Maternal Alcohol-Use Disorder and Child Outcomes

Abstract

OBJECTIVES: Investigate the relationship between maternal alcohol-use disorder and multiple biological and social child outcomes, including birth outcomes, child protection, justice contact, and academic outcomes for both Indigenous and non-Indigenous children. METHODS: Women with a birth recorded on the Western Australian Midwives Notification System (1983-2007) and their offspring were in scope. The exposed cohort were mothers with an alcohol-related diagnosis (International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision) recorded in an administrative data set and their offspring (non-Indigenous: n = 13 969; Indigenous: n = 9635). The exposed cohort was frequency matched with mothers with no record of an alcohol-related diagnosis and their offspring (comparison cohort; non-Indigenous: n = 40 302; Indigenous: n = 20 533). RESULTS: Over half of exposed non-Indigenous children (55%) and 84% of exposed Indigenous children experienced $1 negative outcome. The likelihood of any negative outcome was significantly higher for the exposed than the comparison cohort (non-Indigenous: odds ratio [OR] = 2.67 [95% confidence interval (CI) = 2.56-2.78]; Indigenous: OR = 2.67 [95% CI = 2.50-2.85]). The odds were greatest for children whose mothers received a diagnosis during pregnancy (non-Indigenous: OR = 4.65 [95% CI = 3.87-5.59]; Indigenous: OR = 5.18 [95% CI = 4.10-6.55]); however, numbers were small. CONCLUSIONS: The effects of maternal alcohol-use disorder are experienced by the majority of exposed children rather than a vulnerable subgroup of this population. These findings highlight the need for universal prevention strategies to reduce harmful alcohol use and targeted interventions to support at-risk women and children.

Perinatal outcomes of Aboriginal women with mental health disorders

“…The latter also used women without severe mental illness as a control group, which could involve women with other mental health disorders. Our findings on SGA, congenital anomalies, low 5-minute Apgar score and foetal distress are consistent with the previous literature showing associations between severe maternal mental illness and foetal distress, anomalies or low Apgar score ( Edvardsson et al, 2022 ; Etchecopar-Etchart et al, 2022 ; Heun-Johnson et al, 2019 ; Zhong et al, 2018 ); and between major depression, bipolar or substance use disorder and SGA ( Mei-Dan et al, 2015 ; O’Leary et al, 2020 ). However, investigations of this nature are rare in Australian Aboriginal populations, suggesting the need for more well-designed prospective studies to replicate our finding and strengthen the evidence base.…”

“…Despite the higher burden of mental health problems among Aboriginal women and their potentially serious impacts ( Owais et al, 2020 ; Pierce et al, 2020 ), scarce empirical evidence exists about the link between maternal mental health problems and perinatal outcomes. A study in Western Australia (WA) examined a range of perinatal and child outcomes among births to Aboriginal and non-Aboriginal women with alcohol use disorder ( O’Leary et al, 2020 ). It highlighted that maternal alcohol use disorder was significantly associated with a greater risk of small for gestational age (SGA) and preterm birth (for both populations) and congenital anomalies and foetal alcohol syndrome (for Aboriginal women only).…”

It takes a village: Influencing policy and practice to prevent alcohol use in pregnancy and promote better outcomes for individuals living with Fetal Alcohol Spectrum Disorder

“…We contributed invited Evidence-Practice/Policy Gap (EPPG) synopses for the NHMRC's 2020 EPPG (Indigenous Health) report [19,20] and informed the National Action Plan for FASD [14] and the Senate Inquiry into Effective Approaches to Prevention, Diagnosis and Support for Fetal Alcohol Spectrum Disorder [13]. Several of our studies (both completed and planned) rely on the use of existing data infrastructure, such as adminstrative data that can be linked to maternal alcohol use disorders [21], prenatal alcohol exposure [22] or cases of FASD (see Figure 3). It is also important to acknowledge the diversity of perspectives, research focus areas, and outputs that have influenced policy and practice change; collectively the importance of our ongoing work to public health was highlighted in a case study by the NHMRC [23].…”

Association of Child Maltreatment With Risk of Death During Childhood in South Australia

“…Poor birth outcomes, which were significantly associated with early death in our study, are not necessarily confounders. They may be associated with unsafe behaviors during pregnancy, such as heavy drinking or illicit drug use (representing neglect of the unborn baby) . As such, the multivariable estimates may be overadjusted, underestimating the association of child protection concerns with risk of death during childhood.…”