Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Termination of Pregnancy | Debate

Drowning our sorrows: clinical and ethical considerations of termination in alcohol-affected pregnancy

Authors: Roger Martin, George Bruxner, Gary Ng, Catherine Brewster, Alka Kothari

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Excerpt

Clinicians caring for pregnant women who consume alcohol face many ethical considerations. They are obligated to provide non-judgmental and non-directive advice. Although current practice is guided by existing clinical guidelines [15] these are based on limited scientific evidence [6]. There is no objective and readily available test to corroborate subjective patient reports of alcohol use to predict the risk of alcohol-related adverse foetal outcomes. Additionally, the effects of alcohol exposure on the developing fetus are not completely understood [7]. …
Literature
1.
go back to reference New South Wales Department of Heatlh: National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. 2006. New South Wales Department of Heatlh: National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. 2006.
2.
go back to reference World Heatlh Organisation: Guidelines for the identification and management of substance use and substance use disorders in pregnancy. 2014. World Heatlh Organisation: Guidelines for the identification and management of substance use and substance use disorders in pregnancy. 2014.
3.
go back to reference University of New South Wales National Drug & Alcohol Research Centre: Supporting pregnant women who use alcohol or other drugs - A Guide for Primary Health Care Professionals. 2015. University of New South Wales National Drug & Alcohol Research Centre: Supporting pregnant women who use alcohol or other drugs - A Guide for Primary Health Care Professionals. 2015.
4.
go back to reference Queensland Government Maternity and Neonatal Clinical Guidelines: Perinatal substance use: maternal 2016. Queensland Government Maternity and Neonatal Clinical Guidelines: Perinatal substance use: maternal 2016.
5.
go back to reference United Nations Office on Drugs and Crime: Women and Drugs. Drug use, drug supply and their consequences. 2018. United Nations Office on Drugs and Crime: Women and Drugs. Drug use, drug supply and their consequences. 2018.
6.
go back to reference Department of Health Alcohol Guidelines Review: Report From the Guidelines Development Group to the UK Chief Medical Officers. 2016. Department of Health Alcohol Guidelines Review: Report From the Guidelines Development Group to the UK Chief Medical Officers. 2016.
7.
go back to reference Subramoney S, Eastman E, Adnams C, Stein DJ, Donald KA. The Early Developmental Outcomes of Prenatal Alcohol Exposure: A Review. Front Neurol. 2018;9:1108.PubMedPubMedCentralCrossRef Subramoney S, Eastman E, Adnams C, Stein DJ, Donald KA. The Early Developmental Outcomes of Prenatal Alcohol Exposure: A Review. Front Neurol. 2018;9:1108.PubMedPubMedCentralCrossRef
10.
go back to reference de Costa C, Douglas H, Hamblin J, Ramsay P, Shircore M. Abortion law across Australia--a review of nine jurisdictions. Aust N Z J Obstet Gynaecol. 2015;55(2):105–11.PubMedCrossRef de Costa C, Douglas H, Hamblin J, Ramsay P, Shircore M. Abortion law across Australia--a review of nine jurisdictions. Aust N Z J Obstet Gynaecol. 2015;55(2):105–11.PubMedCrossRef
11.
go back to reference Andersen A-MN, Andersen PK, Olsen J, Grønbæk M, Strandberg-Larsen K. Moderate alcohol intake during pregnancy and risk of fetal death. Int J Epidemiol. 2012;41(2):405–13.PubMedCrossRef Andersen A-MN, Andersen PK, Olsen J, Grønbæk M, Strandberg-Larsen K. Moderate alcohol intake during pregnancy and risk of fetal death. Int J Epidemiol. 2012;41(2):405–13.PubMedCrossRef
12.
