Australia’s dangerously outdated health guidelines on alcohol and pregnancy

UPDATE from the author –  27 June 2018

In response to a letter outlining our concerns, the Department of Health acknowledged that the alcohol chapter of the Pregnancy Care Guidelines is outdated and may create confusion amongst health professionals.

The Department has advised us that, at the beginning of the alcohol chapter of the Clinical Practice Guidelines: Pregnancy Care, a statement will be included explaining that an update and revision of the NHMRC Alcohol Guidelines are expected to be available in early 2020.

Also to be included are links to several resources that may be of assistance to health professionals: the Australian Guide to the Diagnosis of FASD, the AUDIT-C alcohol screening tool, and Women Want to Know alcohol and pregnancy resources sheets.

This information is to be inserted by 31 July 2018.

– Carol Bower

The Clinical Practice Guidelines: Pregnancy Care, published in February 2018, were developed to ”help ensure that women in Australia are provided with consistent, high-quality, evidence-based maternity care” and are intended for all health professionals who contribute to pregnancy care (including midwives, obstetricians, general practitioners, Aboriginal and Torres Strait Islander health workers and allied health professionals).

Unfortunately, in relation to alcohol use in pregnancy, the Clinical Practice Guidelines have not been updated beyond 2009, when the NHMRC Australian Guidelines to Reduce Health Risks from Drinking Alcohol were published (these Alcohol Guidelines are currently under review).

There have been several major advances in understanding and action on alcohol use in pregnancy since 2009 in Australia (and overseas), not the least of which is the production of the Australian Guide to the Diagnosis of FASD (Fetal Alcohol Spectrum Disorder), released in 2016.  The FASD Guide recommends use of AUDIT-C to ask about prenatal alcohol exposure – this is not mentioned in the Clinical Practice Guidelines chapter on alcohol (chapter 13).

Outdated diagnostic terminology is included in the Clinical Practice Guidelines, not the current, approved nomenclature of Fetal Alcohol Spectrum Disorder, with two sub-categories FASD with three Sentinel Facial Features and FASD with less than three Sentinel Facial Features. Health professionals reading the two guidelines may well be confused and may – not unreasonably – assume that the Clinical Practice Guidelines published in 2018, supersede the FASD Guide published in 2016.

The Clinical Practice Guidelines were published by the Australian Government Department of Health, which also funded the development of the Australian Guide to the Diagnosis of FASD.  The Department of Health has also funded a number of other research and practice initiatives in relation to alcohol in pregnancy and FASD over the past nine years, but of course, the Clinical Practice Guidelines do not benefit from the inclusion of the results of any of these initiatives.

Furthermore, considerable work is being conducted across Australia (some of it also funded by the Department of Health) to educate health professionals about the FASD Guide and the use of AUDIT-C, and eLearning modules have been developed to assist in this education and training.  In the Foreword to the Clinical Practice Guidelines, it is noted that the Department of Health is also funding the development of health professional and consumer aids to assist in the uptake of the Clinical Practice Guidelines. This may lead to further confusion.

The update of the NHMRC Alcohol Guidelines is expected to be open for public consultation in mid-2019, and following their completion, the Department of Health will look at updating the Alcohol chapter in the Clinical Practice Guidelines. Realistically this is unlikely to be completed until 2020.  Given that the Clinical Practice Guidelines are an electronic resource – surely at a minimum – a link could be included in them to the FASD Guide to help ensure that health professionals are provided with consistent and up-to-date information that can help to prevent the lifelong disability of FASD, with its devastating consequences on individuals, family and community.