Ireland among top five countries for alcohol use during pregnancy 

Ireland is ranked as one of the top five countries in the world for the prevalence of both alcohol use during pregnancy and foetal alcohol syndrome. 

The number of pregnant women presenting with opioid addiction at a specialist clinic has fallen in recent years, but the numbers presenting with other drug and alcohol addictions has risen in the same period.

The finding is included in a review of 10 years of work at the DOVE Clinic in the Rotunda Hospital, which notes that Ireland is ranked as one of the top five countries in the world for the prevalence of both alcohol use during pregnancy and fetal alcohol syndrome. 

"As well as the potential risk of neonatal abstinence syndrome (NAS), infants born to mothers who misuse substances during pregnancy face a greater risk of prematurity, low birth weight, behavioural issues and learning difficulties," it said. The research report also showed a fall in the number of newborns with neonatal abstinence syndrome (NAS) - conditions caused when a baby withdraws from certain drugs.

Entitled 'A Decade of DOVE – Multidisciplinary Experience from an Obstetric Addiction Clinic', the research was conducted by a team led by Dr Maeve Eogan, Consultant Obstetrician and Gynaecologist at the Rotunda Hospital. It reviewed a decade of attendances at an obstetric addiction clinic, from 2009 to 2018, and compared the results with the general hospital population.

Specialist treatment has been provided at the Dove (‘Danger Of Viral Exposure’) Clinic and the review found that attendances there have been stable over the past 10 years, but some trends have emerged in the same time period.

"With an average of 8,793 births over 500g annually over the same decade, this represents a rate of attendance of approximately 12/1000 births," it said. 

Changing patterns

"The number of women presenting with opioid addiction has significantly (p=0.04) declined and less women commenced OST for the first time in pregnancy in more recent years (p=0.002)." There has also been a significant reduction in the number of women attending the DOVE clinic with addiction who also have positive virology (HIV, Hepatitis B & C).

However, there have been "changing patterns of addictions", with a significant increase in the number of pregnant women presenting with non-opioid addiction.

To respond to this, the DOVE clinic has evolved from providing care solely for women with opioid addiction, to providing support for those who disclose addiction to other substances (most frequently alcohol, benzodiazepines, cannabis, cocaine and over the counter analgesics).

While in some areas, such as caesarean deliveries, there was no difference between the rates of women attending the clinic and the general hospital population, premature birth (pre-37 weeks) was much more likely among those attending the DOVE clinic (17.4% of those attending) versus the general hospital population (6.9%).

"Furthermore, infants born to women with addiction were significantly more likely to weigh less than 2.5kg than infants in the general hospital population (26.1% compared with 6.5%)," it said, adding that perinatal mortality and SIDS data, although based on small numbers and extrapolated, was notable.

Newborns of mothers attending the DOVE clinic with addiction are more likely to require admission to NICU than infants of mothers in the general hospital population, even though the NAS rate has fallen.

"While opioid addiction has fallen, women are more likely to attend with other addictions," it said. "The service, and its allied agencies, need to ensure access to responsive care for these addictions to support affected women and to limit potential adverse effects."