Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia

Watkins, Rochelle; Elliott, Elizabeth J; Wilkins, Amanda; Mutch, Raewyn; Fitzpatrick, James; Payne, Jan; O’Leary, Colleen; Jones, Heather M; Latimer, Jane; Hayes, Lorian; Halliday, Jane; D’Antoine, Heather; Miers, Sue; Russell, Elizabeth; Burns, Lucy; McKenzie, Anne; Peadon, Elizabeth; Carter, Maureen; Bower, Carol

doi:10.1186/1471-2431-13-156

Cited by 33 publications

(36 citation statements)

References 51 publications

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“…The umbrella term FASD describes disabilities [15,16] that include fetal alcohol syndrome (FAS), partial FAS (PFAS) and neurodevelopmental disorder-alcohol exposed (ND-AE) [17]. The prevalence of FASD has been reported as 2-5% in the USA [18] and in Canada it is estimated as 1/100 births [19].…”

Section: Introductionmentioning

confidence: 99%

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

Payne

Watkins

Jones

et al. 2014

BMC Pregnancy Childbirth

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BackgroundMidwives are an influential profession and a key group in informing women about alcohol consumption in pregnancy and its consequences. There are no current quantitative Australian data on midwives’ knowledge, attitudes and practice in relation to alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorder. We aimed to reduce this knowledge gap by understanding midwives’ perceptions of their practice in addressing alcohol consumption during pregnancy.MethodsThis cross-sectional study was conducted at 19 maternity sites across the seven health regions of country Western Australia. A questionnaire was designed following review of the literature and other relevant surveys. Midwifery managers of the maternity sites distributed questionnaires to all midwives working in their line of management. A total of 334 midwives were invited to participate in the research and (n = 245, 73.4%) of these were eligible.ResultsThe response fraction was (n = 166, 67.8%). Nearly all (n = 151, 93.2%) midwives asked pregnant women about their alcohol consumption during pregnancy and (n = 164, 99.4%) offered advice about alcohol consumption in accordance with the Australian Alcohol Guideline, which states “For women who are pregnant or planning a pregnancy, not drinking is the safest option”. Nearly two thirds (n = 104, 64.2%) of the midwives informed pregnant women about the effects of alcohol consumption in pregnancy, they did not always use the recommended AUDIT screening tool (n = 66, 47.5%) to assess alcohol consumption during pregnancy, nor conduct brief intervention when indicated (n = 107, 70.4%). Most midwives endorsed professional development about screening tools (n = 145, 93.5%), brief intervention (n = 144, 92.9%), and alcohol consumption during pregnancy and FASD (n = 144, 92.9%).ConclusionNearly all midwives in this study asked and advised about alcohol consumption in pregnancy and around two thirds provided information about the effects of alcohol in pregnancy. Our findings support the need for further professional development for midwives on screening and brief intervention. Policy should support midwives’ practice to screen for alcohol consumption in pregnancy and offer brief intervention when indicated.

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Section: Introductionmentioning

confidence: 99%

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

Payne

Watkins

Jones

et al. 2014

BMC Pregnancy Childbirth

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“…Workshop methods and general recommendations, including criteria for diagnosis, are described in detail elsewhere [21]. …”

Section: Methodsmentioning

confidence: 99%

“…Australian health professionals have indicated their need for standard guidelines and explicit criteria that identify how to assess individuals who may have FASD and determine when a specialist diagnostic evaluation is required [20]. This support for the development of standard criteria for referral has been highlighted in recent consensus recommendations for FASD screening and diagnosis in Australia [21]. …”

Section: Introductionmentioning

confidence: 99%

Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia

et al. 2014

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BackgroundFetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia.MethodAn online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed.ResultsAmong the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities.ConclusionReferral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.

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“…This fact may encourage doctors to diagnose these disorders rather than FASD. However, advocates of FASD diagnosis argue that correct (and early) identification and intervention for FASD are important in reducing its adverse outcomes and that FASD can be readily distinguished from ADHD or autism [10,52].…”

Section: Social and Ethical Implications Of Diagnosing Fasdmentioning

confidence: 99%

“…Advances in epidemiology, biogenetics and neurobiology are changing how FASD is understood [2,[6][7][8][9] but there are as yet no biomarkers or definitive diagnostic tests for FASD. A diagnosis of FASD is conferred on the basis of clinical judgement according to a number of different diagnostic criteria, and there is some debate as to the validity of different approaches to its diagnosis [10]. FASD is primarily a diagnosis of exclusion made after other more common genetic disorders and diagnoses have been ruled out [11].…”

Section: Introductionmentioning

confidence: 99%

A Bio-Social and Ethical Framework for Understanding Fetal Alcohol Spectrum Disorders

Lucke

Hall

2014

Neuroethics

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The diagnosis of Fetal Alcohol Spectrum Disorders (FASDs) is embedded in a matrix of biological, social and ethical processes, making it an important topic for crossdisciplinary social and ethical research. This article reviews different branches of research relevant to understanding how FASD is identified and defined and outlines a framework for future social and ethical research in this area. We outline the character of scientific research into FASD, epidemiological discrepancies between reported patterns of maternal alcohol consumption during pregnancy and the incidence of FASD, and the social and ethical considerations that may impact on who is, and is not, diagnosed. We highlight what further research investigating FASD diagnostic processes, as well as the multi-generational impacts of FASD, is needed. Important research priorities are to: 1) enumerate the variety of stakeholders involved in seeking FASD diagnoses; 2) understand the experiences and perspectives of mothers from different backgrounds who have consumed alcohol during pregnancy and their affected children; and 3) collect health histories of maternal alcohol consumption in families to determine the effect of FASD at sub-cultural and cultural levels.

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Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia

Cited by 33 publications

References 51 publications

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder

Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia

A Bio-Social and Ethical Framework for Understanding Fetal Alcohol Spectrum Disorders

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