1. Ann Saunders Substance Misuse Specialist Midwife & Mr Robert Llewelyn Consultant Obstetrician ABMU Health Board Alcohol Concern Cymru’s 2015 Conference 21st September 2015 ‘Drinking for two? Alcohol and Pregnancy’

2. Definitions

4. Assessment tools FAST: Fast Alcohol Screening Test This is a simple test to check whether someone’s drinking has reached hazardous levels

6. Assessment tools T-ACE: Tolerance Annoyance Cut Down Eye Opener T-ACE is a measurement tool of four questions that are significant identifiers of risk drinking (i.e. alcohol intake sufficient to potentially damage the embryo/fetus).

8. 8 drinks in a pub PER WEEK equates to: Vodka: 10.4 units of alcohol or 200mls of Vodka 40% volume, bottle contains 700mls Wine (12%): 21 units of alcohol or 2 litres of wine, bottle contains 700mls = 3 bottles per week Beer/lager/cider (5%): 22.8 units of alcohol or 8 pints (568mls)or 10 cans (440mls)

9. Case Study A 40 year old primigravida non-smoker Initially attended SMANC at 11/40 Long standing alcohol misuse Currently drinking 151.2 units of alcohol per week, 1-1.25 bottles of red wine PER DAY Agreed to be referred to Harm Reduction Service, of which she had been a patient on a few occasions previously Disputed the evidence of fetal harm put forward by WHO and NOFAS.UK Declined to attend SMANC for the rest of the pregnancy Occupation? Outcome

10. Case Study B 34 year old G4 P2 – 1 x late miscarriage PPH Type 1 diabetic, non-smoker Care shared with Specialist Diabetes ANC Initially attended SMANC at 14/40 Long history of alcohol misuse, mostly cans of lager, 8 x cans per day, 134.4 units of alcohol per week, under the care of Harm Reduction Agency Complex pregnancy, alcohol had an adverse effect on her diabetes Occupation? Outcome?

11. Case Study C (1) 27 year old G2 P1, smoker Long history of alcohol misuse, agreed to referral to Harm Reduction Agency Last child has FASD, also physical issues due to developmental problems of the gastrointestinal tract Initially attended SMANC at 27/40, late booker At booking was drinking 42-63 units of alcohol per week, drank 3 x 125mls glasses of schnappes that morning before coming to clinic, smelt strongly of alcohol, accompanied by her mother, who stated that she herself had eaten a crumpet and drunk a can of stella lager for breakfast that morning

12. Case Study 3 (2) Continued to drink increasing volumes of alcohol throughout the pregnancy, drinking a bottle of vodka a day by 30 weeks Cannabis and cigarettes were smoked throughout the pregnancy When she tried to reduce her alcohol intake, she filled the void with amphetamine Fetal wellbeing deteriorated, ultrasound scans showed marked compromise by 30/40 At this stage she was drinking ½ bottle of schnappes and using 1/2gm of amphetamine daily Discussed with the Harm Reduction Agency and a detox plan discussed, very unusual at this stage of pregnancy, eventually did not go ahead due to logistics

13. Case Study C Alcohol use graph

14. Case Study 3 (3) Complex management plan created to accommodate alcohol detox whilst she would be in hospital post-natally Complicated delivery at 37/40 Intense Social Services involvement Occupation? Outcome?

15. FAES & FASD WHO classifies the conditions associated with drinking alcohol in pregnancy as: Fetal Alcohol Effect Syndrome (FAES) when a woman drinks 50 units or less per week Fetal Alcohol Syndrome Disorder (FASD) when woman drinks 50 units or more per week