Date post: | 21-Jan-2017 |
Category: |
Presentations & Public Speaking |
Upload: | hannah-stockdale |
View: | 250 times |
Download: | 0 times |
Perspectives on
FASD from Southern
Ireland
Prepared for Alcohol & Medications in Pregnancy Conference 9th Sept
2015. Dr Mary T O’Mahony, Specialist in Public Health Medicine, -S
Public Health (Alcohol) Bill, 2015
Restrictions on cheap alcohol
Warning labels & calorie details
Strong new powers for Environmental
Health Officers - enforcement
New restrictions on advertising,
marketing & sponsorship
Prevention of Foetal Alcohol Spectrum Disorder
Irish initiatives
Alcohol Harm
RCPI Alcohol Advocacy Group
Alcohol Health Alliance Ireland (RCPI,
IHF, ICS, The Samaritans)
FASD
First Conference in UL June 2014:
280 Day 1; 260 Day 2
“Think Tank”
Prevention of Foetal Alcohol Spectrum Disorder
National Geographic Feb 1992
http://www.faslink.org/national%20geographic%20-%20article%20on%20fetal%20alcohol.htm
Prevention of Foetal Alcohol Spectrum Disorder
“When a million babies are born every year
with permanent brain injury from a
known and preventable cause, the
response ought to be immediate,
determined, sustainable and effective”
International Charter on Prevention of FASD (Fetal Alcohol Spectrum Disorder) Edmonton September 23-25, 2013;
Lancet March 2014.
Chief Medical Officer, DoH
“Given the harmful drinking patterns in
Ireland and the propensity to binge drink,
there is substantial risk of
neurobiological damage to the fetus
resulting in Fetal Alcohol Spectrum
Disorders (FASD). Therefore it is in the
child’s best interest for a pregnant
woman not to drink alcohol during
pregnancy” (Alcohol Action Ireland
2013). Prevention of Foetal Alcohol Spectrum Disorder
Prevention of Foetal Alcohol Spectrum Disorder
2014 National Substance
Misuse Strategy - extracts
6. Alcohol is associated with harms to the baby and is a factor in unplanned pregnancies.
o A range of disorders known as fetal alcohol spectrum disorders (FASD) are caused by mothers drinking alcohol in pregnancy.
o Alcohol is a significant factor in unplanned pregnancies.
Labels on alcohol products sold in Ireland should include the number of grams of alcohol per container, along with calorific content and health warnings in relation to consuming alcohol in pregnancy.
11. Given the concerns about Fetal Alcohol Spectrum Disorder (FASD), a comprehensive awareness campaign on a national and community level is needed to increase public knowledge regarding the risks and impacts of drinking during pregnancy and to discourage the consumption of alcohol during pregnancy.
Strengthen FASD surveillance in maternity hospitals through the Eurocat reporting system and promote greater awareness amongst healthcare professionals of FASD so as to improve the diagnosis and management of children born with FASD.
Prevention of Fetal Alcohol Spectrum Disorder
Irish Guidance: 2003 HSE Little book of Women and Alcohol
ALCOHOL & PREGNANCY
Stopping drinking during pregnancy is the safest advice.
Baby’s vital organs e.g. heart, brain & skeleton are formed between 10–50 days after conception. Often, this is before you know you are pregnant. Cutting down or stopping alcohol while trying to become pregnant protects your baby.
There are risks to your baby if you continue to drink, even in small quantities:
The more you drink, the greater the amount passed on to your baby.
More than 3 drinks a day increases the risk of miscarriage. More than 12 drinks a week increases the risk of premature birth.
Avoid binge drinking, as sudden high levels of alcohol damage the developing brain.
Children exposed to alcohol in pregnancy often show poor attention and hyperactivity, that may only become evident when they are a few years old.
There is no known safe level of alcohol use in pregnancy, and stopping completely is advised.
STOP! THINK TWICE! CUT IT OUT!
http://www.drugsandalcohol.ie/11691/1/HSE_little_book_of_women_and_alcohol.pdf
THE LITTLE BOOK OF
WOMEN AND ALCOHOL
Prevention of Fetal Alcohol Spectrum Disorder
2013 EU Alcohol & Pregnancy
Including the HSE
“Can I drink alcohol when I’m pregnant?
The safest approach in pregnancy is to choose not to drink at all.
