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Drinking – a lifetime of damage

11 Nov 2014

Thousands of babies are being born each year with serious and incurable but entirely preventable disabilities because of the consumption of alcohol during pregnancy, the AMA National Alcohol Summit has been told.

While often dismissed as a problem largely confined to remote Aboriginal communities, experts addressing the Summit said that although Foetal Alcohol Spectrum Disorder – an umbrella term used to describe a range of abnormalities caused in unborn children by in utero exposure to alcohol – is most marked among Indigenous Australians, it is present across society.

According to the National Organisation for Fetal Alcohol Spectrum Disorder (NOFASD), the true incidence and prevalence of FASD in Australia is not known because children are not routinely screened in infancy or early childhood, and there is a lack of data that accurately reflects estimates of the incidence and prevalence of the disorder.

It has been estimated that for every 1000 live births, between 0.06 and 0.68 will involve children with Foetal Alcohol Syndrome (a subset of FASD), though some, such as the Tasmanian Department of Health and Human Services (DHHS) and the Australian Women’s Health Network, think this is an underestimate, and that least 2 per cent of all Australian babies are born with FASD.

The incidence is thought to be significantly higher among Indigenous Australians – the Foundation for Alcohol Research and Education (FARE) estimates the incidence of FAS in these communities is between 2.76 and 4.7 for every 1000 births.

While there is uncertainty about the prevalence of FASD, the speakers addressing the Summit, including paediatrician Professor Elizabeth Elliot of the Sydney Medical School, NOFASD Chair Sue Miers and AMA Federal Councillor Dr Richard Kidd, said there was no doubt its devastating consequences for those affected, including both the child and those who cared for them.

Ms Miers said children with FASD required round-the-clock parenting, and their emotional and psycho-social development lagged far behind that of their peers, even into adulthood.

Dr Kidd told the Summit that the consequences of drinking during pregnancy could be devastating – linked not only to FASD, but also preterm birth, low birth weight and increased risk for sudden infant death syndrome.

But, he said, FASD stood out as the most common preventable cause of birth defects in Australia, and one which had profound lifelong consequences, not only for individuals and families, but also the health, social service, criminal justice, education and employment systems.

Investigations into FASD by intergovernmental committees and parliamentary inquiries have highlighted a general lack of awareness of the problem in the community, including the risks attached to drinking while pregnant, and the paucity of the nation’s response.

One of the problems is that around 50 per cent of all pregnancies are unplanned, and Dr Kidd said evidence showed nearly half of all women consumed alcohol while pregnant before they knew they were pregnant.

But, he added, even when they knew they were pregnant, 19.5 per cent of expectant mothers continued to drink.

One of the issues has been a lack of awareness.

The National Health and Medical Research Council has issued guidelines specifying that maternal alcohol consumption can harm the developing foetus or breastfeeding baby, and that the safest option for women who are pregnant or planning pregnancy is to abstain.

But Dr Kidd said knowledge of this was imperfect, even among the medical profession. He cited a 2013 FARE survey of health professionals which found that, while most were aware of the NHMRC Guidelines, more than two in five (45%) were not familiar with the content.

He said health professionals had a key role in making women aware of the effects of alcohol during pregnancy.

“Because most women seek prenatal care during their first trimester, this is an opportune time for GPs like me, obstetricians, midwives, Aboriginal health workers and others to help them make the changes necessary for a healthy pregnancy,” Dr Kidd said. “It is important for health professionals to know that conversations about alcohol with women who are pregnant and planning a pregnancy are wanted, welcome and worth their time.”

He told the Summit of the Women Want to Know Project, created by FARE in collaboration with the AMA and other health groups, to encourage health professionals to routinely discuss alcohol and pregnancy with women, and to provide advice that is consistent with the NHMRC’s Alcohol Guidelines.

In addition to getting health professionals to talk about drinking with patients who are expecting or planning to get pregnant, public health experts are also pushing for much clearer and more prominent labels on alcohol products about the dangers of drinking while pregnant.

Senior federal Labor MP Graham Perrett, who addressed the Summit, dismissed the warning labels currently used by the industry under its self-regulation code as “pissweak”.

But even more informative and prominent labelling may not, on its own, be enough.

According to a 2009 report by the Intergovernmental Committee on Drug Working Group on Fetal Alcohol Spectrum Disorders, many women continue to drink during pregnancy even after being told of the risks of FASD.

“Knowledge of adverse effects is not as strong a determinant of intention to drink as are tolerant attitudes towards alcohol use in pregnancy,” the Working Group said. “Simply educating women about potential adverse effects of prenatal alcohol exposure will be insufficient to induce behavioural change. Societal attitudes about alcohol use, particularly during pregnancy, must also be addressed.”

Dr Kidd said FASD was part of the wider and complex issue of alcohol use in the community, telling the Summit that, “the AMA believes that any attempt to tackle FASD must occur within a comprehensive and whole-of-government approach to reduce harmful drinking across the population”.

Adrian Rollins

Published: 11 Nov 2014