Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
11.3 Evidence base for policy
A recent review focused on whether there is sufficient evidence about the effect of low to moderate prenatal alcohol exposure on the fetus to advise women to abstain from alcohol during pregnancy (O'Leary and Bower 2011). The review found no strong research evidence
of fetal effects from low levels of alcohol exposure and the authors determined that the reported significant protective effects from low level alcohol exposure are likely due to methodological issues such as confounding and/or misclassification of exposure or outcome. Recent studies have shown increased risk of neurodevelopmental problems (Sayal et al. 2009; O'Leary et al. 2010) and preterm birth following in utero exposure to 30-40g per occasion (3- 4 standard drinks/2-2.5 serves of wine/full strength beer) and as little as 70g per week (O’Leary et al. 2009; O'Leary et al. 2010). The authors concluded that with such a small margin before there is increased risk to the fetus, it is morally and ethically responsible for policies to promote abstinence during pregnancy. It is, however, important to be pragmatic and acknowledge that not all women will follow this advice: some will continue to consume alcohol while pregnant and some will inadvertently consume alcohol before becoming aware of their pregnancy. If poorly handled these situations have the potential to generate stress and anxiety and may lead women to consider terminating an otherwise wanted and potentially unaffected pregnancy. If the abstinence message is mishandled women who have consumed alcohol in pregnancy may not reveal their drinking and women with alcohol related problems may be reluctant to seek antenatal and treatment services. Situations where the mother consumes alcohol require non judgemental and rational advice on the likelihood of risk to the fetus, indicating that low levels of alcohol exposure appear to be low risk and recognising that alcohol exposure is a risk factor but not all exposed pregnancies, even those exposed to heavy levels will be harmed (O'Leary and Bower 2011).
It is important to acknowledge that abstinence during pregnancy requires adopting an approach that is different from that of the general community in Australia, where 81% of people over 14 years report alcohol consumption (AIHW 2011). As per capita alcohol consumption is an indicator of heavy drinking in a community, population based strategies to reduce overall consumption may reduce harms (Rose 1992) including the number of alcohol exposed fetuses (O'Leary and Bower 2011).