Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
2.7 Australian population level data on alcohol use in pregnancy
Several Australian surveys measure patterns of alcohol consumption in pregnancy. One of these is the National Drug Strategy Household Survey (NDSHS), a triennial survey series conducted under the auspices of The National Drug Strategy 2004-2009 (NDS). Ten surveys have been undertaken to date, designed to measure knowledge and attitudes towards drugs (including tobacco, alcohol and illicit drugs) and document drug use histories and related behaviours of the Australian population. In the most recent survey in 2010, more than 26,000 people aged 12 years and over completed the survey. The three most recent surveys gathered comprehensive Australian information on alcohol use in pregnancy. Results from the 2004 survey indicated that pregnant and breastfeeding women were significantly less likely to consume alcohol than other women of childbearing age (47 percent versus 85 percent) nonetheless, it is of concern that a proportion of pregnant women continue to drink above recommended levels (Wallace et al. 2007).
In the 2007 NDSHS data alcohol use was reported by 29 percent of women who were pregnant in the past 12 months. In addition, 43 percent of women who were breastfeeding in the past 12 months reported alcohol use, whereas 36 percent of women who were both pregnant and breastfeeding in the past 12 months reported alcohol use. Consistent with previous research, older age was significantly associated with alcohol use in pregnancy after controlling for other psychosocial characteristics. Most women (95%) reported a reduction in the quantity of their alcohol use while pregnant or breastfeeding (Maloney et al. 2011).
Women's Health Australia is a longitudinal study that has been examining the health and wellbeing of Australian women since 1996. Also known as the Australian Longitudinal Study on Women’s Health, the project conducts surveys with more than 40,000 Australian women who were aged 18-23, 45-50, and 70-75 when the study began. Women’s Health Australia has assessed physical health, mental health and a range of other factors including alcohol use among these women. The study has found that women who were currently pregnant were more likely to be abstinent or to rarely drink, although three percent reported drinking at risky levels (Young et al. 2005).
In addition to these sources of national data, data are available from individual research studies and jurisdictional reporting mechanisms (O'Callaghan et al. 2003; Colvin et al. 2007). In each state and territory the Midwives Data Collection provides perinatal data on obstetric conditions, procedures and outcomes, neonatal morbidity and birth defects for every birth in Australia (of at least 20 weeks gestation, or if gestation is unknown at least 400g birth weight). Self-reported alcohol use in pregnancy is included on perinatal forms in Tasmania, Northern Territory and Australian Capital Territory only (Table 2.1). In 2006 in the Northern Territory, eight percent of non Indigenous and 14 percent of Indigenous mothers reported alcohol use during the first visit with a midwife, decreasing to four percent of non Indigenous and eight percent of Indigenous mothers at 36 weeks (Tew and Zhang 2010). Data from the ACT and Tasmania have not yet been published. The lack of uniform data collection at the national level about alcohol use in pregnancy must urgently be addressed.
Table 2.1: Current alcohol questions on midwives’ data collection forms, by State and Territory
|Q1||-||-||-||-||-||During this pregnancy has the mother consumed alcohol?||Alcohol consumption during pregnancy||Alcohol at 1st antenatal visit|
|Response code||-||-||-||-||-||Yes / no||Yes / no||Yes / no / unknown|
|Q2||-||-||-||-||-||If yes, amount||Number of standard drinks per week||Alcohol at 36 weeks|
|Response Code||-||-||-||-||-||Less than 1 standard / day |
More than 1 standard / day
|NN (numeric field)||Yes / no / unknown|
|Q3||-||-||-||-||-||-||Was substance abuse documented?||-|
|Response code||-||-||-||-||-||-||Yes / no||-|
The National Perinatal Data Collection (NPDC) is a population-based cross sectional data collection about pregnancy and childbirth. The data are based on births reported to the perinatal data collection in each state and territory in Australia. Midwives and other staff, using information obtained from mothers and from hospital or other records, complete notification forms for each birth. Information is included in the NPDC on both live births and stillbirths of at least 400 grams birthweight or at least 20 weeks gestation. Recently the Enhancing the Perinatal Minimum Data Set: Alcohol use in pregnancy project was undertaken by the Australian Institute of Health and Welfare (AIHW) National Perinatal Epidemiology & Statistics Unit (NPESU) as part of the COAG Close the Data Gaps. Based on consultation across a broad range of stakeholders, standard elements to collect data about frequency and amount of alcohol consumed in early and late pregnancy were drafted. Further consultation is being undertaken to assess the feasibility of introducing these items into perinatal data collections.
- Recent increases have been documented in the proportion of women of childbearing age who drink at risky levels.
- The majority of women reduce or cease alcohol consumption upon learning that they are pregnant; however, a significant proportion drink at some time during pregnancy and a significant minority of women continue to drink at high levels.
- Indigenous women are less likely to report alcohol use in pregnancy than their non-Indigenous counterparts; however, when they do drink, it may be at higher levels.
- About half of all pregnancies are unplanned, indicating that many women may inadvertently expose their unborn child to alcohol before becoming aware of their pregnancy.
- Women’s intentions to consume alcohol if planning a pregnancy are strongly associated with: alcohol use prior to and during the last pregnancy; agreeing that pregnant women should be able to drink alcohol; intention to smoke in a future pregnancy; and feeling neutral or positive towards alcohol use during pregnancy. These groups of women are at higher risk of using alcohol in pregnancy and might be targeted through educational initiatives.
- Knowledge about the adverse effects of prenatal alcohol exposure is insufficient for behaviour change; it is necessary to address societal attitudes about alcohol use in the community, particularly in relation to use during pregnancy.
- National population level data collections containing information on alcohol use in pregnancy include the National Drug Strategy Household Survey and Women’s Health Australia.
- There is an urgent need to implement a standardised collection of national data about alcohol use in pregnancy through the National Perinatal Data Collection, collected across each State and Territory. This will require training, resource allocation and a clear pathway of care onwards for identified clients.