go back to reference Mamluk L, Edwards HB, Savović J, Leach V, Jones T, Moore THM, Ijaz S, Lewis SJ, Donovan JL, Lawlor D, et al. Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently ‘safe’ levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ Open. 2017;7(7):e015410.PubMedPubMedCentralCrossRef Mamluk L, Edwards HB, Savović J, Leach V, Jones T, Moore THM, Ijaz S, Lewis SJ, Donovan JL, Lawlor D, et al. Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently ‘safe’ levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ Open. 2017;7(7):e015410.PubMedPubMedCentralCrossRef
13.
go back to reference Harlap S, Shiono PH. Alcohol, smoking, and incidence of spontaneous abortions in the first and second trimester. Lancet. 1980;316(8187):173–6.CrossRef Harlap S, Shiono PH. Alcohol, smoking, and incidence of spontaneous abortions in the first and second trimester. Lancet. 1980;316(8187):173–6.CrossRef
14.
go back to reference Kline J, Stein Z, Shrout P, Susser M, Warburton D. Drinking during pregnancy and spontaneous abortion. Lancet. 1980;316(8187):176–80.CrossRef Kline J, Stein Z, Shrout P, Susser M, Warburton D. Drinking during pregnancy and spontaneous abortion. Lancet. 1980;316(8187):176–80.CrossRef
15.
go back to reference Srikartika VM, O'Leary CM. Pregnancy outcomes of mothers with an alcohol-related diagnosis: a population-based cohort study for the period 1983-2007. BJOG: Int J Obstet Gynaecol. 2015;122(6):795–804.CrossRef Srikartika VM, O'Leary CM. Pregnancy outcomes of mothers with an alcohol-related diagnosis: a population-based cohort study for the period 1983-2007. BJOG: Int J Obstet Gynaecol. 2015;122(6):795–804.CrossRef
16.
go back to reference Gomez-Roig MD, Marchei E, Sabra S, Busardò FP, Mastrobattista L, Pichini S, Gratacós E, Garcia-Algar O. Maternal hair testing to disclose self-misreporting in drinking and smoking behavior during pregnancy. Alcohol. 2018;67:1–6.PubMedCrossRef Gomez-Roig MD, Marchei E, Sabra S, Busardò FP, Mastrobattista L, Pichini S, Gratacós E, Garcia-Algar O. Maternal hair testing to disclose self-misreporting in drinking and smoking behavior during pregnancy. Alcohol. 2018;67:1–6.PubMedCrossRef
17.
go back to reference Abel EL. Maternal alcohol consumption and spontaneous abortion. Alcohol Alcohol. 1997;32(3):211–9.PubMedCrossRef Abel EL. Maternal alcohol consumption and spontaneous abortion. Alcohol Alcohol. 1997;32(3):211–9.PubMedCrossRef
18.
go back to reference Kfir M, Yevtushok L, Onishchenko S, Wertelecki W, Bakhireva L, Chambers CD, Jones KL, Hull AD, Kfir M, Yevtushok L, et al. Can prenatal ultrasound detect the effects of in-utero alcohol exposure? A pilot study. Ultrasound Obstet Gynecol. 2009;33(6):683–9.PubMedPubMedCentralCrossRef Kfir M, Yevtushok L, Onishchenko S, Wertelecki W, Bakhireva L, Chambers CD, Jones KL, Hull AD, Kfir M, Yevtushok L, et al. Can prenatal ultrasound detect the effects of in-utero alcohol exposure? A pilot study. Ultrasound Obstet Gynecol. 2009;33(6):683–9.PubMedPubMedCentralCrossRef
19.
go back to reference May PA, Blankenship J, Marais A-S, Gossage JP, Kalberg WO, Joubert B, Cloete M, Barnard R, De Vries M, Hasken J, et al. Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): quantity, frequency, and timing of drinking. Drug Alcohol Depend. 2013;133:502–12.PubMedCrossRef May PA, Blankenship J, Marais A-S, Gossage JP, Kalberg WO, Joubert B, Cloete M, Barnard R, De Vries M, Hasken J, et al. Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): quantity, frequency, and timing of drinking. Drug Alcohol Depend. 2013;133:502–12.PubMedCrossRef
20.
