Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
11.1 International policy
Policies and guidelines on the use of alcohol during pregnancy have generated considerable debate in many Western countries, including Australia (Nathanson et al. 2007; O'Brien 2007; O'Leary et al. 2007; Whitehall 2007). As discussed in previous chapters, moderate and heavy prenatal alcohol exposure have been shown to increase the risk of a wide range of health and developmental effects in the fetus (Olegard et al. 1979; Abel and Sokol 1986; Jacobson et al. 1993; Sayal et al. 2007; DeRoo et al. 2008; O'Leary et al. 2009; Sayal et al. 2009; O'Leary et al. 2011). Although there is no strong evidence of increased risk to the fetus from low levels of prenatal alcohol exposure, determining whether there is a threshold effect below which there is no harm to the developing fetus is difficult and research into this continues. The lack of clarity in the published literature about the effect of prenatal exposure to low levels of alcohol has resulted in a range of opinions about whether women should be recommended to abstain from alcohol when pregnant or advised that low levels of alcohol consumption are likely to pose a low risk to the developing fetus (Payne et al. 2005; O'Leary and Bower 2011).
In 2006 a review of the policies in Australia, Canada, the UK, the USA, Ireland, New Zealand, and South Africa was conducted (Table 11.1) (O'Leary et al. 2007). Findings reflected the range of policies found within Australia, from an abstinence message to advice that the risk from low amounts of alcohol is minimal (See Table 11.2). Although abstinence from alcohol was recommended as the safest/prudent choice in all the policies from overseas countries, many of the policies advised that the risk from low amounts of alcohol is minimal. Almost every policy emphasised that the risk to the fetus was highest with heavy, frequent alcohol consumption and in particular, a binge pattern of drinking. Three policies highlighted that when women have consumed alcohol early in pregnancy, cessation or reduction of alcohol consumption will reduce the risk to the fetus (South African Department of Health 2001; Ireland Department of Health 2003; American College of Obstetricians and Gynecologists 2006).
The Royal College of Obstetricians and Gynaecologists in the UK was the only organisation included in the 2006 review to have undertaken a systematic review of the literature, which appears to be the basis for government policies in the UK. Six other organisations indicated
that their policy was based on a review (not systematic) of the literature (see Table 11.1).
The current NHMRC (2009) Guidelines now advise that for women who are pregnant or planning a pregnancy, not drinking is the safest option. The level of risk to the fetus is:
- highest when there is high, frequent maternal alcohol intake;
- likely to be low if a woman has consumed only small amounts of alcohol before she knew she was pregnant or during pregnancy;
- hard to predict as it is influenced by maternal and fetal characteristics
Table 11.1: Policies on alcohol and pregnancy reproduced from O’Leary et al (2007) ^*
|Source||Abstinence||Occasional small amounts||Comments||Evidence base|
|Health Canada – National guidelines for the childbearing years||Prudent choice||Risk from low levels of alcohol is minimal||
|Public Health Agency of Canada||Safest||No safe amount||
|Canadian Medical Association||Prudent choice||No specific advise||
|Society of Obstetricians and Gynaecologists||Prudent choice||Occasional intake unlikely to cause harm||
|Royal College of Obstetricians and Gynaecologists||Safest||1-2 Standard units once or twice a week||
|UK Department of Health, National Health Service||Safest||As above||
|Health Scotland||Safest||As above||
|US Surgeon General (2005)||Advised||No Safe amount||
|National Institute on Alcohol|
Abuse and Alcoholism (NIAAA)
|Advised||No safe amount||
|US Department of Health and|
Human Services, Department of
Agriculture Dietary guidelines for
|American College of|
Obstetricians and Gynaecologists
unlikely to cause
|American Academy of Paediatrics||Advised||No safe amount||
|Ireland Department of Health,|
Health Promotion Unit
|New Zealand Ministry of Health|
39 and Alcohol Advisory Council
of New Zealand
|South African Department of|
|Advised||Safe level has not|
^ 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.
* Standard drink: UK unit = 8g,Ireland and New Zealand = 10g, South Africa = 12g, Canada = 13.5g and US = 14g.
† 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 and 5=not mentioned.