It is important to be aware that when you drink alcohol, your baby also drinks.
The risk of damage to your baby’s physical and mental development increases the more you drink and binge drinking is especially harmful. This risk relates to a range of conditions including Foetal Alcohol Syndrome (FAS) and Foetal Alcohol Spectrum Disorders (FASD).”
http://www.drugsandalcohol.ie/20520/1/Alcohol_and_Pregnancy_Guide.pdf
Prevention of Fetal Alcohol Spectrum Disorder
Contd.
What if I have been drinking alcohol before I
knew I was pregnant?
“be reassured …very little risk of harm”
“drinking heavily or ‘binge drinking’ in early
pregnancy can be harmful”
“avoid drinking alcohol until sure not preg”
Binge drinking definition
RoI: 5 units X 10g per unit
UK: 6 units X 8g per unit
(Canada: 3 units)
Prevention of Fetal Alcohol Spectrum Disorder
“ there are lies, damn lies and
statistics” Benjamin Disreali 1804-1881
The “Dr Petr Skrabanek“ of FASD”
Prevention of Fetal Alcohol Spectrum Disorder
Astley SJ replies to Oster
Evidence base appraised: Dutch studies selectively used
1 in 7 with FAS had reported prenatal exposure of 1-8
drinks per week
Children with FAS
50% development preschool normal
All severe brain dysfunction @10yrs
10% attention problem at 5 yrs
60% attention problem at 10 yrs
Only 30% IQ below normal, BUT
100% severe dysfunction in areas e.g. language,
memory, activity level
Prevention of Fetal Alcohol Spectrum Disorder
Surveillance of FAS & FASD
Fetal Alcohol Syndrome – one end of the
spectrum / may have visible signs of
abnormalities and be recognised at birth
Fetal Alcohol Spectrum Disorder – not
recognisable until preschool or school
age when difficulties manifest
Incidence/Prevalence 2009 Canada
1% of live births
2014 Alberta (2003 to 2012 data)
Incidence = 1.42% to 4.38% of live births
Prevalence = 1.17% of Alberta population
2014 Midwest USA
Prevalence = 2.4% to 4.8% of 1st graders
Australia
FAS or pFAS prevalence of 12%
Italy
FAS 0.4-1.2%; pFAS 1.8-4.6%; FASD 2.3-6.3% of children
Prevention of Foetal Alcohol Spectrum Disorder
“Children with FASD fill our Foster Care
places.
Adults with FASD fill our jails.”
25 Differential diagnoses. Many
misdiagnosed as Autism Spectrum
Disorder.
Societal impact
Prevention of Foetal Alcohol Spectrum Disorder
Economic impact – Alberta Canada
10 Strategic Plan to prevent FASD
Population 3.6m,36000 with FASD
(estimate 1%); 450 FASD babies born/a
Lifetime cost to state per child with
FASD estimated: $800K(£394K/€540K)
Prevention of 10 cases p.a. covers cost
of comprehensive services
Alberta FASD Services- Estimated to
save $20m p.a. in reduced demand for
services
Prevention of Foetal Alcohol Spectrum Disorder
Case scenario - Ireland:
evidence & anecdote
80% of nulliparous pregnant women in
the study sample drank alcohol while
pregnant
In Ireland, it’s the accepted social norm
to drink while pregnant
Ireland not alone
Australian study in 2010 (Robinson) OK to
drink
English study in 2011 (Kelly) OK to drink
US Feldman – Not OK to drink
A new 'toolkit' for health professionals was launched in the antenatal clinic in
Letterkenny General Hospital. The project, which aims to increase awareness of
the health benefits to pregnant mums and unborn children of ceasing alcohol
consumption entirely during pregnancy, Photo : L-R: Helen McFarland, ETB; Ciara Doyle, Project Lead, Hidden
Harm, HSE/Alcohol Forum; Cora McAleer, Manager, Mental Health Addiction Services; Evelyn Smith, Asst Director of Nursing/Midwifery; Christina
McEleney, Coordinator Tutor, University of Limerick Diploma in Drug and Alcohol Studies; Dr. Nandini Ravikumar, Consultant Obstetrician; Sean
Murphy, General Manager, Geraldine Hanley, CMM2 Antenatal Education Coordinator; Moira Mills, Alcohol Forum; and Mary Kelly, Health
Promotion Officer
From: Saolta-e-Newsletter-July-2015-pdf
Prevention of Foetal Alcohol Spectrum Disorder
SAOR (S&BI for subs misuse)
Tiers 1-4
18. It is essential to raise awareness of the risks of drinking during pregnancy (Recommendation 1 of Prevention Pillar; see Chapter 7) in all tier 1 and tier 2 settings, particularly in primary care, so that hazardous or harmful drinking can be identified, allowing for change. Screening for alcohol consumption should begin at the first antenatal visit for all pregnant women and be reviewed throughout the pregnancy.
