A review of policies on alcohol use during pregnancy in Australia and other English-speaking countries, 2006

The issue of alcohol use during pregnancy is controversial. It is well accepted that heavy maternal alcohol consumption during early pregnancy - either chronic daily use or binge drinking (five or more drinks per occasion) - is required for the development of fetal alcohol syndrome (FAs),(1,2) but not all children exposed to alcohol in utero will be affected to the same degree, and some will not be affected.(3) A number of factors, such as the pattern and timing of alcohol consumption, stage of fetal development, and sociobehavioural factors, such as poverty and smoking, may exacerbate the impact of alcohol.(4) Maternal nutrition, genetics and concomitant use of other drugs may also influence fetal risk. Alcohol exposure can also cause a range of alcohol-related birth defects and neurodevelopmental disorders which, collectively with FAS, comprise fetal alcohol spectrum disorder (FASD).(5) The amount of alcohol necessary for fetal damage is unclear, and it remains debatable whether there is a threshold level below which alcohol does not harm the fetus.(6)Lack of clarity in the published literature about the relationship between low to moderate alcohol consumption and fetal harm has allowed a range of interpretations and conclusions to be drawn from the data. The way each government and professional body interprets these data is reflected in their policies, and inconsistency in policy is evident not only between, but also within, countries.In this article, we examine government policies on maternal alcohol consumption during pregnancy in seven English-speaking nations - Australia, New Zealand, Canada, South Africa, the United Kingdom, Ireland and the United States - and in Australian states and territories. Where available, policies and clinical practice guidelines of relevant medical, nursing, and non-professional organisations are also presented. This review is timely, in view of the upcoming revision of the guidelines on alcohol use in Australia by the National Health and Medical Research Council (NHMRC).Alcohol and pregnancy policies and guidelines were identified through Internet searches of the websites of the relevant jurisdictions and organisations. Where no policy could be identified, the organisation was contacted by email or telephone. This strategy was based on the assumption that, to be useful tools, policies must be publicly available and easy to access.

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