Fetal alcohol spectrum disorders (FASDs), attributed to brain injury from prenatal alcohol exposure, are characterised by birth defects and developmental and behavioural problems, resulting in lifelong impairment and disability. FASDs occur throughout society, with high prevalence in disadvantaged Indigenous communities with widespread, risky alcohol use, including in Australia, Canada, and New Zealand.[1–4] Importantly, FASDs is preventable, and health professionals have a vital role in supporting women to avoid alcohol when planning pregnancy or when pregnant.
Few Cochrane Reviews are of direct relevance to preventing or managing FASDs, but the following findings can be highlighted:
Psychological/educational interventions may encourage abstinence.
No randomised controlled trials were available for the reviews that assessed whether psychosocial interventions or pharmacological interventions benefit pregnant women with alcohol dependency.
Although home visits (before and after birth) increase service engagement and contraception use, there is no proven benefit for maternal or infant health outcomes.
‘Social support’ for disadvantaged women decreased pregnancy complication and caesarean rates but did not impact birth weight, and attendance at specialised clinics did not reduced prematurity rates.
Although FASDs are prevalent and extremely costly to society, there remains a paucity of good-quality primary or secondary research evidence to guide prevention and optimal management.
Alcohol abuse and dependence represents a very serious health problem worldwide with major social, interpersonal and legal interpolations. Pharmacological treatments presently used are of uncertain effectiveness and there is even more doubt on the comparative effects and value for money. This review summarizes Cochrane reviews that assess the effectiveness and safety of pharmacological interventions in the treatment of alcohol withdrawal.
Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. This review aims to evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity.
Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. This review evaluates the effectiveness of pharmacologic interventions in pregnant women enrolled in alcohol treatment programmes for improving birth and neonatal outcomes, maternal abstinence and treatment retention.
Excessive use of alcohol, or drug use, in pregnancy has been associated with increased risk of miscarriage, a reduction in fetal growth and impaired neurodevelopment. One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits. This review aims to determine the effects of home visits during pregnancy and/or after birth for women with a drug or alcohol problem.
Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. This review aims to evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs for improving birth and neonatal outcomes, maternal abstinence and treatment retention.
Diagnostic ultrasound is used selectively in late pregnancy where there are specific clinical indications. However, the value of routine late pregnancy ultrasound screening in unselected populations is controversial. The rationale for such screening would be the detection of clinical conditions which place the fetus or mother at high risk, which would not necessarily have been detected by other means such as clinical examination, and for which subsequent management would improve perinatal outcome. This review assesses the effects on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound in women with either unselected or low-risk pregnancies.
Diagnostic ultrasound examination may be employed in a variety of specific circumstances during pregnancy such as after clinical complications, or where there are concerns about fetal growth. Routine screening may be planned for early pregnancy, late gestation, or both. This review assesses whether routine early pregnancy ultrasound for fetal assessment (i.e. its use as a screening technique) influences the diagnosis of fetal malformations, multiple pregnancies, the rate of clinical interventions, and the incidence of adverse fetal outcome when compared with the selective use of early pregnancy ultrasound (for specific indications).
Preventive health care promotes health and prevents disease or injuries by addressing factors that lead to the onset of a disease, and by detecting latent conditions to reduce or halt their progression. Many risk factors for costly and disabling conditions (such as cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) can be prevented, yet healthcare systems do not make the best use of their available resources to support this process. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), could offer a convenient and cost-effective way to support desirable health behaviours for preventive health care. This review assesses the effects of mobile phone messaging interventions as a mode of delivery for preventive health care, on health status and health behaviour outcomes.
Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. This reviews aims to compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.
Between the 1970s and 1990s, the World Health Organization promoted traditional birth attendant training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of traditional birth attendant training is limited but promising for some mortality outcomes. This review assesses the effects of traditional birth attendant training on health behaviours and pregnancy outcomes.
Many people with mental, neurological and substance-use disorders do not receive health care. Non-specialist health workers and other professionals with health roles are a key strategy for closing the treatment gap. This review assesses the effect of these health workers delivering mental, neurological and substance-use interventions in primary and community health care in low- and middle-income countries.
