Prenatal alcohol exposure (PAE) is a major preventable cause of health and developmental problems in children. It may cause irreversible damage to the brain, resulting in fetal alcohol spectrum disorder (FASD), which is characterized by learning difficulties, executive dysfunction, impaired speech, motor problems, and behavior problems.¹ Fetal alcohol spectrum disorder may affect 3% to 5% of mainstream school-aged children, with many remaining undiagnosed.² Fetal alcohol syndrome (FAS) is diagnosed when cognitive impairment occurs together with abnormalities of growth and a characteristic facial phenotype. Diagnostic criteria of FAS include short palpebral fissures, flat philtrum, and thin upper lip,³ but the condition has also been associated with midfacial and auricular anomalies.⁴ Detailed morphologic studies of the face have found a reduction in ear length and midfacial hypoplasia, evidenced by reduced midfacial depth and flattening of the nasal bridge and malar regions and a reduction in the size of the neurocranium and face (reduced upper facial width, head circumference, and total facial height), as well as retrognathia and micrognathia (reduced bigonial breadth), in individuals who received a diagnosis of partial FAS and in individuals with heavy PAE who do not meet the diagnostic criteria for FASD.^5-7 Furthermore, comparisons of the physical characteristics of children with FASD and the physical characteristics of children without FASD have shown that maternal drinking measures significantly correlated with facial dysmorphology, with higher levels of drinking predicting higher dysmorphology scores.^8-10 Together these findings suggest a possible dose-related association between PAE and craniofacial shape.

This paper presents drinking patterns in a prospective study of a population-based cohort of 1570 pregnant women using a combination of dose and timing to give best estimates of prenatal alcohol exposure (PAE). Novel assessments include women’s special occasion drinking and alcohol use prior to pregnancy recognition. Information on up to nine types of alcoholic drink, with separate frequencies and volumes, including drinking on special occasions outside a ‘usual’ pattern, was collected for the periconceptional period and at four pregnancy time points. Weekly total and maximum alcohol consumption on any one occasion was calculated and categorised. Drinking patterns are described in the context of predictive maternal characteristics. 41.3 % of women did not drink during pregnancy, 27 % drank in first trimester only; most of whom stopped once they realised they were pregnant (87 %). When compared to women who abstained from alcohol when pregnant, those who drank in the first trimester only were more likely to have an unplanned pregnancy and not feel the effects of alcohol quickly. Almost a third of women continued to drink alcohol at some level throughout pregnancy (27 %), around half of whom never drank more than at low or moderate levels. When compared with abstainers and to women who only drank in trimester one, those who drank throughout pregnancy tended to be in their early to mid-thirties, smoke, have a higher income and educational attainment. Overall, almost one in five women (18.5 %) binge drank prior to pregnancy recognition, a third of whom were identified with a question about ‘special occasion’ drinking. Women whose age at first intoxication was less than 18 years (the legal drinking age in Australia), were significantly more likely to drink in pregnancy and at binge levels prior to pregnancy recognition. We have identified characteristics of pregnant women who either abstain, drink until pregnancy awareness or drink throughout pregnancy. These may assist in targeting strategies to enhance adherence to an abstinence policy and ultimately allow for appropriate follow-up and interpretation of adverse child outcomes. Our methodology also produced important information to reduce misclassification of occasional binge drinking episodes and ensure clearly defined comparison groups.

Worldwide, women fail to reach the recommended exclusive breastfeeding target of 6 months postpartum. The objective of this study was to present a conceptual and methodological synthesis of interventions designed to promote exclusive breastfeeding to 6 months in high-income countries. A systematic search of leading databases was conducted for scholarly peer-reviewed randomized trials published between January 2000 and June 2013. Seventeen articles were identified as relevant; all were published in English and assessed exclusive breastfeeding with a follow-up period extending beyond 4 months postpartum. Articles were analyzed for overall quality of evidence, regarding duration of exclusive breastfeeding, using the Grading and Recommendations Assessment, Development, and Evaluation approach. A significant increase in the duration of exclusive breastfeeding was found in eight of the 17 studies, with most interventions using supportive or educational approaches. Interventions in pregnancy focused on educating mothers on the benefits of exclusive breastfeeding. Fifteen interventions took place, at least in part, in the postnatal period and provided educational and emotional support to mothers. Of the eight successful interventions, five took part in the postnatal period in the mothers' own homes. The quality of the evidence for duration of exclusive breastfeeding was moderate. The most successful interventions were conducted in the postnatal period and over a long period of time; however, the findings were inconsistent. No study assessed intervention fidelity, and only two studies noted maternal body mass index, a variable known to affect exclusive breastfeeding rates. Further research is needed to provide a robust evidence base to inform future interventions.

Objective  To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a pamphlet in supporting women’s decision making.Design  A cluster randomised controlled trial.Setting  Primary health care.Population  Women in early pregnancy consulting a GP.Methods  GPs were randomised to provide women with either a decision aid or a pamphlet. The decision aid was a 24‐page booklet designed using the Ottowa Decision Framework. The pamphlet was an existing resource available in the trial setting.Main outcome measures  Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post.Findings  Women in the intervention group were more likely to make an informed decision 76% (126/165) than those in the control group 65% (107/165) (adjusted OR 2.08; 95% CI 1.14–3.81). A greater proportion of women in the intervention group 88% (147/167) had a ‘good’ level of knowledge than those in the control group 72% (123/171) (adjusted OR 3.43; 95% CI 1.79–6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), pamphlet 1.65 (0.55) (adjusted mean difference 0.10; 95% CI −0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes.Conclusion  A tailored prenatal testing decision aid plays an important role in improving women’s knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values.