National Drug Strategy
National Drug Strategy

Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders

Monograph

Fetal Alcohol Spectrum Disorders in Australia: An Update

June 2012

11.4 The importance of dissemination and implementation of policy

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Alcohol and pregnancy policy should be evidence-based and have the support of policy makers, health professionals, women and the community. National policies need to be delivered consistently by all State and Territory governments and medical and nursing organisations. Variation in alcohol and pregnancy policy around Australia is confusing and hinders implementation. Public health policy should be widely disseminated to health professionals, women, and the general community and ideally its implementation should be
evaluated.

Recent Australian research suggests there is little knowledge of the official NHRMC 2009 guidelines among the general population (Livingston 2012). The study did not specifically examine knowledge about the guideline referring to alcohol consumption in pregnancy but
found that Australians to do not have a good sense of low risk drinking levels. Two-thirds of males and one-third of females estimated low-risk drinking in the short-term to be more than the current NHMRC guidelines (i.e. no more than four drinks on an occasion). A clear association was found between age, the amount the respondent drank and estimates of lowrisk drinking, with younger, heavier drinkers estimating higher thresholds for low-risk (Livingston 2012).

Powers and colleagues used data from the Australian Longitudinal Study on Women’s Health to examine pregnant women’s compliance with the NHMRC low alcohol (2001) and abstinence (1992) guidelines (Powers et al. 2010). The data allowed them to compare drinking during pregnancy among women who had been pregnant when the different recommendations for alcohol consumption during pregnancy were in effect. The study found that guidelines for low alcohol intake (2001) or abstinence (1992) had little effect on the alcohol intake during pregnancy, with around 80% of pregnant women in both time periods consuming alcohol. The strongest predictor of women drinking alcohol during pregnancy was alcohol consumption prior to pregnancy.

Consistent messages from health professionals are very important. As discussed in Chapter 7, surveys of health professionals in 2002/03 found that the majority do not routinely provide information on the consequences of alcohol use in pregnancy (Payne et al. 2005). Only 23 percent of Australian paediatricians routinely ask about alcohol use when taking a pregnancy history and only four percent routinely provide information on the consequences of alcohol use during pregnancy (Elliott et al. 2006). There have been some improvements in Australian health professionals’ knowledge about alcohol and pregnancy and an increase in the percentage advising women to abstain from alcohol during pregnancy in recent years (Payne et al. 2011; Payne et al. 2011).

However, there are still improvements to be made. Health professionals should endorse the NHMRC 2009 guidelines, promote abstinence during pregnancy, and provide clear and consistent messages about the risk to the fetus from prenatal alcohol exposure. All women of
child bearing age and pregnant women should be routinely asked about their alcohol consumption and advised of the risk to the fetus from alcohol. Where indicated, brief interventions should be implemented and women referred to alcohol treatment programs as appropriate. Newborn infants heavily exposed to alcohol in utero should be referred for paediatric assessment.

Table 11.2 Australian policies on alcohol and pregnancy (reproduced from O’Leary et al. 2007) 1^*

SourceAbstinenceOccasional small
amounts
CommentsEvidence base†
Commonwealth
Government
National Health and
Medical Research
Council (2001) +
May be
considered
2 per day and less than 7
per week is low risk
 Should never become intoxicated
 Risk is highest in the early stages of pregnancy
2
Australian
Government
Department of Health
and Ageing
May be
considered
2 per day and less than 7
per week is low risk
 Should never become intoxicated, but the evidence about low to moderate alcohol
consumption is less clear
 Risk is highest in the early stages of pregnancy
2
Ministerial Council on
Drug Strategy
National Clinical
Guidelines‡
Safest2 per day & 7 per week
is low risk, but no level
can be assumed to be
completely safe
Provide NHMRC recommendations
 State that no alcohol consumption has been determined as completely safe
 All pregnant women should be asked about their alcohol consumption and given
information on the risk associated with drinking alcohol during pregnancy
NHMRC 2; Point
2, 4
State and Territory
Government
ACT: no policy--The ACT Drug and Alcohol Office advised that the information provided to
women varies across health service providers
-
NSW HealthSafestEven a small amount
may be harmful
Binge drinking, particularly during the first trimester, is harmful
 A safe level or safe time for drinking has not yet been determined
5
NSW Health, Centre
for Drug and Alcohol
SafestModerate alcohol use
may be harmful
 Heavy drinking is known to be dangerous
 Moderate use of alcohol defined as 2 drinks per day, 3-4 times a week
5
Queensland HealthOptionalReductionAlcohol reduction or cessation advised, but no level of alcohol consumption
specified
5
South Australian
Department of Health
SafestNot advisedReduce alcohol when planning pregnancy and abstain when pregnant
 The risks increase with increasing quantity, with harm occurring with high
exposure, and a safe level has not yet been determined
5
Tasmanian
Department of Health
and Human Services
safest2 per day and less than 7
per week is low risk
Follow the NHMRC guidelines2
Victorian Department
of Health
Safest2 per day and less than 7
per week is low risk
 There are varying opinions about the harm from drinking alcohol during pregnancy,
but a safe level has not yet been determined
 Present the NHMRC guidelines (2001)
2
Western Australian
Drug and Alcohol
Office
Safest2 per day and less than 7
per week is low risk
 Follow the NHMRC guidelines (2001)2
Western Australian
Department of Health
No
specific
advice
No specific adviceDrinking alcohol at hazardous or harmful levels during pregnancy increases the risk
of low birthweight, intrauterine growth retardation and prematurity
2
Medical and nursing
Organisations
Royal Australian
College of General
Practitioners
PreferableLimit drinkingPregnant women and those planning pregnancy should be assessed annually on their
quantity and frequency of alcohol intake and the number of alcohol-free days each
week
 High-risk drinkers should receive brief interventions
5
Royal Australian and
New Zealand College
of Obstetricians and
Gynaecologists
-- No policy guidelines identified-
Australian College of
Midwives#
Safest2 per day and less than 7
per week is low risk
 Follows the recommendations set out in the National Clinical Guidelines (NCG)As per NCG
Royal Australasian
College of Physicians,
Royal Australian and
New Zealand College
of Psychiatrists
SafestNo level has been
determined completely
low risk for the fetus
All pregnant women should be given information on the risk associated with
drinking alcohol during pregnancy
5 “usually based
on NHMRC”
Australian Medical
Association (AMA)
DesirableNot advised The position statement was written in 1998 and is based on the 1992 NHMRC
recommendations
 In 2005, the AMA President stated that the NHMRC should revise the guidelines
on alcohol consumption during pregnancy, indicating that an abstinence message
should be given
Point 2,4

^ Reproduced from O'Leary CM et al. A review of policies on alcohol use during pregnancy in Australian and other English-speaking countries, 2006. MJA 2007; 186(9): 466-471. ęCopyright 2007. The Medical Journal of Australia - reproduced with permission.
* Australian standard drink equals 10g of alcohol.
† Key to evidence base: 1= systematic literature review; 2= literature review (not systematic review); 3= broad statement or indication that the policy is based on the evidence, but no specific references provided; 4= consensus of authors; 5=not mentioned.
+ ‡ National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn

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