Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia.

Background: Fetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia.

Maternal alcohol consumption during pregnancy and the risk of orofacial clefts in infants: a systematic review and meta-analysis.

Background: The teratogenic effects of maternal alcohol consumption during pregnancy include anomalies of craniofacial structures derived from the cranial neural crest cells. The presence of specific craniofacial anomalies contributes to the diagnosis of fetal alcohol spectrum disorders. Cleft lip and palate [orofacial clefts (OFCs)], also derived from the cranial neural crest cells, are common congenital anomalies, but their relationship with prenatal alcohol consumption is unknown.

Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia.

Background: Fetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals have endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus recommendations for the diagnosis of FASD in Australia.

Methods: A panel of 13 health professionals, researchers, and consumer and community representatives with relevant expertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of FASD obtained from a systematic literature review, a national survey of health professionals and community group discussions.

Involving consumers and the community in the development of a diagnostic instrument for fetal alcohol spectrum disorders in Australia.

Background: Australia's commitment to consumer and community participation in health and medical research has grown over the past decade. Participatory research models of engagement are the most empowering for consumers.

Methods: As part of a project to develop a diagnostic instrument for fetal alcohol spectrum disorders (FASD) in Australia (FASD Project), the Australian FASD Collaboration (Collaboration), including a consumer advocate and two consumer representatives, was established.

Exploring the potential to use data linkage for investigating the relationship between birth defects and prenatal alcohol exposure.

Background: This study explores the potential of data linkage to investigate the proportion of birth defects classified as alcohol-related (ARBD) by the Institutes of Medicine (IOM) that are attributable to maternal alcohol-use disorder.

Methods: Maternal alcohol-use disorder was identified using International Classification of Diseases (9th and 10th revision) codes for alcohol-related diagnoses recorded on record-linked Western Australian health, mental health, and/or drug and alcohol datasets 1983 to 2007. Children of these mothers (n=23,859) were compared with a randomly selected cohort of children born to mothers without an alcohol diagnosis, frequency-matched by maternal age, Aboriginal status, and child's birth year (n=61,370).

Prenatal alcohol exposure and educational achievement in children aged 8-9 years.

Objective: This study examines the relationships between the dose, pattern, and timing of prenatal alcohol exposure and achievement in reading, writing, spelling, and numeracy in children aged 8 to 9 years.

Methods: Data from a randomly selected, population-based birth cohort of infants born to non-Indigenous women in Western Australia between 1995 and 1997 (n = 4714) (Randomly Ascertained Sample of Children born in Australia's Largest State Study cohort) were linked to the Western Australian Midwives' Notification System and the Western Australian Literacy and Numeracy Assessment statewide education testing program. The records for 86% (n = 4056) of the cohort were successfully linked with education records when the children were aged 8 to 9 years.

Discovering multiple myeloma early in ambulatory patients with chest pain.

Multiple myeloma (MM) is a systemic malignancy of plasma cells often characterized by sternal, rib, or back pain. This article describes how a patient who had chest pain for more than one month was mistakenly diagnosed with reflux esophagitis. Healthcare providers should be mindful of MM when determining the source of unidentified chest pain in patients.

Dental hospital admissions in the children of mothers with an alcohol-related diagnosis: a population-based, data-linkage study.

Objective: To investigate the relationship between maternal alcohol-use disorder and dental hospital admissions in children up to 5 years of age.

Study Design: Mothers with an International Classification of Diseases, 9th revision/10th revision alcohol-related diagnosis, a proxy for alcohol-use disorder, were identified through the Western Australian data-linkage system. Exposed mothers were frequency-matched by maternal age, Aboriginal status, and child's birth year to randomly selected comparison mothers without an alcohol diagnosis.

Maternal alcohol use and sudden infant death syndrome and infant mortality excluding SIDS.

Background: Improvements in the rate of infant mortality (death in first year of life) have not occurred in recent years. This study investigates the association between maternal alcohol-use disorder and sudden infant death syndrome (SIDS) and infant mortality not classified as SIDS using linked, population-based health and mortality data.

Methods: Exposed mothers were identified through the presence of an International Classification of Diseases 9/10 alcohol diagnosis, a proxy for alcohol-use disorder, recorded on health, mental health, and/or drug and alcohol datasets (1983-2005).

A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia.

Background: There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals' perceptions about screening for FASD in Australia.

Method: A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia.

Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: a modified Delphi study.

