Assessing prenatal alcohol exposure
Assessment of prenatal alcohol exposure (PAE) may be conducted before or during pregnancy to inform risk reduction efforts, as part of general paediatric assessment, or if a child is born with clinical characteristics of fetal alcohol spectrum disorder (FASD) (ie to inform diagnosis). Use a sensitive approach as outlined in An approach to discussing alcohol use in pregnancy (the 3 Ss) at all times.
Open questions are useful to start clinical discussion about prenatal alcohol exposure—for examples, see Open questions to discuss and assess prenatal alcohol exposure. Ideally, take a detailed history of prenatal alcohol exposure using the AUDIT-C (Alcohol Use Disorders Identification Test–Consumption) screening questionnaire; see the Royal Australian College of General Practitioners (RACGP) website for more information.
Multiple measurement tools and methods might be needed to identify prenatal alcohol exposure at different points during and after pregnancy. Biomarkers are not readily available or useful for standard clinical practice currently.
Normalise the questions used to assess prenatal alcohol exposure:
- ‘These are standard questions I ask all mothers/couples/families about their pregnancy, to understand their physical and mental health and lifestyle.’
Start by asking the mother/couple/family:
- ‘How is alcohol used in your family/home?’
- ‘How is/was your/the birth mother’s mental health during the pregnancy?’
- ‘How is/was your/the birth mother’s physical health during the pregnancy?’
- ‘Is/was the pregnancy a surprise, planned or somewhere in between?’
- ‘When did you/the birth mother find out about the pregnancy?’
After the questions above, it is often safer and easier to ask more specifically about alcohol use during pregnancy:
- ‘Did you/the birth mother make lifestyle changes after the pregnancy was confirmed?’
- ‘What did that involve?’
- ‘What was your/the birth mother’s alcohol intake before you/she became pregnant?’
- ‘Did you/the birth mother drink alcohol before or after the pregnancy was confirmed?’
- Are you drinking alcohol currently?’
If assessing a child who lives with foster parents or other caregivers who are not their biological parents, confirm the child’s exposure history with child protection services or another independent source, preferably with written documentation. See also Diagnosis of fetal alcohol spectrum disorder. In some situations, it may be appropriate to contact the birth mother to discuss drinking in pregnancy. Do this with the assistance of family or professionals who are engaged with the mother and can support her as required; ensure discussion is well-planned and considerate, utilising the 3s approach, with a focus on better understanding the child’s development.