Reducing the risk of prenatal alcohol exposure and FASD through social services: promising results from the FAR SEAS pilot project

The Prevalence and Changes in Alcohol Consumption across Three Trimesters of Pregnancy Assessed by Ethyl Glucuronide Concentration in Maternal Hair and Self-Reports: A Cross-Sectional Study

INTRODUCTION

The teratogenic effect of alcohol is well known, but its prevalence is usually underestimated. This study presents the findings of a cross-sectional study conducted in Poland, which aimed to assess the prevalence and changes in alcohol consumption during pregnancy. The study utilized ethyl glucuronide (EtG) concentration in maternal hair and self-reports as measures to evaluate alcohol intake across the three trimesters of pregnancy.

METHODS

The study involved postpartum women (n = 150) and their babies. Hair samples from 135 participants allowed segmental analysis (separately for the three trimesters), and hair from 15 were analysed for the entire 9 months by gas chromatography tandem mass spectrometry. Survey data included self-reports of health-related behaviours and socio-demographic characteristics; medical records - information on the course of a pregnancy and newborn's health.

RESULTS

Standard medical interview revealed no cases of alcohol use during pregnancy. The analysis of EtG indicated 50.3% of women had been drinking alcohol at any time during pregnancy, including 10% with excessive alcohol consumption. Most participants maintained the same level of alcohol consumption throughout the pregnancy, but 8.7% of women decreased and 20.7% increased the amount of alcohol consumed between the 1st and 2nd or 2nd and 3rd trimesters. Gestational consumption of alcohol was not related to socio-demographic characteristics, course of pregnancy, and self-reported health behaviours, but babies of women who drank alcohol during pregnancy were more often small for gestation age than babies of abstainers (odds ratio [OR] = 6.008), with the highest risk observed in case of increased alcohol consumption (OR = 12.348).

CONCLUSIONS

Maternal hair analysis is useful in detecting pregnancy alcohol use and allows retrospective analysis over a longer period than other biological samples, providing a more comprehensive pattern of use throughout pregnancy. However, there is a need to improve routine methods of interviewing patients about alcohol use and to implement effective preventive strategies regarding alcohol consumption during pregnancy in Poland.

Prevention of alcohol exposed pregnancies in Europe: the FAR SEAS guidelines

INTRODUCTION

Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap.

METHODS

FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination.

RESULTS

The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women's autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women's partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes.

CONCLUSIONS

The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.