Doctors are being urged to ask pregnant women tough questions about their alcohol consumption as part of efforts to reduce the number of children born with Fetal Alcohol Spectrum Disorder (FASD).
The condition, which relates to brain damage caused by fetal alcohol exposure, is recognised as the leading preventable cause of birth defects and developmental and learning disabilities worldwide.
People with the disorder can have problems with memory, attention, reasoning and impulsivity.
But Australian experts say the failure of doctors to routinely ask expectant mothers about their alcohol consumption means risky behaviour is not being identified and women are not being given information that might lead them to stop drinking.
"We as clinicians have been doing something wrong by not asking, or not asking well enough in order to elicit the history,” said Gold Coast paediatrician Doug Shelton at an FASD event in Melbourne earlier this week.
“The difference is made by having the courage to ask carefully and respectfully and in a non-judgmental, non-blaming way about alcohol use in pregnancy."
Stereotypes and stigma
Jane Halliday, professor of paediatrics and principal research fellow at Murdoch Children's Research Institute said raising the topic can be challenging for clinicians “because there is this association of blame and stigma with drinking in pregnancy."
“So people are somewhat loath to ask about it.”
Up to five per cent of the Australian population are believed to have FASD and one in three people in youth justice facilities are affected, where Indigenous young people outnumber non-Indigenous youth.
, conducted in an Aboriginal community in Western Australia in 2012, found a prevalence rate of 12 per cent among children. Critics of the study have noted its high-risk population and small sample size, in which fifty-five per cent of 127 pregnant women studied drank during pregnancy.
Victorian Aboriginal Child Care Agency CEO Muriel Bamblett said failing to ask mothers-to-be about their drinking is jeopardising the health of children.
"I think that a lot of doctors feel concerned about asking the question, particularly of Aboriginal women,” she said.
“But it shouldn't be something to shy away from, or not ask."
One mother's experience
Anne Russell has two sons in their thirties, both with FASD.
When she fell pregnant in the 1980s, doctors did not suggest she avoid alcohol. Far from it.
One suggested Ms Russell, who is from Cairns, go to the pub for a celebratory drink.
Anne Russell is an FASD educator and mother of two sons with the disorder. Source: SBS
"I took the pregnancy vitamins that were available at the time,” she said.
“I stopped smoking, what little smoking I did.”
“I was not taking any other drugs.”
“I remember even asking my doctor if I could take Panadol.”
“But alcohol was not on anyone's radar, including my own, and I did not drink any more or less than my peers."
Ms Russell’s sons were not diagnosed until their late teens.
Anne Russell's sons were not diagnosed with FASD until after they had left school. Source: Supplied
She wishes the disorder had been spotted earlier.
"If my first son had been diagnosed when he was young, my second son would not have FASD,” she said.
“To avoid that would have been life-changing for all of us."
'Lack of expertise'
FASD is described as a hidden condition because it is often overlooked, ignored or attributed to another condition.
The characteristic features of the disorder are very similar to other conditions, such as Attention Deficit Hyperactivity Disorder and Autism, so it is often misdiagnosed.
“There is a lack of expertise and capacity to actually diagnose the condition,” said Professor Halliday.
“It requires a multidisciplinary approach, and there are just not the trained people out there who know about it."
Early diagnosis can protect a child from some of the negative implications of the condition.
"I have seen what can happen and how you can change the trajectory for a young person if you have early diagnosis,” said Professor Muriel Bamblett.
“Identifying that much earlier you get to understand the behaviour, and then you can put in a treatment plan."
