Barry and colleagues 1 completed a study estimating the prevalence of alcohol, cigarette and illicit drug use by women attending the Coombe Women’s Hospital between 1988 and 2005.  The researchers examined the association between substance use and immediate outcomes for the newborn baby in the light of the recommendations of the Second Report  of the Strategic Task Force on Alcohol 2 that deal with alcohol use and pregnancy. These were:

• Encourage pregnant women and women who are planning to become pregnant to avoid alcohol consumption, especially during the critical first trimester of pregnancy.
• Require a health-warning label on all alcohol products and alcohol promotional materials (p.39)

Anonymous data were extracted from a computerised database maintained by nursing and clerical staff at the hospital.  In June 1999, some questions on the database were revised and new questions were added.  This article presents results from 1 June 1999 to 30 March 2005.

Table 1 presents alcohol use before and during pregnancy between 1999 and 2005.  Of the 36,108 women who consumed alcohol prior to pregnancy, 4,752 (13.2%) stopped during their pregnancy. Of the 3,947 women who consumed six or more units per week prior to becoming pregnant, only 876 (22%) stopped drinking during their pregnancy; this is a matter of concern.  Level of alcohol use during pregnancy was not positively or negatively associated birth weight or the baby’s ability to breathe spontaneously at birth. 

Table 1   Alcohol use before and during pregnancy, 1999 to 2005 (43,318 women)

Table 2 presents the increase between 2000 and 2005 in the proportion of women who stopped smoking during pregnancy.  As the number of cigarettes smoked increased the likelihood of delivering a baby weighing less than 2,500 grams increased, indicating a direct and visible negative outcome associated with smoking (Table 3). 

Table 2   Percentage of pregnant women who stopped smoking during pregnancy, 2000 to 2005

Table 3   Percentage of women who delivered a baby weighing less than 2,500 grams, by smoking status, 1999 to 2005

Overall, the reduction in consumption of alcohol, a potentially harmful substance, is very low and compares unfavourably with the increasing numbers of women who stopped smoking during their pregnancy (Table 2).  It is apparent that the dangers of smoking were clearly understood by women attending the hospital and that the dangers of alcohol were not.  This indicates a need to highlight the dangers of alcohol use for the foetus and for the child’s long-term development.  The major negative outcome of alcohol consumption during pregnancy is the development of foetal alcohol spectrum disorder, which comprises partial and complete foetal alcohol syndrome as well as alcohol-related neuro-development disorder.  The latter disorder includes neuro-behavioural effects, which can develop from lower levels of alcohol consumption and manifest themselves in children and adolescents as attention and behavioural difficulties. 

In total, 447 (1.0%) women reported using drugs associated with dependency during their pregnancy (Table 4).  However, it is difficult to comment on these figures as it is not clear how many were using methadone or diazepam as a treatment rather than in an unregulated manner (street use). A higher proportion of women who reported drug use (16.6%) were likely to have a baby weighing less than 2,500 grams than the proportion of women who did not report drug use (5.1%). 

Table 4   Drug use during pregnancy, 1999 to 2005 (43,318 women)

*The total number of drugs is greater than the total number of women as some women used more than one drug.

†These numbers do not discriminate between prescribed and street use.

According to the authors, the pertinent recommendations of the Strategic Task Force on Alcohol need to be implemented and substance use during pregnancy needs to be monitored.  In addition, the authors recommend that a surveillance system be established to detect infants with foetal alcohol spectrum disorder. (Jean Long)

1. Barry S, Kearney A, Lawlor E, McNamee E and Barry J (2006) The Coombe Women’s Hospital study of alcohol, smoking and illicit drug use, 1988–2005. Unpublished.
2. Strategic Task Force on Alcohol (2004) Second report. Dublin: Department of Health and Children.