Preventing alcohol related birth damage: A review

Since 1974 numerous clinical studies have made it clear that heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units daily) can result in a child being born with a specific combination of physical and mental disabilities known as the Fetal Alcohol Syndrome. More moderate levels of intake (as little as 10 g of 1 unit daily) are associated with other fetal problems known as Fetal Alcohol Effects. The most common of these is growth retardation. Reduction of alcohol consumption is beneficial to pregnancy outcome. However, despite this great clinical and research interest within the field there has been comparatively little attention paid to researching possible preventative strategies and appropriate policy development. This paper first describes the size of the problem posed by drinking in pregnancy in the U.S.A. and the U.K., detailing the contrasting policy response on either side of the Atlantic. It examines the difficulties of formulating appropriate advice and then assesses the available research reports on preventative measures. The strategies described include general publicity and counselling for pregnant women. In addition, attention has been paid to the problems of dissemination by emphasising professional education. One major shortcoming is that most of these studies appear to have been carried out with little reference to existing knowledge on health education and promotion, or educational work in the antenatal or alcohol fields. In addition, little attention appears to have been paid to the characteristics of the groups at whom intervention might be targeted or the underlying social or psychological factors which maintain drinking in these groups. The second part of this paper, therefore, attempts to suggest appropriate avenues for developing preventative strategies by presenting a wide-ranging review with special reference to British experience. Particular attention is given to the issues of form and content of appropriate messages, targeting of risk populations, the venue for intervention, and media and the actual mechanisms involved in implementing the programme. We conclude that women should be advised to limit their alcohol consumption to no more than one unit a day when they are either pregnant or planning a pregnancy. We recommend that pregnant women should be asked about their alcohol and given appropriate advice during routine antenatal clinic visits. We suggest that the form of advice should be designed with the characteristics of the risk population in mind. Information about appropriate levels of alcohol intake and further professional help for those in need should be widely available and form an integral part of the primary health service, as well as the antenatal and family planning clinics in addition to the more specialist alcohol treatment and prevention services already available.