Saturday 16 December 2017

Patricia Casey: When will we call time on pregnant women drinking in Ireland?

When a pregnant woman consumes alcohol it goes directly to the foetus
When a pregnant woman consumes alcohol it goes directly to the foetus

Patricia Casey

Last week Health Minister Simon Harris launched a new strategy: Reducing Harm, Supporting Recovery - a health-led response to drug and alcohol use in Ireland 2017-2025.

The strategy contains a 50-point action plan. One is to recruit seven additional liaison midwives to work with pregnant women who are dependent on substances such as alcohol and other drugs.

There is now hard data in relation to alcohol use among pregnant women in Ireland and its impact on the baby in utero and the statistics make for grim and disturbing reading.

In Ireland today, it is estimated that there are up to 1.35m harmful drinkers. This data, presented by Mr Harris, points to the severity of our relationship with alcohol.

This is all the more serious during pregnancy since there are two lives at stake - the mother and her unborn baby. In 2015, UK researchers from the University of Cambridge carried out a study of almost 18,000 women in four countries - Ireland, the UK, Australia and New Zealand. They found that drinking before and during pregnancy was common in all four countries, however Ireland had the highest rates, with 82pc drinking during pregnancy, just 8pc less than the total for women overall. Ireland also had the highest rate of binge-drinking before pregnancy (59pc) and during pregnancy (45pc).

However, the Growing Up in Ireland study estimated that between 20pc and 46pc of women consumed alcohol during pregnancy suggesting that either one study was underestimating the prevalence or the other was overestimating.

In 2008, Dr Jennifer Donnelly from the Rotunda Hospital in Dublin conducted a study of alcohol consumption among 1,000 first-time mothers, and obtained a figure of 50pc.

The Cambridge researchers emphasised that most of the women who did drink during pregnancy only consumed low levels of alcohol. However, they pointed out that since the risks of low levels of alcohol on the developing foetus are not fully understood, women should avoid alcohol during pregnancy.

Regrettably a recent study published in January in The Lancet Global Health and authored by Dr Svetlana Popova from the University of Toronto in Canada demonstrated the accuracy of the higher figures in relation to Ireland. By linking studies that examined the prevalence of drinking during pregnancy (328 studies) to prevalence studies of foetal alcohol syndrome (FAS) (62 studies) from 1973 to 2015 globally, she found that overall 10pc of women consumed alcohol during pregnancy. Foetal alcohol syndrome (FAS) represents the most serious complication resulting from alcohol consumption during pregnancy.

Translating her world-wide data into actual numbers, one in 67 women delivered a child with FAS amounting to about 15 per 10,000 live births worldwide or 119,000 children born with this condition annually.

Specifically, the five countries with the highest rates of alcohol consumption in pregnancy were Russia (36.5pc), the UK (41.3pc), Denmark (45.8pc), Belarus (46.6pc) and Ireland (60.4pc). Did the level of alcohol consumption translate into FAS? Ireland had the third highest prevalence of FAS worldwide at 89.7 per 10,000 people, after South Africa and Croatia.

How does alcohol effect the developing baby? When a mother-to-be consumes alcohol it goes directly to the foetus through her bloodstream. These children may be born with foetal alcohol spectrum disorder (FASD), which is an umbrella term that covers all alcohol-related diagnoses, of which FAS is the most severe and visibly identifiable form because of changes to the facial features including a thin upper lip, small head and brain, flattened mid-face among others.

FASD is associated with a wide range of physical, behavioural and learning problems including growth impairments, problems with brain function and developmental delays.

The seven new midwives that will be charged with dealing with alcohol in pregnancy are likely to be in high demand. But when will we as a nation start to have a debate about our extraordinary attitude to alcohol in this country? One that has resulted in us being spotlighted for our seeming indifference to its adverse impact on others in our charge.

It took Father Mathew to highlight the problem of alcohol in Ireland in the 1800s. Is there a Nurse Mathew to respond to the crisis we face in 2017? Let us hope so, before more young and defenceless lives are blighted.

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