1. Considerations for alcohol use during pregnancy

2. Foetal alcohol spectrum disorder (FASD) It is known that prenatal exposure to alcohol can cause abnormalities in the child (Mattson & Riley, 1998 ). Alcohol easily passes the placental barrier. It is considered that the early stages of pregnancy are the most damaging to the foetus (Heather, 2001). FASD is distinguished by facial and cranial deformities, intellectual disability and behavioural problems such as hyperactivity (Knight, 2001). There is also a risk of stillbirth (RCOG, 2015).

3. FASD advice NICE guidelines and the Royal College of Obstetricians & Gynocologists (RCOG) recommend that the mother should remain abstinent throughout the pregnancy, but especially in the first 3 months (NICE 2008; RCOG 2015 ). Government guidelines in 2016 advised no alcohol during pregnancy or if planning a pregnancy (DH 2016). The early stages are the most sensitive so this has implications for mums-to-be before they realise they are pregnant.

4. FASD advice for service users The Government guidance advises women to avoid alcohol during pregnancy to avoid any health risks to the unborn child (DH 2016). It also advises women considering becoming pregnant to avoid alcohol. “The risk of harm to the baby is likely to be low if a woman has drunk only small amounts of alcohol before she knew she was pregnant or during pregnancy” (DH 2016:5) People who have problems with their drinking should be advised to aim for abstinence or at least a reduction of their intake. They are likely to need support to do so.

5. Other problems associated with alcohol use and pregnancy (BMA 2007) Infertility - a decreased chance of becoming pregnant Miscarriage – alcohol consumption is associated with an increased risk of miscarriage Sudden infant death syndrome - prenatal alcohol exposure may be associated with an increased risk SIDS Pre-term deliveries and stillbirth – –A high level of maternal alcohol consumption in early and late pregnancy is associated with pre-term labour. –Low-to-moderate levels are associated with an increased risk of stillbirth.

6. Engaging and maintaining women with problematic alcohol use (Goodman, 2009) It is important to ensure that pregnant women keep in touch with health and social care services. They will need the support and the health checks available, especially from antenatal services. Women with problematic substance use are likely to feel judged and fear that the baby will be taken away. Therefore it is vital that they feel supported and engaged in a partnership with the practitioner, working towards the goal of a healthy mum and baby.

7. References British Medical Association (2007) Fetal Alcohol Spectrum Disorders. BMA Board of Science. Department of Health (2016) UK Chief Medical Officers’ Alcohol Guidelines Review. Summary of the proposed new guidelines. Available online at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf Goodman (2009) Social work with Drug and Substance Misusers. Exeter, Learning Matters. Heather, N. (2001) Int. Handbook of Alcohol Dependence and Problems. Wiley, Chichester. Knight, R (2001). Neurological consequences of alcohol use. In: Heather (op cit). Mattson & Riley (1998) A review of the neurobehavioural deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical & Experimental Research. 22; 279-294. NICE (2008) Ante Natal Care. CG62. available at: http://www.nice.org.uk/guidance/cg62/chapter/1-recommendations#lifestyle-considerations http://www.nice.org.uk/guidance/cg62/chapter/1-recommendations#lifestyle-considerations RCOG (2015) Information for you: Alcohol & Pregnancy. Available at: https://www.rcog.org.uk/globalassets/documents/patients/patient-information- leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf https://www.rcog.org.uk/globalassets/documents/patients/patient-information- leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf