ASK all women about their alcohol use as part of their general health check.For women who are pregnant or planning pregnancy, assess their alcohol consumption on their first visit and regularly thereafter. When asking about alcohol, aim to:
- Ask open-ended questions;
- Be non-judgemental;
- Be attentive to her concerns;
- Refrain from negative comments or negative reactions;
- Be focused on the health of the mother as well as the baby;
- Be sensitive to other issues such as domestic violence, other drug use and money issues; and
- Make positive comments and congratulate the woman for seeking prenatal care during pregnancy.
ASSESS and record the level of risk of alcohol consumption using validated screening tools.1Once you have initiated a discussion on alcohol consumption it is important to know how much a woman is drinking and/or how this has changed since she found out that she is pregnant. The assessment of alcohol consumption in pregnancy is an important aspect of prenatal care and if this assessment of consumption is combined with education and support, this can result in stopped or reduced alcohol consumption in pregnancy.2
One way to assess alcohol consumption in pregnancy is by using the AUDIT – C (Alcohol Use Disorders Identification Test – Consumption). This tool consists of three short questions to calculate alcohol consumption in a standard, meaningful and non-judgemental manner. The total score from these questions can then be used to guide a conversation about alcohol and pregnancy with information that is relevant to the woman.
The AUDIT-C is a shortened version of the 10-item AUDIT tool, first developed by the World Health Organization (WHO) in 1989. AUDIT-C has been validated for used with pregnant women3 and has been recommended for use by an Australian study that examined the questions that should be asked about alcohol consumption and pregnancy.4
A resource has been developed on the AUDIT-C and can be downloaded here: link to AUDIT-C resource
The Australian standard drinkStandard drinks are a measure of alcohol consumption and are used in the AUDIT-C questions. It is more reliable to count standard drinks than counting glasses or bottles or cans as alcohol is served in many different containers. A standard drink also contains the same amount of alcohol regardless of its type i.e. beer, wine or spirits.
The Australian standard drink measure contains 10g of alcohol (equivalent to 12.5mls of pure alcohol).5 For example:
- 100ml glass of red wine at 13% alc vol = 1 standard drink.
- 100ml glass of white wine at 11.5% alc vol = 0.9 of a standard drink.
- 375ml bottle or can of full strength beer at 4.8% alc vol = 1.4 standard drinks.
- 30ml nip of high strength spirit at 40% alc vol = 1 standard drink.
- 330ml bottle of full strength ready-to-drink 5% alc vol = 1.2 standard drinks.6
ADVISE all women, regardless of whether or not they are drink alcohol that:
- No alcohol is the safest choice when pregnant or trying to get pregnant.
- No safe level of alcohol consumption during pregnancy has been determined.
ASSIST women to stop or reduce their alcohol consumptionIt is important to provide positive reinforcement to those women who have already stopped drinking and to remind them of the reasons to continue to avoid alcohol for the remainder of their pregnancy.
Some women may express difficulty in being able to be completely alcohol-free during their pregnancy. For these women the health professional should undertake a brief intervention to assist her in stopping or cutting down her alcohol consumption.
A brief intervention involves an investigation of the influences on a woman’s alcohol consumption and seeks to increase her readiness and confidence to change and become alcohol-free in her pregnancy. These brief interventions should take between 5 to 10 minutes.
Brief interventions should include the following steps:
1. Begin with open-ended questions and an exploration of both the positive and negative aspects of drinking alcohol, e.g. “How do you feel about your drinking at the moment?” and “Can you think of some benefits of stopping drinking or even reducing the amount you drink?” Summarise the information she has given and particularly emphasise the benefits of change.
2. Encourage the woman to come up with tips and strategies for taking action. This could include seeking the support of a partner to be alcohol-free with them or preparing what to say in social situations where people are drinking.
3. Assess the woman’s motivation and readiness to change by asking them to rate on a scale of 1 to 10 how confident they feel in being able to change. If the score is low, explore with her ideas that will help increase this confidence.
All women should be provided with assistance about alcohol by:
- providing positive reinforcement for those who are already abstaining from alcohol;
- advising on the harms of alcohol exposure to the fetus and to the woman’s health;
- encouraging women to seek the support of their partner and loved ones in abstaining;
- offering brief interventions to support women to stop or cut down their alcohol consumption during pregnancy; and
- arranging referral and treatment where necessary.
ARRANGE for further support for women who are unable or unwilling to abstain from alcohol by planning additional consultations or by referral to specialist services and support groups.All women should be given information to take away with them on alcohol consumption and pregnancy. As part of the Women Want to Know project a consumer leaflet - Women Want to Know: Information for women on alcohol and pregnancy has been developed. This leaflet provides information on why it’s best to avoid alcohol consumption during pregnancy, hints and tips for saying ‘no’ to alcohol when out with friends and information on where to go for further information or advice. Hard copies can be ordered from the resources and publications page.
As part of the Women Want to Know project, two scenarios have been developed that show health professionals speaking to pregnant women about their alcohol consumption:
- Video: Health professional speaking to a woman in her second pregnancy about her continued alcohol consumption during pregnancy.
- Video: Health professional speaking to a pregnant woman about an episode of heavy alcohol consumption before she knew she was pregnant.
1 Dawson, D., Grant, B., Stinson, F. and Zhou, Y. (2005). Effectiveness of the Derived Alcohol Use Disorders Identification Test (AUDIT-C) and Risk Drinking in the US General Population. Alcohol Clinical and Experimental Research Vol 29, 5 pp: 844-854.
3 Dawson, D. Grant, B., Stinson, F. and Zhou, Y. (2005). Effectiveness of the derived Alcohol Use Disorder Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking the US general population. Alcohol Clinical and Experimental Research Vol 29, No 5. Pp: 844-854.
4 Murdoch Children’s Research Institute (2010). Alcohol in Pregnancy: What questions should we be asking? Report to the Commonwealth Department of Health and Ageing. AQUA Project (Asking QUestions about Alcohol in pregnancy), Victoria.
5 National Health and Medical Research Council (2009). Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Commonwealth of Australia. Canberra.
6 Australian Government webpage :Standard drinks guide:http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/drinksguide-cnt