19. Pregnant women who are alcohol dependent should be prioritised for immediate access to tier 3 and tier 4 services.
Prevention of Foetal Alcohol Spectrum Disorder
TIER 1
Interventions where
main focus is not drug
treatment
TIER 2
Drug-related
Interventions
TIER 3
Specialist Drug-related
Interventions
TIER 4
Specialist Dedicated
Inpatient or Residential
Units or Wards
Family Support
Social Care
Pharmacies
Community
Based
Job
Seeking Prison
Community Education
Skills Setting
Setting Services
Primary Care
Outreach
Hospital Setting
Specialist Addiction
Services
Vocational Criminal Justice
Training & Probation
Services
General Healthcare Setting
Prevention of Foetal Alcohol Spectrum Disorder
PCAP: Parent Child
Assistance Programme
A supportive non-judgmental relationship
Support to the mother and the target child
“Wrap around service”
3 year programme, 2 visits per month
Relapse is tolerated, start again
Prevention of Foetal Alcohol Spectrum Disorder
PCAP: three objectives
Motivate the women to stop using
If can’t, help women not to get pregnant
Family planning does not mean never having another child but plan family
Effective contraception
Use mandated treatment for alcohol and drug abuse
Use women only treatment
Use service where children can stay
Provide client specific support to addiction service providers as indicated.
Prevention of Foetal Alcohol Spectrum Disorder
PCAP: Outcomes
more employed
less on welfare
months sober
% in treatment
number in education
connected to community support
services
Prevention of Foetal Alcohol Spectrum Disorder
“Safe Limiting” in Pregnancy
FASD: alcohol causal, a co-factor, correlated
No amount of RoH absolutely safe
No amount of RoH absolutely dangerous
A relative risk of harm
Multiple mechanisms direct & indirect action
Fraternal twins with lesser effect in one
Maternal nutrition
Maternal & foetal metabolism
Stop drinking – 2o prevention, selective
Prevention of Foetal Alcohol Spectrum Disorder
Alcohol use by women is increasing in all
socioeconomic groups (SEG), as is
binge drinking especially among
students and those of lower SEG
How prevalent is Prenatal Alcohol
Exposure?
Surveillance of prenatal alcohol
exposure: cord blood (EtG) on bloodspot
card / meconium (FAEE)
An increasing problem? Yes
Transgenerational aspects
ICGP Lead GP for Substance Misuse
The cycle of addiction from generation to
generation
Those with FASD at increased risk of
addiction to alcohol themselves
Prevent FASD and break the cycle
Most inspiring speaker*
Who’s the DD (designated driver) and
have the girls done their PT (pregnancy
test)?
PT ($2) dispenser in the bar restroom
Goal_mtom: “pregnant pause” - that
drinking in pregnancy will be at least as
unacceptable as drink driving
Prevention of Foetal Alcohol Spectrum Disorder
* @ First International Prevention of FASD Conference, Edmonton Sept 2013
The elephant in the room –
FASD or ASD?
Need first to document prenatal alcohol
intake by pregnant women.
To document prenatal alcohol exposure
(PAE) for aetiological studies
Women and alcohol
The pregnant pause
Who are the stakeholders?
Anecdote
LIG parent group
Prevention of Foetal Alcohol Spectrum Disorder
Prevention of Fetal Alcohol Spectrum Disorder
Screening & brief intervention for alcohol
in pregnancy
Parent child assistance programmes
Many resources developed to assist
Information leaflets, posters, videos etc
on diagnosis
on strategies for care
Effective interventions in
prevention of FASD
Collect information and
evidence
Active surveillance for FAS in at risk populations Children in state care
Young offenders
Prison population
Population based within national schools – all those less than 10th / 25th centile for growth (height)
Active surveillance for prenatal alcohol exposure Antenatal screening +/- Brief intervention
Cord blood
Meconium