go back to reference Anderson AE, Hure AJ, Forder PM, Powers J, Kay-Lambkin FJ, Loxton DJ. Risky drinking patterns are being continued into pregnancy: a prospective cohort study. PLoS One. 2014;9(1):e86171.PubMedPubMedCentralCrossRef Anderson AE, Hure AJ, Forder PM, Powers J, Kay-Lambkin FJ, Loxton DJ. Risky drinking patterns are being continued into pregnancy: a prospective cohort study. PLoS One. 2014;9(1):e86171.PubMedPubMedCentralCrossRef
21.
go back to reference O'Leary CM, Bower C. Guidelines for pregnancy: what's an acceptable risk, and how is the evidence (finally) shaping up? Drug And Alcohol Review. 2012;31(2):170–83.PubMedCrossRef O'Leary CM, Bower C. Guidelines for pregnancy: what's an acceptable risk, and how is the evidence (finally) shaping up? Drug And Alcohol Review. 2012;31(2):170–83.PubMedCrossRef
23.
go back to reference Alvik A, Heyerdahl S, Haldorsen T, Lindemann R. Alcohol use before and during pregnancy: a population-based study. Acta Obstet Gynecol Scand. 2006;85(11):1292–8.PubMedCrossRef Alvik A, Heyerdahl S, Haldorsen T, Lindemann R. Alcohol use before and during pregnancy: a population-based study. Acta Obstet Gynecol Scand. 2006;85(11):1292–8.PubMedCrossRef
24.
go back to reference Anderson AE, Hure AJ, Forder P, Powers JR, Kay-Lambkin FJ, Loxton DJ. Predictors of antenatal alcohol use among Australian women: a prospective cohort study. BJOG: Int J Obstet Gynaecol. 2013;120(11):1366–74.CrossRef Anderson AE, Hure AJ, Forder P, Powers JR, Kay-Lambkin FJ, Loxton DJ. Predictors of antenatal alcohol use among Australian women: a prospective cohort study. BJOG: Int J Obstet Gynaecol. 2013;120(11):1366–74.CrossRef
25.
go back to reference Anderson AE, Hure AJ, Powers JR, Kay-Lambkin FJ, Loxton DJ. Determinants of pregnant women's compliance with alcohol guidelines: a prospective cohort study. BMC Public Health. 2012;12:777.PubMedPubMedCentralCrossRef Anderson AE, Hure AJ, Powers JR, Kay-Lambkin FJ, Loxton DJ. Determinants of pregnant women's compliance with alcohol guidelines: a prospective cohort study. BMC Public Health. 2012;12:777.PubMedPubMedCentralCrossRef
26.
go back to reference Skagerstróm J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Women’s Health (2002). 2011;20(6):901–13.CrossRef Skagerstróm J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Women’s Health (2002). 2011;20(6):901–13.CrossRef
27.
go back to reference Parackal SM, Parackal MK, Harraway JA. Prevalence and correlates of drinking in early pregnancy among women who stopped drinking on pregnancy recognition. Matern Child Health J. 2013;17(3):520–9.PubMedCrossRef Parackal SM, Parackal MK, Harraway JA. Prevalence and correlates of drinking in early pregnancy among women who stopped drinking on pregnancy recognition. Matern Child Health J. 2013;17(3):520–9.PubMedCrossRef
28.
go back to reference Powers J, McDermott L, Loxton D, Chojenta C. A Prospective Study of Prevalence and Predictors of Concurrent Alcohol and Tobacco Use During Pregnancy. Matern Child Health J. 2013;17(1):76–84 79.PubMedCrossRef Powers J, McDermott L, Loxton D, Chojenta C. A Prospective Study of Prevalence and Predictors of Concurrent Alcohol and Tobacco Use During Pregnancy. Matern Child Health J. 2013;17(1):76–84 79.PubMedCrossRef
29.
