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Antenatal alcohol exposure: An East Anglian study of midwives' knowledge and practice

02 March 2015
Volume 23 · Issue 3



To study midwives' knowledge, practice and opinions regarding advice about fetal alcohol syndrome (FAS), fetal alcohol spectrum disorders (FASDs) and alcohol intake in pregnancy.


A postal questionnaire was sent to 1862 midwives employed in 13 NHS Trusts in East Anglia, incorporating city and rural areas.


The authors received responses from 33.5% of the midwives contacted (n=624), of which 98% stated that alcohol abstinence in pregnancy would be their preferred advice, and 38% had seen an infant with FAS. Less than 2% indicated that they were ‘very prepared’ to deal with the subject. Only 10% identified all four classic features of FAS.


More than a third of midwives had seen an infant with FAS. The advice given to pregnant mothers by participants varied. The midwives stated that they would like more information and support.

Implications for practice:

Expansion of midwives' knowledge should improve the quality of antenatal advice, leading to better prevention, intervention and recognition of FASD in children.

In 1968, the French doctor Lemoine and his colleagues first described a pattern of physical and neurodevelopmental abnormalities observed among children of mothers with alcohol problems (Lemoine et al, 1968). Unfortunately, this series of French case studies went unnoticed until Jones et al (1973) publicised their independent observations in the USA 5 years later. Jones et al (1973) introduced the term ‘fetal alcohol syndrome’ (FAS) to describe common features of the disorder.

FAS is a complex, multifactorial disorder in which exposure to alcohol consumption interacts with other environmental and genetic factors. Two developments in research have suggested further complications (National Perinatal Epidemiology Unit, 2006):

The worldwide incidence of FAS is 0.97 cases per 1000 births, making it the most common cause of non-genetic learning disabilities around the world. Western countries report a FASD diagnosis in as many as 9 cases per 1000 births; therefore, the condition is of global concern (British Medical Association (BMA), 2007).

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