Alcohol Use Disorders

Overall, despite the literature so far published seems to report conflicting data, some evidence coming from some retrospective cohort studies provide some data on the effects of maternal alcohol intake during pregnancy and/or breastfeeding. Alcohol use disorder (AUD) during pregnancy and postpartum period may determine the onset of major and/or minor congenital malformations (during the exposition in the first pregnancy trimester), intellectual disability in the newborns exposed throughout pregnancy and the risk of developing a foetal alcohol syndrome (FAS) and foetal alcohol spectrum disorders (FASD). Alcohol use during lactation has also been associated with an increased prevalence of adult deficit hyperactivity disorder (ADHD) and altered infant sleep patterns. Overall, there is little research information and methodologically well-designed clinical studies able to guide clinicians working within Mental Health’s and Drug Addiction’s services regarding clinical decision-making and therapeutic flowchart for the management and treatment of pregnant and/or nursing women affected with AUD. Motivational interviewing and brief interventions have been demonstrated to be more effective than judgmental or punitive approaches in encouraging positive behavioural lifestyle changes. Little evidence is available in the treatment and management of alcohol withdrawal during pregnancy and in the prescription of acamprosate, naltrexone and disulfiram. Overall, the best management approach should be recommended to all clinicians to advise all women who are pregnant or planning a pregnancy the potential risks related to alcohol intake during pregnancy and breastfeeding, the associated risk if a woman is already affected with AUD and she is at-risk to develop alcohol dependence. In particular, women should be recommended that not drinking is the safest option to limit/reduce the risk of fetal malformations, perinatal and/or obstetrician complications and limit the risks on newborns. Similarly, alcohol intake should be greatly avoided during the postpartum period, particularly when the woman decides to breastfeed the newborn. All women should be adequately supported in a non-judgemental manner and help them in the management of alcohol intake throughout the perinatal period.