Tag: Alcohol

Alcohol and Pregnancy – An Approach Nurses Can Use to Prevent Fetal Alcohol Spectrum Disorders

By: Ann M. Mitchell, Holly Hagle, and Brayden Kameg

Prenatal exposure to alcohol can lead to a range of physical, mental, behavioral, learning, and developmental disabilities, with possible lifelong effects for the child exposed in utero. This range is commonly known as fetal alcohol spectrum disorder or FASD. FASDs are 100% preventable when a baby is not  exposed to alcohol during pregnancy.

Healthcare professionals may tell women that it’s OK to drink alcohol on occasion or even in moderation, when they are pregnant. However, evidence shows that there is no known safe type, safe amount, or safe time to consume alcohol while pregnant.

Additionally, it’s important for healthcare professionals to broach the subject of alcohol consumption, not only with their pregnant patients, but with all women of reproductive age. Women who are sexually active and not using effective contraception may be at an increased risk for alcohol exposed pregnancies, as nearly half of all pregnancies within the United States are unplanned.

It is critical that healthcare professionals educate all women of reproductive age about alcohol use and pregnancy. Alcohol screening and brief intervention (alcohol SBI) is one evidence-based approach to assessing patients for at-risk alcohol use. Screening includes use of a validated tool, such as the Alcohol Use Disorders Identification Test (AUDIT). The AUDIT is a clinically reliable and valid instrument (Bohn, Babor & Kranzler, 1995). The AUDIT has been consistently found to screen and detect alcohol use across a spectrum of low, moderate, and high risk consumption (Reinert & Allen, 2007).  The AUDIT has been found to be valid and reliable with diverse populations and in a variety of settings.

When a patient screens positive for at-risk use, a non-judgmental discussion, called a “brief intervention” occurs with the use of motivational interviewing techniques. For example, the patient is provided with the score on the AUDIT during the health care visit. If a patient scores between an 8 and 15, this score is discussed in relation to their current health condition and presented objectively to the patient as moderate alcohol consumption. If the AUDIT score is between 16 and 19, then brief counseling and continued monitoring are suggested. With a score of 20+ a referral for further assessment is indicated (Babor & Higgins-Biddle, 2001). The main goals of the brief intervention are to increase a patient’s awareness of their alcohol consumption patterns, understand the associated risks and options for reducing or eliminating those risks, and to increase their motivation to make healthy choices.

As nurses, it is our obligation to ensure that women are provided with the knowledge needed to make informed choices regarding their health. For example, giving the patient objective feedback about their score on the AUIDT and then asking them “What are your thoughts about this score?” is a way to elicit their thoughts and feelings about their alcohol consumption in relation to their health and wellness. Further, exploring the pros and cons of the patients current level of alcohol consumption is an excellent technique to elicit the patients thoughts and provides an opportunity for the health professional to provide feedback and health education.  Patients have high trust in confiding to their healthcare provider and in particular nurses.

Additional Resources

Dr. Ann M. Mitchell is professor of nursing and psychiatry at the University of Pittsburgh School of Nursing. She is principal investigator on a CDC-funded project for the implementation of alcohol screening and brief intervention with the ultimate goal of preventing FASDs.

Dr. Holly Hagle is Director of Education for the Institute for Research, Education and Training in Addiction (IRETA) and a partner in the CDC-funded FASD project.

Brayden Kameg is a graduate student in the psychiatric-mental health nurse practitioner DNP program at the University Of Pittsburgh School Of Nursing. She is actively participating in grant-related activities on Dr. Mitchell’s projects.

What I Wish I’d Known About Alcohol & Pregnancy

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NOFAS_Kathy_Karli_blossomsby, Kathleen Tavenner Mitchell, MHS, LCADC

“Your daughter has full-blown fetal alcohol syndrome.”

Those words hit me like a tsunami. I was drowning in waves of grief, disbelief, horror and remorse. For 15 years, I searched to understand why Karli wasn’t learning and growing stronger, like my other two children. Doctors told me ear infections had caused her minor delays, but she would “grow out of it.” Today, Karli is 42 years old; developmentally, she is about 6 years old.

I grew up in the 1960s in an upper middle-class suburban neighborhood. My charismatic father suffered with alcoholism, and my co-dependent mom worked hard to cover his tracks. At 16, I was already experimenting with alcohol and other drugs when I got pregnant, married and dropped out of school. I wanted to have a healthy baby so I gave up all of the drugs and drank apple wine on the weekends.

shutterstock_152343584Effects of Alcohol in Pregnancy
My first child, a boy, was born with a clubbed foot, which the doctor told me was a genetic disorder. I had Karli a year later, when the research describing fetal alcohol syndrome (FAS) was published. A few years later, I gave birth to another daughter and still had never been told not to drink during pregnancy.

I divorced my high school sweetheart and remarried another man who liked to drink. My own issues with alcoholism and addiction spiraled out of control. I had two unplanned pregnancies while on methadone to treat my heroin addiction. No one at the clinic ever mentioned that it wasn’t OK to drink. My second son came prematurely and died the day he was born. After a full-term pregnancy with my third baby girl, I found her breathless in her crib at 10 weeks old: Sudden Infant Death Syndrome (SIDS). I didn’t realize how those years of addiction affected each of my children.

No Safe Amount of Alcohol
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Most people with FASD don’t have intellectual disabilities, but do have attention deficits, behavioral issues, learning disabilities, mental health issues, and problems with memory, judgment and reason. Each person can be affected in different ways and, often, a person with an FASD has a mix of these problems. FAS is the most severe form of FASD.

Alcohol is a leading cause of fetal brain damage, birth defects and both fetal and infant death, including SIDS. While pregnant, there is no safe amount of alcohol, no safe time to drink alcohol, and no safe type of alcohol.

Clean and sober for the last 31 years, I have dedicated my life’s work to increasing awareness and improving services for individuals with FASD and for women dealing with addiction issues. I have a beautiful marriage and 5 wonderful grandchildren. I went on to receive my Master of Human Services (MHS) degree and became a licensed clinical alcohol and drug counselor (LCADC). I know that treatment works, and by encouraging women to get help, we save their children too. Now I am that good mother I always wanted to be.

If you’re struggling or think your child may be affected by FASD, don’t hesitate to reach out to your nurse, midwife or other healthcare provider. There is no shame in asking for help—your child’s life depends on it.

Fetal Alcohol Syndrome Disorder (FASD)

  • FASD’s effects are lifelong—but they’re also preventable
  • Alcohol in pregnancy is more harmful than any other recreational drug, including cocaine, heroin and marijuana
  • Alcohol can damage a developing baby before you even know you’re pregnant
  • FASD is rarely diagnosed, making it an invisible disorder
Source: NOFAS.org

Kathleen_webKathleen is vice president of the National Organization on Fetal Alcohol Syndrome (NOFAS).

 

 

Resources
FASD PREVENTION PROJECT

AWHONN is a national partner on the Fetal Alcohol Spectrum Disorders Prevention Project of the Arc, a non-profit advocacy organization serving people with intellectual and developmental disabilities. The goal of the FASD Prevention Project is to increase health care professional knowledge of the risks alcohol can pose to a fetus, encourage the use of FASD prevention strategies and provide educational opportunities to health care professionals, including nurses, midwives, and nurse practitioners. Learn more about this project and resources you can use.