Ann Saunders Substance Misuse Specialist Midwife

&Mr Robert Llewelyn Consultant Obstetrician

ABMU Health Board

Alcohol Concern Cymru’s 2015 Conference 21st September 2015 ‘Drinking for two?

Alcohol and Pregnancy’

Definitions

Assessment toolsFAST: Fast Alcohol Screening Test

This is a simple test to check whether someone’s drinking has reached hazardous levels

Assessment toolsT-ACE: Tolerance Annoyance Cut Down Eye OpenerT-ACE is a measurement tool of four

questions that are significant identifiers of risk drinking (i.e. alcohol intake sufficient to potentially damage the embryo/fetus).

8 drinks in a pub PER WEEKequates to:

Vodka: 10.4 units of alcohol or 200mls of Vodka 40% volume, bottle contains 700mls

Wine (12%): 21 units of alcohol or 2 litres of wine, bottle contains 700mls = 3 bottles per week

Beer/lager/cider (5%): 22.8 units of alcohol or 8 pints (568mls)or 10 cans (440mls)

Case Study A40 year old primigravida non-smokerInitially attended SMANC at 11/40Long standing alcohol misuse Currently drinking 151.2 units of alcohol per week,

1-1.25 bottles of red wine PER DAYAgreed to be referred to Harm Reduction Service, of

which she had been a patient on a few occasions previously

Disputed the evidence of fetal harm put forward by WHO and NOFAS.UK

Declined to attend SMANC for the rest of the pregnancy

Occupation?Outcome

Case Study B34 year old G4 P2 – 1 x late miscarriage PPHType 1 diabetic, non-smokerCare shared with Specialist Diabetes ANCInitially attended SMANC at 14/40Long history of alcohol misuse, mostly cans

of lager, 8 x cans per day, 134.4 units of alcohol per week, under the care of Harm Reduction Agency

Complex pregnancy, alcohol had an adverse effect on her diabetes

Occupation?Outcome?

Case Study C (1)27 year old G2 P1, smokerLong history of alcohol misuse, agreed to

referral to Harm Reduction AgencyLast child has FASD, also physical issues due to

developmental problems of the gastrointestinal tract

Initially attended SMANC at 27/40, late bookerAt booking was drinking 42-63 units of alcohol

per week, drank 3 x 125mls glasses of schnappes that morning before coming to clinic, smelt strongly of alcohol, accompanied by her mother, who stated that she herself had eaten a crumpet and drunk a can of stella lager for breakfast that morning

Case Study 3 (2)Continued to drink increasing volumes of alcohol

throughout the pregnancy, drinking a bottle of vodka a day by 30 weeks

Cannabis and cigarettes were smoked throughout the pregnancy

When she tried to reduce her alcohol intake, she filled the void with amphetamine

Fetal wellbeing deteriorated, ultrasound scans showed marked compromise by 30/40

At this stage she was drinking ½ bottle of schnappes and using 1/2gm of amphetamine daily

Discussed with the Harm Reduction Agency and a detox plan discussed, very unusual at this stage of pregnancy, eventually did not go ahead due to logistics

Case Study 3 (3)Complex management plan created to

accommodate alcohol detox whilst she would be in hospital post-natally

Complicated delivery at 37/40Intense Social Services involvementOccupation?Outcome?

FAES & FASDWHO classifies the conditions associated

with drinking alcohol in pregnancy as:

Fetal Alcohol Effect Syndrome (FAES) when a woman drinks 50 units or less per week

Fetal Alcohol Syndrome Disorder (FASD) when woman drinks 50 units or more

per week