Quality statement 2: Fetal alcohol exposure
Supporting women to make decisions about their care is important during pregnancy. Healthcare professionals should ensure that women have the information they need to make decisions and to give consent in line with General Medical Council (GMC) guidance and the Nursing and Midwifery Council (NMC) Code.
Pregnant women are asked about their alcohol use throughout their pregnancy and this is recorded.
Talking about and recording alcohol consumption during pregnancy allows personalised discussions about the risks of alcohol use as part of routine healthcare throughout pregnancy. It also gives opportunities to offer tailored support and interventions if the woman wishes to cut down or stop drinking. This may reduce risks and improve outcomes for the mother and baby. Women should be asked about their alcohol consumption in a sensitive, non-judgemental way. Women who wish to discuss their alcohol use should be asked about the quantity, frequency and pattern of drinking, and this should be documented in their maternity records. This information may also help support early diagnosis and treatment for children with fetal alcohol spectrum disorder (FASD).
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Evidence of local arrangements to ensure that antenatal appointments include discussion about drinking alcohol in pregnancy.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from appointment schedules and information given to pregnant women about what is covered in their antenatal appointments.
a) Proportion of antenatal booking appointments where drinking of alcohol is reported.
Numerator – the number in the denominator where the weekly number of alcohol units reported is greater than 1.
Denominator – the number of antenatal booking appointments.
Data source: The NHS Digital Maternity Services Data Set includes information on the weekly number of alcohol units reported at the antenatal booking appointment. Public Health Outcomes Framework indicator C03b – 'Drinking in early pregnancy' presents this measure at national and local authority level.
b) Proportion of routine antenatal appointments attended in which alcohol consumption is recorded.
Numerator – the number in the denominator in which alcohol consumption is recorded.
Denominator – the total number of routine antenatal appointments attended.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local audits of maternity records. The NHS Digital Maternity Services Data Set includes information on alcohol consumption recorded at the antenatal booking appointment. The Perinatal Institute's Pregnancy notes record information on alcohol consumption in pregnancy.
Service providers (maternity services) ensure that antenatal appointments include discussion and recording of alcohol consumption in pregnancy. They ensure that midwives providing antenatal care are aware of the risks to the fetus of drinking alcohol in pregnancy, and have training on FASD awareness and alcohol brief interventions.
Healthcare professionals (midwives, nurses and doctors) ask pregnant women about their alcohol consumption and discuss the associated risks. They use a non-judgemental approach, discuss any concerns and provide support according to the woman's needs. They record information on a woman's alcohol consumption during pregnancy in her maternity records at antenatal appointments, including the number and types of alcoholic drinks consumed, as well as the pattern and frequency of drinking.
Commissioners (such as clinical commissioning groups or integrated care systems) commission maternity services that discuss alcohol use during pregnancy at antenatal appointments and record it in the mother's maternity records. They commission services for pregnant women who continue to drink but are not alcohol dependent and for those who are alcohol dependent.
Pregnant women are asked at antenatal appointments about any alcohol they have drunk during pregnancy. They have a discussion with their midwife about the risks of drinking alcohol while pregnant, and are asked if they have any concerns or would like further information. Women who continue to drink are offered support if they wish to stop drinking. Information about these discussions, including their alcohol use, is documented in their maternity records.
Antenatal care. NICE guideline NG201 (2021), recommendations 1.2.11 and 1.3.10
Children and young people exposed prenatally to alcohol. Scottish Intercollegiate Guidelines Network guideline SIGN 156 (2019), recommendations 2.1 (page 11) and 2.1.2 (page 12)
Alcohol-use disorders: prevention. NICE guideline PH24 (2010), recommendation 9