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. – 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 Fetal Alcohol Spectrum Disorder FASD

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