go back to reference Black KI, Stephens C, Haber PS, Lintzeris N. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Aust N Z J Obstet Gynaecol. 2012;52(2):146–50.PubMedCrossRef Black KI, Stephens C, Haber PS, Lintzeris N. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Aust N Z J Obstet Gynaecol. 2012;52(2):146–50.PubMedCrossRef
30.
go back to reference Rowe H, Holton S, Kirkman M, Bayly C, Jordan L, McNamee K, McBain J, Sinnott V, Fisher J. Prevalence and distribution of unintended pregnancy: the understanding fertility Management in Australia National Survey. Aust N Z J Public Health. 2016;40(2):104–9.PubMedCrossRef Rowe H, Holton S, Kirkman M, Bayly C, Jordan L, McNamee K, McBain J, Sinnott V, Fisher J. Prevalence and distribution of unintended pregnancy: the understanding fertility Management in Australia National Survey. Aust N Z J Public Health. 2016;40(2):104–9.PubMedCrossRef
31.
go back to reference Walker MJ, Al-Sahab B, Islam F, Tamim H. The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian maternity experiences survey (MES). BMC Pregnancy Childbirth. 2011;11:52.PubMedPubMedCentralCrossRef Walker MJ, Al-Sahab B, Islam F, Tamim H. The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian maternity experiences survey (MES). BMC Pregnancy Childbirth. 2011;11:52.PubMedPubMedCentralCrossRef
33.
go back to reference Inskip HM, Crozier SR, Godfrey KM, Borland SE, Cooper C, Robinson SM. Women's compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ (Clin Res Ed). 2009;338:b481.CrossRef Inskip HM, Crozier SR, Godfrey KM, Borland SE, Cooper C, Robinson SM. Women's compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ (Clin Res Ed). 2009;338:b481.CrossRef
34.
go back to reference Streissguth AP, Sampson PD, Olson HC, Bookstein FL, Barr HM, Scott M, Feldman J, Mirsky AF. Maternal drinking during pregnancy: attention and short-term memory in 14-year-old offspring--a longitudinal prospective study. Alcohol Clin Exp Res. 1994;18(1):202–18.PubMedCrossRef Streissguth AP, Sampson PD, Olson HC, Bookstein FL, Barr HM, Scott M, Feldman J, Mirsky AF. Maternal drinking during pregnancy: attention and short-term memory in 14-year-old offspring--a longitudinal prospective study. Alcohol Clin Exp Res. 1994;18(1):202–18.PubMedCrossRef
35.
go back to reference Higgins PG, Clough DH, Frank B, Wallerstedt C. Changes in health behaviors made by pregnant substance users. Int J Addict. 1995;30(10):1323–33.PubMedCrossRef Higgins PG, Clough DH, Frank B, Wallerstedt C. Changes in health behaviors made by pregnant substance users. Int J Addict. 1995;30(10):1323–33.PubMedCrossRef
36.
go back to reference Loxton D, Chojenta C, Anderson AE, Powers JR, Shakeshaft A, Burns L. Acquisition and Utilization of Information About Alcohol Use in Pregnancy Among Australian Pregnant Women and Service Providers. J Midwifery Women's Health. 2013;58(5):523–530 528.CrossRef Loxton D, Chojenta C, Anderson AE, Powers JR, Shakeshaft A, Burns L. Acquisition and Utilization of Information About Alcohol Use in Pregnancy Among Australian Pregnant Women and Service Providers. J Midwifery Women's Health. 2013;58(5):523–530 528.CrossRef
37.
go back to reference Jones SC, Telenta J. What influences Australian women to not drink alcohol during pregnancy? Aust J Prim Health. 2012;18(1):68–73.PubMedCrossRef Jones SC, Telenta J. What influences Australian women to not drink alcohol during pregnancy? Aust J Prim Health. 2012;18(1):68–73.PubMedCrossRef
38.
