September 9, 2019

Victorian research leads in FASD prevention

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Fetal Alcohol Spectrum Disorder

Fetal Alcohol Spectrum Disorder (FASD) represents a spectrum of neurological conditions that may occur as a result of prenatal alcohol exposure.1 Alcohol consumption during pregnancy can have a range of impacts on the baby, including physical, behavioural and cognitive impacts.2

The prevalence of FASD in Australia is not well understood, but is thought to be higher than previously estimated.3 There is some data to suggest that it affects between 3% to 5% of Australians and it occurs wherever alcohol is consumed, impacting people across socio-economic, racial and education boundaries.2-4

Current research clearly indicates that there is a link between heavy drinking during pregnancy and resulting FASD1, however Victoria’s Murdoch Children’s Research Institute (MCRI) is leading the way to better understanding low-level alcohol use.5

Below, we take a look at this exciting research and how it is contributing to the important prevention work required to reduce the impact of alcohol in Australia and around the world.

The AQUA Study

The Asking Questions about Alcohol in Pregnancy (AQUA) study is looking to answer two key questions: Can the occasional glass of wine hurt? And what if a woman has already had a drink before knowing she was pregnant?

Since commencement in 2011, the AQUA study has engaged approximately 1,600 women in early pregnancy across seven public hospitals in Melbourne. The study has so far obtained information from participants about their consumption of alcohol during pregnancy, using a total of three questionnaires for each of the trimesters of pregnancy.6 The researchers have also collected other information relating to diet, medication and body size, to understand how other aspects of a woman’s life impacts the effects of alcohol.6

Once the babies were born, participants also provided information about the health and development of their baby at one and two years old. Some participants were invited to have a 3D photo taken of their baby’s face to record any physiological effects of alcohol consumption during pregnancy.6

The findings so far

We know from previous research that in Australia at least 30% of pregnancies are unplanned, which means that the impact of alcohol consumption in early pregnancy is potentially high. As part of the AQUA study, a novel question was included regarding ‘special occasion drinking’, to capture times when women may have consumed alcohol prior to knowing they were pregnant.1, 7

The study found that high rates of drinking among women of childbearing age and high rate of unplanned pregnancies could be resulting in many unintended alcohol exposures.1

The initial surveys also found that women who were from higher income earning households were more likely to drink throughout pregnancy.1 According to the study:

‘Women with a tertiary degree were twice more likely to continue drinking throughout pregnancy at moderate/high levels than women whose highest level of education was a secondary school certificate.’1

The 3D photo taken at one year of age found evidence of some minor changes to facial structure among children exposed to alcohol, when compared to children with no exposure to alcohol.4 These changes were not visible to the naked eye but existed in children exposed to any level of alcohol, particularly moderate levels, in the first trimester of pregnancy.4 For children at two years of age, it was found that those who were exposed to binge drinking in the first trimester, and low-level drinking throughout, experienced some sensation-avoiding behaviours.8

These early findings among children exposed to alcohol during pregnancy support the prevention approach that the safest choice is for pregnant women to not drink at all.1, 4, 8

In their published work, the researchers emphasise the need to continue the research and follow the participants of the study as children reach school age.8

The early school years are when children are developing complex social, academic and physical abilities. This is a really good time to revisit any potential impacts of pregnancy alcohol exposure.9

Current recruitment

The AQUA study has secured funding to proceed with AQUA at 6, which will follow participants as the children are starting school. The recruitment for this phase of research is currently underway. The researchers have developed a range of activities facilitated by a trained psychologist, to gain an understanding of children’s cognitive, physical and social abilities. The children are again invited to have a 3D photo taken of their face and some children will also have brain imaging, via an MRI.9

A note about the authors

This Insights article was prepared by Sejla Stammers with input from Evi Muggli (MCRI) and Prof. Jane Halliday (MCRI). A brief bio is provided for each contributor below.

Sejla Stammers is an Information Officer at the Alcohol and Drug Foundation. In her role she prepares alcohol and other drug-related content for the organisation, works on projects internally and externally and answers AOD-related queries via the DrugInfo line.

Evi Muggli has managed the Alcohol in Pregnancy project since its pilot phase in 2009, which at the time involved a comprehensive assessment of the literature and focus groups with pregnant women to develop a set of questions to accurately and sensitively assess alcohol use in pregnancy. As one of the investigators of the NHMRC-funded ‘Asking Questions about Alcohol in Pregnancy (AQUA)’ cohort study, research into the effects of alcohol use in pregnancy has become her primary research focus since 2011.

Professor Jane Halliday is an epidemiologist with a PhD in the field of human genetics. She is Group Leader of Reproductive Epidemiology in the Genetics theme at the MCRI. Jane has been leading research into outcomes for children exposed in pregnancy to common patterns of alcohol consumption. She is closely involved in national strategies to diagnose and prevent FASD, collaborating with key practitioners and policy makers in this field.

  1. Muggli E, O’Leary C, Donath S, Orsini F, Forster D, Anderson PJ, et al. “Did you ever drink more?” A detailed description of pregnant women’s drinking patterns. 2016;16(1):683.
  2. Moreno MA. Prenatal Alcohol Exposure: No Safe Amount JAMA Pediatrics Patient Page. JAMA Pediatrics. 2017;171(8):820-.
  3. Association AM. Fetal Alcohol Spectrum Disorder(2016) [cited 2019 September 9].
  4. Muggli E, Matthews H, Penington A, Claes P, O’Leary C, Forster D, et al. Association between prenatal alcohol exposure and craniofacial shape of children at 12 months of age. 2017;171(8):771-80.
  5. Bower C, Baynam G. New Opportunities for Evidence in Fetal Alcohol Spectrum Disorder. JAMA Pediatrics. 2017;171(8):731-2.
  6. Murdoch Children's Research Institute. Asking Questions about Alcohol in Pregnancy (AQUA) 2019 [cited 2019 September 9].
  7. Muggli E, Cook B, O’Leary C, Forster D, Halliday JJM. Increasing accurate self-report in surveys of pregnancy alcohol use. 2015;31(3):e23-e8.
  8. Halliday JL, Muggli E, Lewis S, Elliott EJ, Amor DJ, O’Leary C, et al. Alcohol consumption in a general antenatal population and child neurodevelopment at 2 years. J Epidemiology and Community Health. 2017;71(10):990-8.
  9. Murdoch Children's Research Institute. AQUA at 6 2019 [cited 2019 September 9].

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