Health promotion in the pre-pregnancy period has been proposed for improving pregnancy outcomes by encouraging behavioural change, or allowing early identification of risk factors. This review examines evidence from randomised controlled trials of preconception health promotion, and assesses the effectiveness of routine pre-pregnancy health promotion for improving pregnancy outcomes.
Prenatal ultrasound is one of many techniques used in screening and diagnosis. It gives parents instant access to the images of the foetus. Receiving information promotes knowledge and understanding, but it may also increase maternal anxiety. This review aims to compare high feedback versus low feedback during prenatal ultrasound for reducing maternal anxiety and improving maternal health behaviour.
Amongst the risk factors for preterm birth, previous preterm delivery is a strong predictor. Specialised clinics for women with a history of spontaneous preterm delivery have been advocated as a way of improving outcomes for women and their infants. This review aims to assess the value of specialised antenatal clinics for women with a pregnancy at high risk of preterm delivery when compared with 'standard' antenatal clinics.
Studies consistently show a relationship between social disadvantage and low birthweight. Many countries have programmes offering special assistance to women thought to be at risk for giving birth to a low birthweight infant. These programmes may include advice and counselling (about nutrition, rest, stress management, alcohol, and recreational drug use), tangible assistance (e.g., transportation to clinic appointments, household help), and emotional support. This review aims to assess effects of programmes offering additional social support compared with routine care, for pregnant women believed at high risk for giving birth to babies that are either preterm or of low birthweight.
Current research suggests that alcohol intake of seven or more standard drinks per week during pregnancy places the baby at risk of serious, lifelong developmental and cognitive disabilities. Psychological and educational interventions may help women to reduce their alcohol intake during pregnancy. This review aims to determine the effectiveness of psychological and educational interventions to reduce alcohol consumption during pregnancy in pregnant women or women planning pregnancy.
Maternal complications including mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. This review assesses outcomes for women and babies of different home-visiting schedules during the early postpartum period; it focuses on frequency, duration, intensity, and different types of home-visiting interventions.
Telephone communication is increasingly being accepted as a useful form of support within health care. There is some evidence that telephone support may be of benefit in specific areas of maternity care such as breastfeeding support and for women at risk of depression. There is a plethora of telephone-based interventions currently being used in maternity care. This review assesses the effects of telephone support during pregnancy and the first six weeks post birth, compared with routine care, on maternal and infant outcomes.
While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions, many require facility-based and outreach services. A significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packaged interventions supplemented by developing and strengthening linkages with the local health systems. This review assesses the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes.
3. Fitzpatrick J, Latimer J, Carter M, Oscar J, Ferreira ML, Carmichael Olson H, et al. Prevalence of fetal alcohol syndrome in a population-based sample of children living in remote Australia: the Lililwan Project. Journal of Paediatrics and Child Health 2014;51(4):450-7. dx.doi.org/10.1111/jpc.12814
4. Fitzpatrick JP, Latimer J, Ferreira ML, Carter M, Oscar J, Martiniuk ALC, et al. Prevalence and patterns of alcohol use in pregnancy in remote Western Australian communities: the Lilliwan Project. Drug and Alcohol Review dx.doi.org/10.1111/dar.12232
5. Stade BC, Bailey C, Dzendoletas D, Sgro M, Dowswell T, Bennett D. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. Cochrane Database of Systematic Reviews dx.doi.org/10.1002/14651858.CD004228.pub2
10. Whitworth M, Quenby S, Cockerill RO, Dowswell T. Specialised antenatal clinics for women with a pregnancy at high risk of preterm birth (excluding multiple pregnancy) to improve maternal and infant outcomes. Cochrane Database of Systematic Reviews dx.doi.org/10.1002/14651858.CD006760.pub2
This Special Collection is a collaborative work by Professor Davina Ghersi (National Health and Medical Research Council, Australia), Samantha Faulkner (National Health and Medical Research Council, Australia), and Elizabeth Elliott (Professor of Paediatrics and Child Health at University of Sydney, Consultant Paediatrician at The Sydney Children’s Hospitals Network (Westmead), and NHMRC Practitioner Fellow, Sydney, Australia). Professor Elliott wrote the introduction.