1. Exploring the feasibility and clinical effectiveness of antenatal alcohol screening to clinicians, pregnant women and their partners Helen Howlett SSA Annual Conference 7th November 2018

2. The Risks of Alcohol in Pregnancy
Increased risk of miscarriage, stillbirth and FASD.
Alcohol is a teratogen - even small amounts can damage the development of an unborn baby – alcohol passes freely through the placenta – so whatever a woman drinks the baby drinks too.
Depends upon many factors and there is no way of knowing the impact that alcohol may have on the unborn baby.
A woman can benefit her baby by completely avoiding alcohol when trying for a baby, or at any stage of pregnancy.
41.3% of British women drink alcohol in pregnancy (Popova et al 2017)
Providing antenatal and postnatal care for women who drink alcohol in pregnancy is only possible if those at risk can be identified.
Confounded by Tobacco use, Other drug use , Poor nutrition, Stress
Dose and timing

3. Aims:
1) To conduct a systematic review to compare the efficacy of blood analysis and maternal self-report in detecting at risk women during pregnancy.
2) To estimate the prevalence of alcohol consumption in a random sample of pregnant women in the first trimester of pregnancy using blood biomarkers compared to self reported.
3) To establish awareness of the risks of drinking alcohol in pregnancy and the acceptability of alcohol screening, from the perspective of pregnant women and their partners.
4) To establish health care professionals' level of FASD knowledge and experience and establish the acceptability of alcohol screening in pregnancy, via internet survey.

4. Methodological quality all eight eligible studies was good
Methodological quality all eight eligible studies was good. None of the biomarkers had both high sensitivity and specificity when compared to self-report, particularly with low to moderate alcohol consumption. Evidence suggested that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. Biomarkers picked up slightly more women who may be drinking in pregnancy than self-report, although both methods are likely to result in under-estimates. Self-report may under-estimate drinking levels due to factors such as stigma, recall bias, social pressures and patient-clinician interaction. Further studies using additional blood biomarkers (such as Ethyl glucuronide (EtG)) or a combination of blood biomarkers and self-report may be beneficial in detecting a more detailed drinking history.

5. Pregnant women and their partners were surveyed to investigate self-reported beliefs and practice regarding drinking during pregnancy and the acceptability of screening. The data was summarised using descriptive statistics and thematic analysis. Confusion over what level of alcohol is safe and using screening as an opportunity for education and support emerged as key themes from free-text responses. Most women viewed screening for alcohol in pregnancy positively, although its acceptability in the small number of women who continue to drink is unclear. A Survey of Health Care Professionals’ Knowledge and Experience of Fetal Alcohol Spectrum Disorder (FASD) and Alcohol Use in Pregnancy Only a small percentage of UK children with FASD are currently identified. An online survey was designed to determine healthcare professionals' knowledge and opinions. We had 250 responses from Midwives, Health Visitors, Obstetricians, Paediatricians and General Practitioners (GPs). We identified a significant gap in knowledge around FASD and the risks of alcohol related harm in pregnancy in our sample of UK health professionals. Consequently, there is a clear need for training across the professions to improve FASD awareness and recognition.

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