Drinking History
Treatment
Withdrawal
Stabalization
Case Management
Service Delivery

Taking a Drinking History

It is important that a information on alcohol consumption is integrated into the routine history taking in ante-natal clinics.  This need not be a lengthy process.  The simplest way to take a drinking history is by using the past Week's Drinking Diary. This involves asking the woman what she had to drink on each of the previous seven days.  The grid below shows the information needed.  It is best to start by asking about the most recent events so "Starting yesterday can you tell me what you had to drink?"

In this way the past seven days drinking can be noted ensuring that information is collected on the type of alcoholic drink consumed and the amount.  It is important to bear in mind that "home measures" are usually two to three times larger than pub measures, so this needs to be taken into account when calculating the week's drinking total. 

To calculate this total the drinks are calculated into units of alcohol and then added up a unit of alcohol in the UK is found in one small glass of table wine, half a pint of ordinary strength beer or lager and a pub measure of spirits.  It is important to note that strong beers, lagers and ciders can be up to two and a half times stronger that ordinary beers.  So one pint of special lager contains  the same amount of alcohol as five pub measures of spirits.  It is also useful to check whether this amount and pattern of drinking were typical for the woman.

In most cases the woman will report little drinking particularly as in the first three months of pregnancy many women seem to find alcohol distasteful.  However this is an important first step in an early warning system if drinking is at levels which are not safe for the foetus.  

In the United Kingdom at this time, the guidelines for most of the Royal Colleges are "a maximum of one to two units once or twice a week"   (for units please see above).  However it is important that a pregnant woman who chooses not to drink during her pregnancy should be supported in this decision and not pressured to drink.

The history of Fetal Alcohol Syndrome (FAS) is now well documented from Warner and Rosett (1975) to more recent writings Plant (1997).  However there is still some debate about the levels and patterns of drinking which put the baby at risk.  In the USA the message is quite clear if you are pregnant you must not drink any alcohol.  In other countries the message is less restrictive.  In the UK the standard given by most of the Royal Colleges e.g. Psychiatrists. Physicians and General Practitioners hold to "One or two units once or twice a week".  A number of European countries have little or no "official" advice.  Examples of these countries are France, Germany, Portugal, Spain and Switzerland.