Management of alcohol use during pregnancy
Heavy drinking before pregnancy may be associated with increased risk of impaired nutrition; micronutrient deficiencies (in particular, thiamine, folate and iron) may have an adverse effect on the pregnancy. Offer patients who use alcohol options for contraception. For patients who are planning pregnancy, preventive micronutrient supplementation and planning for abstinence are recommended. For information on supplements, see Folate supplementation for pregnant people, Thiamine supplementation and oral iron supplementation.
Approximately 10 to 15% of people continue to consume alcohol during pregnancy. Many people who continue drinking during pregnancy have a history of a parent drinking while pregnant; this history may reduce a patient’s perception of risk.
Any alcohol consumption during pregnancy is strongly discouraged because there is no known safe amountGosdin, 2022. Alcohol has potential adverse effects on the embryo, starting early in the first trimester, often at a time when a person is unaware of their pregnancy. The harm from alcohol does not appear to be confined to first trimester alcohol consumption, and it is possible that the pattern of drinking may be more important than the average number of drinks per week. Learning about the potential adverse effects of alcohol on a fetus can heighten anxiety and exacerbate drinking in pregnancy. Careful counselling is helpful for many, but some patients require specialist counselling about this risk. Specialist alcohol and other drug services to support pregnant patients are listed by state and territory on the every moment matters website.
Alcohol withdrawal can be associated with increased risk for spontaneous abortion in the first trimester and premature labour in the third trimester. Planned alcohol withdrawal should be timed for the second trimester, preferably with support from a specialist alcohol and drug treatment service. After withdrawal and subsequent improvement in cognitive functioning, a decision about continuing the pregnancy may change. Referral to a specialist obstetric service with access to perinatal psychiatry is recommended to support decision-making.
Alcohol withdrawal management should be followed by counselling to support ongoing abstinence. The safety during pregnancy of drugs used to reduce alcohol cravings (eg naltrexone, acamprosate) has not been established. The safety of disulfiram is also unknown; while there are case reports of normal pregnancies, there are also isolated reports of congenital malformations including a case of limb reductions.
Infants with significant alcohol exposure in utero can develop a neonatal abstinence syndrome; this is characterised by irritability, poor feeding and impaired bonding, and may be associated with impaired engagement in breastfeeding. Neonatal abstinence syndrome should be managed by a specialist neonatologist or in consultation with them.
Fetal Alcohol Spectrum Disorder (FASD) affects a substantial proportion of infants with significant alcohol exposure in utero. While some of these infants might be identified early by a paediatrician, many are not diagnosed in childhood and some may not receive a specific diagnosis during their lifetime. For information on diagnosis and management, see Fetal alcohol spectrum disorder.
Tobacco smoking is frequently associated with heavy drinking; this highlights the importance of providing support to a person to stop smoking and drinking in pregnancy. See Management of tobacco smoking in pregnancy.
Patient information on alcohol and pregnancy is available at the MotherSafe website.
Intervention for alcohol, smoking and other drug use is a priority during the postnatal period. Some patients may have already made significant changes during pregnancy that require consolidation, while others may still be precontemplative. Every effort should be made to capitalise on a person’s motivation to engage with treatment during this time and thus provide the safest environment for their child.