Alcohol_in_Pregnancy

INTRODUCTION There is no European or worldwide agreement as to what constitutes a safe level of alcohol consumption before or during pregnancy. The discourse as to whether thousands of mothers are putting their babies at risk of permanent brain damage by drinking more then the recommended alcohol intake, recommended by their countries is unending. America, Canada, New Zealand, Austrailia, Holland, Ireland and more recently France, among others, recommend that a woman, who is pregnant, or trying to become pregnant, should not drink alcohol at all. (ICAP. 2006) The advise given to woman who are pregnant or trying to become pregnant in the United Kingdom is that “ women who are pregnant or at any stage of pregnancy, should not drink more than one to two units of alcohol more than once or twice a week, and should avoid episodes of intoxication” (ICAP 2006) This essay will look at the advice in the literature available as to whether a moderate intake of alcohol during pregnancy poses a risk to both the woman and the child. It will compare the research findings of the risks associated with moderate intake, versus heavy drinking. It will also look at the methods used to ascertain how much alcohol women are drinking, and if the tests currently in use are effective. DISCUSSION In 1973 FAS (Fetal Alcohol Syndrome) was recorded as a newly discovered birth defect, by Drs. Jones and Smith in Seattle U.S.A. (redefined by the Fetal Alcohol Syndrome Study group 1980). FAS is characterised by a pattern of facial anomalies such as mid-face hypoplasia, thin upper lip, smooth filtrum, CNS abnormalities and growth restriction, affecting both gestation length and birth weight. ‘Partial fetal abnormalities and alcohol neurodevelopmental disorders are also attributed in some extent to alcohol abuse by the mother during pregnancy’ Hannigan J and Randall A (2000) Ernst Abel argues in his 1998 book ‘Fetal Alcohol Abuse Syndrome’ That FAS should be redefined and called ‘Fetal Alcohol ABUSE Syndrome’ he sees the term ‘FAS’ as misleading as it implies that any amount of alcohol is ‘toxic’. Instead as Jones and Smith (1973) clearly stated “the pattern of anomalies comprising the Syndrome only occur in children born to alcohol ‘abusing’ mothers” This would nullify the argument that all children whose mothers drink 1-2 units of alcohol per week area risk. There is an inherent difficulty in ascertaining whether women are telling the truth when they are questioned about their alcohol intake levels prior to, and during the early stages of pregnancy. Comparing concurrent and retrospective reports can however be useful. A Norwegian Study ‘Alcohol Consumption Before And During Pregnancy-Comparing Concurrent And Retrospective Reports’ concluded that there was a big difference in the findings when the same questionnaire was filled out by women after having a healthy baby. The relief that the baby had been born healthy reduced the feelings of guilt and blame that the mothers had previously had during their pregnancy, as they had been drinking during the early stages of pregnancy but had not disclosed this information, as they feared they might have been blamed for harming their baby. Thus the retrospective report showed quite a high usage of alcohol during and before pregnancy. These reports are closely related to the scores on the MAST( Michegin Alcohol Screening Test). ”The higher the MAST score the higher the underreporting” Erhart et al. (1988). The evidence of this underreporting brings into question the validity of many of the studies that base their findings on initial questionnaires carried out during the booking visit. The TWEAK test, Chan et al. (1993) and other screening tests are useful tools in ascertaining the alcohol intake of a woman. The questionnaire assesses the woman’s tolerance to alcohol and works on the assumption that the woman does indeed consume alcohol. If you score two or more on the test you are seen as ‘at risk’ and consuming too much alcohol. Because of the spiralling costs of health care it is interesting to contrast the advice given to women by health insurance companies. The VHI (Voluntary Health Insurance) in Ireland and BUPA (British United Provident Association) in the U.K. The VHI defines exactly what constitutes a unit of alcohol, and focuses on the possible alcohol related birth defects. It encourages ‘Trying to cut down’ and in some way attempts to remove part of the blame from the woman as it remarks on the fact that in many cases of FAS, the fathers of the children born with FAS are also heavy drinkers. It does however also make the point that very little research has been done as to whether the alcohol consumption by the male, affects the condition of the sperm and cell division. VHI DEFENITION OF 1 UNIT OF ALCOHOL 1 SINGLE MEASURE OF SPIRITS 1 SMALL GLASS SHERRY 1 SMALL GLASS WINE .5 PINT STRONG BEER, LAGER, OR CIDER .5 PINT ORDINARY STRENGTH BEER, LAGER OR CIDER (THERE DOES NOT APPEAR TO BE ANY ACCOUNT TAKEN OF THE INCREASED ALCOHOL CONTENT IN STRONG BEER AS THE RECOMMENDATIONS STAY THE SAME) BUPA concentrates on how quickly the body absorbs alcohol and it highlights the different absorption rates remarking on the fact that absorption is quicker if you are small, young or female’. BUPA maintains that although a total abstinence from alcohol is to be recommended it is ok to drink one unit, very occasionally. A recent report in The Irish Independent Newspaper (3/3/07) cites a study carried out by ‘The Coombe Women’s Hospital’ in Dublin led by Psychiatrist Dr. Siobhan Barry. Her study found that circa.600 babies were born per year with FAS. The study was carried out on 120,000 women over 20 years. It showed that women in both Ireland and The United Kingdom consume more alcohol than their counterparts in other European countries. Taking a moderate alcohol intake to be 1-2 units of alcohol once or twice a week, such as is the guidelines given to women in the U.K.it is interesting to note the report of The Medical Council on Alcohol 2002. (A Study on Moderate Alcohol Intake and the Risk Of Spontaneous Abortion) which was undertaken by the Dept.of OBS and Guinae. At Aarhus University in Denmark in 2001. It produced the following interesting statistics. Women who drank Up to 1 drink p/w = 1.4% spontaneous abortion in trimester 1 Up to 5 drinks p/w = 8.9% spontaneous abortion in trimester 1 The findings indicated that the women drinking up to 5 drinks p/w were 6 times more likely to have a spontaneous abortion in trimester 1.Risk in trimester 1 peaked at week 9 of gestation. Their findings were: that alcohol intake is underestimated in questionnaires, and that increases alcohol consumption co-related with increases in spontaneous abortion in trimester 1. Jacqueline Dunkley ( Health Promotion in Midwifery Practice-A resource for Health Professionals 2000) cites Tranmer’s 1995 study which looks at the absorption of 7 units of alcohol (8 oz) which equates to the amount seen as o.k. in the U.K.(RCOG 1996) ingested over a quick time. His study was carried out on 6 women who at 17 weeks gestation had booked for abortions .He tested the cord bloods of the babies and the amniotic fluid around the foetuses. He found that the cord blood alcohol levels were the same as the maternal blood alcohol levels and that there was even traces of alcohol in the amniotic fluid. The researcher was of the opinion that the foetus because of its small size would have taken double the time of the mother to get rid of the alcohol from its system. This brings into question the amount of alcohol recommended as safe for women in the U.K. because if they consumed their weekly allowance of alcohol on one day they would be in the same position, and this could damage the foetus. CONCLUSION Having discussed the evidence in the literature and looked at many of the studies available both retrospective and concurrent it is clear that alcohol should be avoided prior to conception and during the whole of the pregnancy. The underreporting of alcohol intake by women who are pregnant would appear to stem from a fear of being blamed for harming their baby. Promoting sensible alcohol consumption throughout life and total abstinence during pregnancy is a must. Education through the media as well as information leaflets and school workshops on pre conception health should be recommended. The onus is on the Health Service providers to see that every available chance is taken to make women aware of the dangers posed by alcohol misuse. 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