3rd January 2023
In support of Dry January, we are delighted to share a Voices blog by Jayne Walker, Lesley Smith, Andrea Hilton, Lolita Alfred, Lisa Scholin and Anand Ahankari from the School of Advanced Practice in the Faculty of Health Sciences at the University of Hull, on the role that health visitors can play in promoting an alcohol-free pregnancy and not just for January.
Jayne Walker, Senior Lecturer | School of Advanced Practice | Faculty of Health Sciences | University of Hull
A challenge for 2023…… Health visitors are you ‘up for’ promoting an alcohol-free (dry) pregnancy not just Dry January…
Many people make resolutions to take steps towards a healthier lifestyle after the New Year, and ‘Dry January’ is an opportunity to think about cutting down on alcohol consumption.
Making healthy resolutions are also important when planning for pregnancy. Planning and promoting an alcohol-free pregnancy, rather than just an alcohol-free month, will help to optimise the health of the future offspring and to improve maternal health.
Alcohol increases the risk of poorer health for all of us. Drinking over the recommended low-risk guidelines can lead to short-term harms such as unsafe sex and injuries, and cancer, liver or heart disease in the longer term (Office for National Statistics (ONS) 2021). During pregnancy, research has not established a threshold at which alcohol causes harm to the developing baby, but the more alcohol a woman drinks the higher the risk of negative outcomes. For this reason, abstaining from alcohol is recommended as the safest option (Chief Medical Officer 2016). Miscarriage, small for gestational age, low birth weight and Foetal Alcohol Spectrum Disorders (FASD) are risks of alcohol exposure during pregnancy. FASD includes a range of physical, behavioural, cognitive and emotional problems with lifelong effects (Vorgias and Bernstein 2022).
Using preconception as a time to promote healthy lifestyle.
Preconception care aims to promote behaviour change to modify risk factors, such as alcohol consumption, to optimise health before the start of a pregnancy. Better health before a pregnancy can improve both maternal and child health outcomes and reduce inequalities (World Health Organisation 2013; Sher 2016; Public Health England 2018; Royal College of Obstetricians and Gynaecologists 2019).
The COVID-19 pandemic has increased inequalities across society, including alcohol-related harm. Before the pandemic, the rate of alcohol-related hospital admissions and deaths were increasing, but a recent review suggested that the pandemic had accelerated these trends (ONS 2021).
In March 2022, the National Institute for Health and Care Excellence (NICE) published a new comprehensive quality standard designed to improve the diagnosis and assessment of FASD (NICE 2022). The guidance states that midwives and other healthcare professionals, including Health Visitors (HVs), should give clear and consistent advice on avoiding alcohol throughout pregnancy. HVs should explain the benefits of abstinence, including preventing FASD and reducing the risks of poor birth outcomes.
The role of Health Visitors in promoting healthier drinking habits.
Two main priorities for HVs should be to encourage women to consume no alcohol during pregnancy or to avoid pregnancy while continuing to drink alcohol (Queen’s Nursing Institute Scotland 2022). There are opportunities for HVs to reinforce guidance around alcohol for those who might be planning for a pregnancy, or by circumstances might be at risk of pregnancy even if they don’t plan to. As professionals, HVs are ideally placed and have the necessary skills to have meaningful conversations with parents about their alcohol use (Institute of Health Visiting (iHV) 2022). Sharing information about the current alcohol guidelines, communicating the health risks from drinking over the low-risk recommendations, and supporting individuals who need help with changing their drinking behaviour are ways to do this. Sensitive, responsive preconception support from HVs is potentially one of the most important opportunities for HVs to make a difference to maternal and child health outcomes.
Investment in alcohol education and skills training for healthcare professionals is required to ensure a coherent message is communicated across services, and that shared decision making about healthcare between service users and health professionals is facilitated (Smith et al 2022).
This is now an opportunity for you as HVs to seize the moment, and be instrumental in ‘making the difference’ and ensuring the best start for the next generation.
For further information and guidance please read the iHV Good Practice Points – Reducing alcohol harm: Early intervention and prevention (iHV 2022).
Jayne Walker, Lesley Smith, Andrea Hilton, Lisa Scholin and Anand Ahankari – School of Advanced Practice | Faculty of Health Sciences, University of Hull
References
- CMO UK (2016) Chief Medical Officers’ Low Risk Drinking Guidelines. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf [Accessed 16.12.2022].
- Institute of Health Visiting (2022). Good Practice Points – Reducing alcohol harm: Early intervention and prevention. Available at: https://ihv.org.uk/for-health-visitors/resources-for-members/resource/good-practice-points/generic-gpps/reducing-alcohol-harm-early-intervention-and-prevention/ [Accessed 15.12.2022].
- National Institute for Health and Clinical Excellence (2022) Fetal alcohol spectrum disorder. Quality standard [QS204]. Available at: https://bit.ly/36xkV9W [Accessed 15.12.2022].
- ONS (2021) Alcohol-specific deaths in the UK: registered in 2021. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/alcoholspecificdeathsintheuk/2021registrations [Accessed 16.12.2022].
- Public Health England (2021). Alcohol consumption and harm during the COVID-19 pandemic. Available at: https://bit.ly/3kXwNG5 [Accessed 15.12.2022].
- Public Health England (2018) Health matters: reproductive health and pregnancy planning. Available at: https://www.gov.uk/government/publications/health-matters-reproductive-health-and-pregnancy-planning/health-matters-reproductive-health-and-pregnancy-planning [Accessed 5.12.2022].
- Queen’s Nursing Institute Scotland (2022). FASD is becoming more of a concern for community nurses and midwives. Available at: https://www.qnis.org.uk/blog/fasd-is-becoming-more-of-a-concern-for-community-nurses-and-midwives/ [Accessed 22.12.2022].
- Royal College of Obstetricians and Gynaecologists (2019). Better for women, improving the health and wellbeing of girls and women. Available at: https://www.rcog.org.uk/better-for-women [Accessed 15.12.2022].
- Sher, D.J., (2016). Missed periods: Scotland’s opportunities for better pregnancies, healthier parents and thriving babies the first time… and every time.
- Smith, L., Hilton, A., Walker, J., Alfred, L., Ahankari, A. and Schölin, L., (2022). Prevention of alcohol related harm though preconception care: A scoping review of barriers and enablers. Dialogues in Health, p.100040.
- Vorgias, D. and Bernstein, B., (2022). Fetal alcohol syndrome. In StatPearls [Internet]. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448178/ [Accessed 16.12.2022].
- World Health Organisation (2013). Preconception care: Maximizing the gains for maternal and child health policy brief. Available at: https://www.who.int/publications/i/item/WHO-FWC-MCA-13.02 [Accessed 15.12.2022].
