Preventing Fetal Alcohol Spectrum Disorder: A Maternity Health Care Initiative in Jönköping

1. Alcohol and pregnancy AER, fourth peer review

2. Why is it harmful? • The child gets the same blood alcohol concentration as the mother • The Placenta can’t stop alcohol from passing over to the child • The child get’s as intoxicated as the mother

3. What happens? • The brain develops from the third week and forward • The child grows rapidly between the 10th and 20th week • The production of brain cells is damaged when the mother drinks alcohol

4. Fetal Alcohol Spectrum DisorderFASD – Caused by alcohol use in the prenatal period – Most common preventable cause of mental retardation • First trimester- morphologic abnormalities • Second trimester- spontaneous abortion • Third trimester-poor fetal growth – Through out- Central Nervous System/Brain Damage

5. Consequences of FASD • Primary Disabilities – Brain damage – Lowered cognitive function – Inability to learn from consequences – Facial dysmorphology – Growth deficiency • Secondary Disabilities – Disrupted school experiences – Trouble with the law – Inappropriate sexual behaviors – Alcohol/drug problems

6. Why do pregnant women drink? • Women are older when they get children 29-30 years old • Changed social patterns • Increased consumption of alcohol • A subject we don’t talk about • Lack of knowledge about how alcohol effects the unborn child?

7. Riskbruksprojektet • National initiative concerning alcohol prevention in the primary health care • Maternity health care is one part • Started in 2004 • Education and training to all midwives

8. Objectives The midwife in the primary health care must have: • knowledge about how alcohol effects the pregnancy and the child • knowledge about methods to identify and support women who drinks during pregnancy • see the possibilities of working with alcohol prevention in the primary health care

9. Why alcohol prevention in the maternity health care? • Pregnancy is a unique opportunity to influence the drinking habits among women • Pregnant women with a hazardous consumption are highly motivated to change this during pregnancy • Pregnant women want help to change • It’s unethical to do nothing when the pregnant woman is motivated to change her life and receive help for this • (Source: Göransson & Magnusson, KI, 2004)

10. What have we done in Jönköping? • Changed routines concerning the first visit to the maternity health care. From 12th week to the first call! • Changed questions about alcohol consumption • Screening through AUDIT and TLFB (time line follow back) • Support through out the pregnancy, those identified as addicted gets help from professionals outside the primary health care • A team working on education and information in the primary health care • Developed a new policy and action plan for alcohol and drug prevention

11. AUDIT–Alcohol Use Disorder Identification Test • Instrument for screening (WHO 1982) to find persons with early drinking problems • AUDIT is used in 30 countries

13. What are the key problems your region faces in this context? • What policies have you adopted to respond to these problems? • Present an example of a policy your region has implemented and evaluate its success