go back to reference Anderson BL, Dang EP, Floyd RL, Sokol R, Mahoney J, Schulkin J. Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients’ use of alcohol. J Addict Med. 2010;4(2):114–21.PubMedCrossRef Anderson BL, Dang EP, Floyd RL, Sokol R, Mahoney J, Schulkin J. Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients’ use of alcohol. J Addict Med. 2010;4(2):114–21.PubMedCrossRef
39.
go back to reference Payne J, Elliott E, D'Antoine H, O'Leary C, Mahony A, Haan E, Bower C. Health professionals’ knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy. Aust N Z J Public Health. 2005;29(6):558–64.PubMedCrossRef Payne J, Elliott E, D'Antoine H, O'Leary C, Mahony A, Haan E, Bower C. Health professionals’ knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy. Aust N Z J Public Health. 2005;29(6):558–64.PubMedCrossRef
40.
go back to reference Jones SC, Eval M, Telenta J, Cert G, Shorten A, Johnson K. Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive? Midwifery. 2011;27:489–96.PubMedCrossRef Jones SC, Eval M, Telenta J, Cert G, Shorten A, Johnson K. Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive? Midwifery. 2011;27:489–96.PubMedCrossRef
41.
go back to reference O'Leary CM. Alcohol and pregnancy: do abstinence policies have unintended consequences? Alcohol Alcohol (Oxford, Oxfordshire). 2012;47(6):638–9.CrossRef O'Leary CM. Alcohol and pregnancy: do abstinence policies have unintended consequences? Alcohol Alcohol (Oxford, Oxfordshire). 2012;47(6):638–9.CrossRef
42.
go back to reference Pruett D, Waterman EH, Caughey AB. Fetal alcohol exposure: consequences, diagnosis, and treatment. Obstet Gynecolog Surv. 2013;68(1):62–9.CrossRef Pruett D, Waterman EH, Caughey AB. Fetal alcohol exposure: consequences, diagnosis, and treatment. Obstet Gynecolog Surv. 2013;68(1):62–9.CrossRef
43.
go back to reference Falcon M, Valero F, Pellegrini M, Rotolo MC, Scaravelli G, Joya J, Vall O, Algar OG, Luna A, Pichini S. Exposure to psychoactive substances in women who request voluntary termination of pregnancy assessed by serum and hair testing. Forensic Sci Int. 2010;196:22–6.PubMedCrossRef Falcon M, Valero F, Pellegrini M, Rotolo MC, Scaravelli G, Joya J, Vall O, Algar OG, Luna A, Pichini S. Exposure to psychoactive substances in women who request voluntary termination of pregnancy assessed by serum and hair testing. Forensic Sci Int. 2010;196:22–6.PubMedCrossRef
44.
go back to reference Robertson M, Walter G. Overview of psychiatric ethics II: virtue ethics and the ethics of care. Australas Psychiatry. 2007;15(3):207–11.PubMedCrossRef Robertson M, Walter G. Overview of psychiatric ethics II: virtue ethics and the ethics of care. Australas Psychiatry. 2007;15(3):207–11.PubMedCrossRef
46.
go back to reference Roberts SCM, Treffers R, Thomas S, Drabble L. Forty years of state alcohol and pregnancy policies in the USA: best practices for public Health or efforts to restrict Women’s reproductive rights? Alcohol Alcohol. 2017;52(6):715–21.PubMedPubMedCentralCrossRef Roberts SCM, Treffers R, Thomas S, Drabble L. Forty years of state alcohol and pregnancy policies in the USA: best practices for public Health or efforts to restrict Women’s reproductive rights? Alcohol Alcohol. 2017;52(6):715–21.PubMedPubMedCentralCrossRef
Metadata
Title
Drowning our sorrows: clinical and ethical considerations of termination in alcohol-affected pregnancy
Authors
Roger Martin
George Bruxner
Gary Ng
Catherine Brewster
Alka Kothari
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03012-9

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue