Exploring the implementation and efficacy of Maternal Alcohol Consumption interventions within an Australian context

Thomas Douglas and Peter Sheeran

Introduction

Maternal alcohol consumption (MAC) and foetal alcohol spectrum disorders (FASD) are a significant public health concern within the Australian context, with FASD the leading cause of preventable brain damage and developmental disability nationwide. Whilst reported MAC rates have been consistently declining, disadvantaged Australian communities are disproportionately impacted with some ‘at-risk’ communities reporting FASD rates of up to 28%. 

Objectives

This systematic review endeavours to identify MAC and FASD prevention strategies that have been implemented within Australia with an aim to evaluate the effectiveness of these interventions and provide a perspective on possible further avenues of research and focus. The development of our research question was as follows:  How effective have MAC and FASD prevention/reduction strategies been at reducing MAC/FASD for women within Australia?

Methods

We implemented a PRISMA checklist and flow diagram in order to identify articles which outline MAC/FASD prevention strategies within Australia. Four databases were searched: CINAHL, Cochrane Library, PsycInfo, PubMed for the keywords: Alcohol AND pregnan* AND Australia AND intervention OR program* AND prevent* or reduc*. Additionally filters of ‘full text’, ‘peer reviewed’, ‘scholarly journal’ and a timeframe of between 2000 and 2023 were applied. 

Results

Initially, 494 titles were returned and underwent title and abstract screening which left 17 full text articles for review, eventually providing 5 articles which met eligibility for inclusion. Of these articles, 4 were randomised control trials and 1 was analysed survey data on behavioural change. The findings of the studies indicated that MAC rates were significantly higher than reported national data, between 9-16% compared to 0.5-6%. Education and advice based programs were effective in reducing MAC in ‘low-risk’ groups, being most impactful in reducing “special occasion drinking”, however were probably ineffective for those within ‘at/high risk’ groups, with some studies reporting increased MAC rates following intervention.

Conclusion

Overall, rates of MAC/FASD are declining within Australia, however these improvements may not be as significant as national records rates suggest. Additionally there are limited studies observing MAC/FASD reduction/prevention strategies within Australia, with a distinct paucity of studies targeting ‘at/high risk’ communities and women. Broad population based awareness, education and advice programs are largely effective at reinforcing behaviour change in ‘low-risk’ groups. Further studies observing interventions that may target ‘at/high risk’ individuals and communities are in great need, particularly if the disproportionate impact upon disadvantaged communities is to be addressed.