In Western Australia, 70% of mothers of babies with fetal alcohol syndrome did not have an alcohol-related diagnosis recorded during pregnancy
- School of Population Health, Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia
- Correspondence to: Dr Rosa Alati, School of Population Health, Centre for Youth Substance Abuse Research, University of Queensland, Herston Road, Brisbane, Queensland 4006, Australia;
Implications for practice and research
Alcohol consumption by pregnant women should be routinely assessed in maternity and other health settings.
Pregnant women who report excessive alcohol consumption should be referred to the appropriate intervention and support services.
Future research should confirm the extent of under-reported alcohol diagnoses among pregnant women.
Consistent and widespread use of practice guidelines is needed to reduce high risk in utero alcohol exposure among indigenous as well as non-indigenous populations.
There is an increasing concern that alcohol-use disorders in women have become more prevalent, ranging from 3% to 28% according to the setting in which they are reported and the population studied. While recent evidence suggests that women have started to avoid alcohol use during pregnancy, those who tend to consume alcohol at high risk levels continue to do so.1 ,2 Excessive alcohol use during pregnancy can lead to a range of physical, behavioural and cognitive sequelae in the child, generally known as fetal alcohol spectrum disorder (FASD).3 This study aimed to identify alcohol-use disorders in pregnant women and the extent to which these are documented in healthcare settings.
This is a record linkage study of routinely collected birth, hospital, mental health and drug and alcohol services data in the state of Western Australia. The authors aimed to identify non-Aboriginal (n=5839) and Aboriginal (n=2583) mothers who had been recorded to have met the criteria for an alcohol-related diagnosis during pregnancy and during 1 year before and after pregnancy. This cohort was matched with a comparison group of mothers without an alcohol-related diagnosis (non-Aboriginal: n=33 979; Aboriginal: n=8005). The primary outcomes were to examine the alcohol-use disorders during pregnancy and to identify trends in alcohol-related diagnoses over time. The study also explored the extent of under-reporting of maternal alcohol diagnoses during pregnancy. The data analysis included descriptive statistics conducted separately for Aboriginal and non-Aboriginal births and an adjusted logistic regression analysis with women with an alcohol disorder as the exposed group.
The study found that Aboriginal mothers in Western Australia are 10 times more likely to be diagnosed with an alcohol disorder compared with non-aboriginal mothers (23.15% vs 2.3%, respectively). Between 1985 and 2006, the percentage of babies born from mothers diagnosed with an alcohol disorder increased more markedly for Aboriginal births. The study also found that 70% of mothers of children diagnosed with FAS had not been recorded as having an alcohol disorder during pregnancy.
This is a well-designed study, which uses record linkage datasets to explore trends in alcohol-use disorders in pregnant women and the extent to which these problems go unrecognised in the Australian healthcare system. The authors acknowledge the study limitations, for example, the possibility of underestimating the alcohol-related problems for non-Aboriginal women as well as the comparison cohort.
Some findings were expected, for example, the high prevalence of maternal alcohol diagnoses in Aboriginal mothers. The increase in documenting alcohol problems during pregnancy from 1985 to 2006 is consistent with the 2007–2011 trends, during which time alcohol use during pregnancy has declined, but high-risk consumption has not changed.2 The extent of under-reported alcohol diagnoses among mothers of children with FAS is a concerning finding. Combined with mounting evidence that even small amounts of alcohol consumed during pregnancy may affect the child's development,4–6 these findings suggest that the recognition and documentation of levels of alcohol consumption during pregnancy should become a priority for health professionals working in maternity or other healthcare settings. Overall, this is a very interesting study. If these findings are confirmed by further research, efforts should be made to ensure widespread use of current national guidelines in maternity healthcare services; however, targeted strategies may be needed to reach high-risk populations.