Sunday 18 March 2018

Keep it corked: heed the warnings during pregnancy

Patricia Casey

Last week our Government announced that it plans on placing pregnancy-health warnings on bottles saying that alcohol is dangerous. We are following Britain, France, Chile and the US in this.

It is unclear if these admonishments will be extended to breast-feeding also, even though it should be, since alcohol is excreted in breast milk.

The range of harm that occurs is called foetal alcohol spectrum disorder (FASD), of which the most visible is foetal alcohol syndrome (FAS) and is reported to occur in one to three per 1,000 births, while FASD is found in 9/1000 births in the US.

These are the leading causes of a learning disability, and the risk of an alcoholic woman having a child with a disability is as high as 35pc.

Typically, FAS is associated with failure to develop in utero so that the brain is small in size, called microcephaly, and there may be malformations of the facial bones also.

Teeth and lips may be abnormal in appearance and significant neurological problems can occur, such as seizures, deafness or blindness. Heart defects and small stature in adulthood are common. And behavioural problems and learning problems in adulthood are also a feature.

The impact of alcohol is not confined to the early months of pregnancy but continue up to birth and beyond, since the brain continues to develop after delivery as new language and physical skills are acquired.

Although less talked about, the newborn babies of alcoholic mothers can develop a withdrawal reaction after delivery. This is potentially life-threatening, especially if fits are present.

The effect of using alcohol when breast-feeding is unknown, and so should be regarded with caution.

Some suggest that the occasional drink is not damaging but others point to the possible impact on the baby's brain development.

The inclusion of these warnings is clearly a good thing, yet some women may ignore them, claiming that these refer only to those who consume large quantities.

The problem is that there is no evidence concerning low levels of intake, and so the advice has to be to err on the side of caution. This view is reiterated by the World Health organisation who states that there is no safe level of alcohol in pregnancy.

It is also highlighted by some researchers, who suggest that even moderate amounts of alcohol in pregnancy cause subtle changes to brain function resulting in lasting impairment.

A question that begs to be asked is whether these warnings will make any difference?

While we have no data from Ireland, a recent study from Britain indicated that 61pc of women did not reduce their alcohol intake at all during pregnancy.

And a survey carried out by St George's hospital in London revealed that just under 50pc of mothers visiting the teenage antenatal clinic drank more than four units on a single occasion, and 27pc admitted to, at times, "getting drunk".

While versed in other health matters, the Irish public has little information on or knowledge of the effects of alcohol on unborn or newborn infants.

As our binge-drinking culture continues apace, putting this information into the public domain is imperative. Yet studies from the US, where such warning have been in use since 1989, suggest little or no effect on adolescent behaviour.

Reports suggest that awareness rose initially followed by a decline in recall of the content of such warnings after about three years.

Whether these warnings will be more successful in reducing alcohol consumption during pregnancy with the generality of the population remains to be seen.

As part of this initiative, the Government should monitor the knowledge and alcohol-related behaviour of the pregnant population to test its effectiveness.

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