Alcohol
|
Safe Drinking Levels |
·
No safe threshold for maternal alcohol intake.
Abstinence is recommended during pregnancy · Women can be reassured that adverse fetal effects have not been demonstrated with mild social drinking before realizing they were pregnant |
|
Screening and Identification |
· Ask about number of standard drinks per day and per week. · 1 standard drink = 1 bottle beer, 5 oz wine, 1 1/2 ounce liquor · Ask about maximum consumption on any 1 day since pregnancy began. · Order GGT and MCV if alcohol use suspected (sensitivity 50% for 4 or more drinks per day) T-ACE screening questionnaire
T Tolerance:
How many drinks does it take for you to feel an effect? Scoring
T: 2 points if it takes more than 2 drinks to make her feel "high" A,C,E: 1 point for each "yes" A total of 2 or more points indicates that the woman likely has an alcohol problem (requires further assessment for diagnosis) |
|
Symptoms and Signs of Withdrawal |
· Common in women drinking 6 or more drinks per day · Onset 8-12 hours after last drink, peaks 24-72 hours, may last 7 days · Tremor (postural, intention), ataxia, sweating are most reliable signs · Other signs: hypertension, tachycardia, gastrointestinal upset, anxiety ·
Complications:
seizures (grand-mal, non-focal, brief), hallucinations,
arrhythmias, delirium tremens |
|
Management of Withdrawal |
· Admit to hospital · Monitor hydration status and rule out electrolyte imbalance · Monitor for non-reassuring fetal status · Folic acid 5mg po od · Thiamine 100 mg po od x 3 days ·
If not in labour,
treat with diazepam 20 mg po q 1-2 h until minimal
tremor; ongoing treatment not usually needed · Notify neonatology/paediatrics: benzodiazepines can cause "floppy baby syndrome" · Use lorazepam 2-4 mg sl, po q 2-4 h prn |
|
Fetal Effects |
Fetal Alcohol Spectrum Disorder (FASD) Prevalence of Fetal Alcohol Syndrome: ~1 in 1000
live births (general population): 4-5% in heavy drinkers · Growth restriction · Characteristic facial anomalies, e.g., microcephaly, micrognathia, short palpebral fissure, flat philtrum · Central nervous system abnormalities, developmental delays, brain malformations, intellectual impairment, behavioural problems · See guideline on diagnosing FASD in CMAJ 2005; 172 (5 suppl.): S1-S21 (www.cmaj.ca) Other complications of alcohol: · Spontaneous abortion · Fetal compromise |
|
Neonatal Effects |
If mother intoxicated at time of delivery, assess neonate for withdrawal |
|
Breastfeeding |
· Alcohol enters breast milk and infants are exposed to a fraction of the alcohol ingested by the mother · Potential adverse effects include: impaired motor development in child and decreased let-down reflex and suppressed lactation in mother ·
An acceptable level of alcohol in breast
milk has not been established · With moderate, occasional alcohol use: delay nursing for 1-2 hours per drink to minimize infant exposure; heavy alcohol consumption while breastfeeding should be avoided while breastfeeding |
|
Management of Alcohol Dependence |
· Behavourial interventions recommended · Pharmacotherapy can help to maintain abstinence e.g., anti-craving (naltrexone and acamprosate) and aversive (disulfiram) agents |
|
Anti-alcohol Drugs |
· Disulfiram: acetaldehyde dehydrogenase inhibitor; teratogenic, contraindicated in pregnancy · Naltrexone: opioid receptor antagonist; safety not established in pregnancy; use only if behavioural treatment has failed and benefit outweighs risk · Acamprosate: glutamate modulator; safety not established in pregnancy, use not recommended in pregnancy |
This site last edited:
June 2008