Alcohol and FASD

“Given the harmful drinking patterns in Ireland and the propensity to binge drink, there is a substantial risk of neurological damage to the foetus resulting in Foetal Alcohol Spectrum Disorders (FASD). Therefore, it is in the child’s best interest for a pregnant woman not to drink alcohol during pregnancy.”

Department of Health’s Chief Medical Officer

Ireland is estimated to have the third highest prevalence of Foetal Alcohol Spectrum Disorder (FASD) in the world[1]. No amount of alcohol at any stage of pregnancy is safe for the baby. According to expert Dr Mary O’Mahony, this means that 600 Irish babies are born each year with FAS, and more than 40,000 Irish people live with the condition.

The Screening for Pregnancy Endpoints (SCOPE) study, carried out in Ireland, Australia, the UK and New Zealand [2] found that Ireland emerged as the country with the highest rates of drinking, both before (90%) and during (82%) pregnancy, and of binge drinking, before (59%) and during (45%) pregnancy. Estimates of drinking during pregnancy from the Growing up in Ireland (GUI) and the Pregnancy Risk Assessment Monitoring System (PRAMS) studies were substantially lower (20-46%), but still at levels that warrant serious concern.

Researchers concluded that alcohol use during pregnancy is highly prevalent and evidence shows that gestational alcohol exposure may occur in over 75% of pregnancies in Ireland. The number of pregnant women who drank heavily was small, but the researchers point out that “since most women who consume alcohol do so at lower levels where the offspring growth and development effects are less well understood (than at higher levels), the widespread consumption of even low levels of alcohol during pregnancy is a significant public health concern”.

 

It is imperative that health and social care professionals who are in contact with mothers and prospective mothers ensure a clear and consistent message that there is no safe amount of alcohol at any stage of pregnancy.

In Ireland:

  • Four in five of first pregnancies are exposed to alcohol; nearly one in two (45%) are exposed at high-risk levels.
  • Two in five pregnancies are unplanned, increasing the chance they will be exposed to alcohol.
  • Pregnant women do not consistently receive timely maternity care or support for their Alcohol & Drug issues.
  • Health professionals do not consistently provide information on the risks of drinking during pregnancy or routinely screen for alcohol issues.
  • Most clinicians lack the capability to diagnose FASD.
  • families of people with FASD struggle to access appropriate support and report a lack of understanding from services, professionals and even other family members

In addition, drinking heavily during pregnancy can increase the chances of complications during pregnancy and childbirth, as well as increasing the risk of miscarriage and stillbirth.

What needs to happen?

Clearly more work is needed to ensure that women are provided with information and support during pregnancy. Screening and brief interventions must be carried out with pregnant women at the early stages of pregnant and the risks of drinking should be communicated in a clear and consistent fashion.  Families and children living with Foetal Alcohol Spectrum Disorders must also be recognised and supported.

The Steering Group of the National Substance Misuse Strategy identifies effective policies and actions to reduce the harm caused by alcohol and Alcohol Action Ireland calls for the recommendations of the Steering Group to be implemented in full. The Report makes a number of recommendations on how best to reduce the harms caused by alcohol during pregnancy. These are

  • Implement policies and clinical protocols in all healthcare settings to prevent, assess and respond to issues arising in relation to pregnant women affected by alcohol use
  • Strengthen FASD surveillance and promote greater awareness among healthcare professionals of FASD so as to improve the diagnosis and management of FASD
  • Labels on alcohol products sold in Ireland to include information on alcohol content, calorific content and health warnings in relation to consuming alcohol during pregnancy

[1] Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth

[2] ‘Keeffe LM, Kearney PM, McCarthy FP, et al. Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies, BMJ Open 2015.