice – either solicited or unsolicited – can impact outcomes for a child and their family,’ Associate Professor McBride said.
 
Representatives from the FASD Research Australia Centre of Research Excellence, Telethon Kids Institute, also highlighted the importance of health professionals having routine and up-to-date training about FASD, and looking at its impacts more broadly across the community.
 
‘In our education and training we’ve tried to target not only paediatricians but also GPs, hospital doctors, Aboriginal health workers, allied health workers and psychologists, to build capacity across the community to recognise this condition and what is required for its diagnosis,’ paediatrician and FASD Research Australia Co-Director Professor Elizabeth Elliott said at the hearing.
 
‘Making a diagnosis of FASD recognises that there has been a brain injury caused by prenatal alcohol exposure, yet our research shows that 60% of women in Melbourne, Sydney and Newcastle who attend antenatal services still drink alcohol during pregnancy, often at risky levels.
 
‘Despite these high levels of drinking, FASD was underdiagnosed in Australia,’ Professor Elliott said.
 
To help address underdiagnosis, FASD Research Australia has launched national clinical diagnosis training, as well as the FASD Hub and its Australian guide to the diagnosis of fetal alcohol spectrum disorder.
 
Professor Elliott also said ongoing funding to support research on prevention, diagnosis and management of FASD is needed, as well as implementation of the National FASD Action Plan.
 
Many experts agree that extending the conversation of drinking alcohol during pregnancy is only possible through education and awareness across the board, to aid the discussion with as little ‘shame and blame’ as possible.
 
‘One of the things that we, as paediatricians, are advocating [is] that there be a continuum through general practice, midwifery, obstetric care, neonatal care and general paediatric care. That continuum is absolutely crucial,’ Professor Elliott said.
 
‘[We] try very hard not to shame or blame mothers, because when we understand why the mothers that we see drink alcohol it becomes evident that that’s because of social disadvantage, domestic violence, etcetera.’
 
Dr Hester Wilson, GP and Chair of the RACGP Addiction Medicine Specific Interests network, has a steadfast approach to discussing alcohol and other drug use with pregnant patients ­– a supportive, non-judgemental and gentle easing into the conversation.
 
‘Removing judgement is very important, because stigma around substance use can often prevent women from being honest with their GPs, which can then lead to less positive outcomes,’ Dr Wilson previously told newsGP.
 
‘I ask permission first, so, “Is it okay if I ask you?”, and then I will ask, “Do you smoke cigarettes? Do you drink alcohol? Do you use any other drugs?”
 
‘And it’s all on that basis of what I need to know in terms of helping the woman to manage the risk.’
 
The Senate inquiry into effective approaches to prevention and diagnosis of FASD reporting closes December 2020.
 
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