Journal article

Midwives’ knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

5 Nov 2014

Report attempts to understand midwives’ perceptions of their practice in addressing alcohol consumption during pregnancy.

Alcohol is a teratogenic substance and, when consumed during pregnancy, is associated with a range of adverse effects in the developing fetus, including spontaneous abortion, stillbirth, low birthweight, growth deficiency, intra-uterine growth restriction , and prematurity.

The umbrella term FASD describes disabilities that include fetal alcohol syndrome (FAS), partial FAS (PFAS) and neurodevelopmental disorder-alcohol exposed (ND-AE). The prevalence of FASD has been reported as 2-5% in the USA and in Canada it is estimated as 1/100 births.

FASDs are under-diagnosed and under-reported in Australia where the prevalence is reported as 1.7/1,000 live births and 4.7/1,000 Indigenous live births. Children with FASDs may experience developmental delay, deficits in intellectual functioning and difficulties with learning, memory and attention; may have poor executive functioning and deficits in social and adaptive functioning.

Prenatal alcohol exposure may also result in secondary disabilities, for example, limited opportunities for work and mental health problems such as depression and self-injury. Very few adults with FAS work and live independently, many have mental health problems, trouble with the law, inappropriate sexual behaviours, drug and alcohol problems, and experience incarceration. These secondary disabilities may be prevented by early diagnosis and management of FASD.

The degree of harm to the fetus from prenatal alcohol exposure is influenced by the dose, pattern, and timing of alcohol exposure and the stage of development of the fetus when exposed. Research evidence is inconclusive about the effects of low levels of alcohol consumption during pregnancy and its risk of harm to the fetus has not been determined. Thus the Australian Guidelines to Reduce Health Risks from Drinking Alcohol Guideline 4 (Australian Alcohol Guideline) aims to prevent alcohol consumption during pregnancy and applies an evidence based precautionary principle: “For women who are pregnant or planning a pregnancy, not drinking is the safest option”. It is important to prevent exposure of the fetus to alcohol - there is no cure for FASDs and their burden and cost to individuals, families, communities and society is great.

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