Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
Bogenshcultz and Geppert noted that very few studies have investigated pharmacological treatments for pregnant women (Bogenschutz and Geppert 2003). They suggested reasons for this as the hesitation of pharmaceutical companies to conduct trials with women who may become pregnant, difficulties in recruiting women (particularly from minority groups), and the widespread academic and industry practice of almost exclusively recruiting men in treatment trials. As women are often excluded from pharmacological trials, the knowledge base of the effects of pharmacotherapies for women who use alcohol in pregnancy comes from animal studies, case reports and reports of adverse events.
The assessment of pharmacotherapies in pregnancy is limited. A systematic review of pharmacological treatments for pregnant women found no randomised or quasi-randomised studies comparing any pharmacologic intervention versus other pharmacologic treatment alone or in association with psychosocial treatment, placebo, non-intervention or psychosocial intervention (Smith et al. 2009). Case series, case reports and cohort studies of women who have used pharmacologic treatments for alcohol use during their pregnancy provide the evidence for pharmacotherapy use in pregnancy.
Table 3.1 summarises findings to date and was used in the development of the National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and the Early Development Years of the Newborn (NSW Department of Health 2006; NSW Department of Health 2006).
Although few studies have included pregnant women, a recent analysis of gender differences in pharmacological and behavioural treatments for alcohol dependence reported that alcohol dependent women responded to naltrexone similarly to alcohol-dependent men (Greenfield et al. 2010). In this study, fewer women reported having ever received alcohol treatment and women tended to use primary health care as opposed to specialised alcohol and drug treatment services.