Objective: To evaluate health professionals' agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia.

Design: A modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds.

Alcohol and pregnancy: do abstinence policies have unintended consequences?

Most policies and guidelines recommend that women abstain from alcohol during pregnancy. This can be difficult to achieve in developed nations where the majority of women consume alcohol and almost half of pregnancies are unplanned, leading to many pregnancies being exposed to alcohol prior to pregnancy awareness. Concerns have been raised that abstinence policies may lead women in this situation to terminate their pregnancy out of fear that they have harmed their baby; however, the evidence is limited.

Health professionals' perceptions about the adoption of existing guidelines for the diagnosis of fetal alcohol spectrum disorders in Australia.

Background: Despite the availability of five guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD), there is no national endorsement for their use in diagnosis in Australia. In this study we aimed to describe health professionals' perceptions about the adoption of existing guidelines for the diagnosis of FASD in Australia and identify implications for the development of national guidelines.

Methods: We surveyed 130 Australian and 9 international health professionals with expertise or involvement in the screening or diagnosis of FASD.

Heavy maternal alcohol consumption and cerebral palsy in the offspring.

Aim: The aim of this study was to investigate the association between heavy maternal alcohol consumption and pre- peri- and postneonatally acquired cerebral palsy (CP).

Method: The records of all mothers with an International Classification of Diseases, revision 9 or 10 (ICD-9/-10) alcohol-related diagnostic code, indicating heavy alcohol consumption, recorded on population-based health, mental health, and drug and alcohol data sets from 1983 to 2007, and their children were identified through the Western Australian Data-linkage System. This 'exposed' cohort was frequency matched with mothers without an alcohol-related diagnosis and their offspring (comparison group).

Guidelines for pregnancy: what's an acceptable risk, and how is the evidence (finally) shaping up?

Issues: The lack of consensus about whether low to moderate levels of prenatal alcohol exposure are a risk factor for fetal development has generated considerable debate about what advice policies and guidelines should provide.

Approach: This paper reviews the evidence from systematic reviews and meta-analyses examining the risk from low and moderate levels of prenatal alcohol exposure, along with the results of articles published 2009-2010, after the reviews.

Key Findings: The reported significant effects from low levels of prenatal alcohol exposure are likely due to methodological issues such as confounding and/or misclassification of exposure or outcome and there is no strong research evidence of fetal effects from low levels of alcohol exposure.

RE-AIM evaluation of the Alcohol and Pregnancy Project: educational resources to inform health professionals about prenatal alcohol exposure and fetal alcohol spectrum disorder.

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals.

Prenatal alcohol exposure and risk of birth defects.

Objective: The goal was to examine the associations between dose, pattern, and timing of prenatal alcohol exposure (PAE) and birth defects.

Methods: Data from a randomly selected, population-based cohort of nonindigenous women who gave birth to a live infant in Western Australia (WA) between 1995 and 1997 (N=4714) were linked to WA Midwives Notification System and WA Birth Defects Registry data. We assessed the associations of PAE before pregnancy, in the first trimester, and in late pregnancy with any birth defect and with birth defects classified as alcohol-related birth defects (ARBDs) by the Institute of Medicine (IOM), by using logistic regression.

Evidence of a complex association between dose, pattern and timing of prenatal alcohol exposure and child behaviour problems.

Background: There is a lack of evidence regarding the effect of dose, pattern and timing of prenatal alcohol exposure and behaviour problems in children aged 2 years and older.

Methods: A 10% random sample of women delivering a live infant in Western Australia (1995-96) were invited to participate in an 8-year longitudinal survey (78% response rate n = 2224); 85% were followed-up at 2 years, 73% at 5 years and 61% at 8 years. Alcohol consumption was classified by combining the overall dose, dose per occasion and frequency to reflect realistic drinking patterns.

Changing risks of stillbirth and neonatal mortality associated with maternal age in Western Australia 1984-2003.

There has been a trend over the past two decades in some Western countries for women to delay childbearing, a factor associated with an increased risk of perinatal mortality (stillbirth and neonatal death). While the rates of stillbirth and neonatal mortality have improved in some countries, it has not been established whether maternal age remains a risk factor for perinatal mortality in Australia. The Western Australian Maternal and Child Health Research Database (MCHRDB) was used to examine the effect of maternal age on perinatal death in the periods 1984-93 and 1994-2003 after adjustment for parity and sociodemographic factors.

A review of policies on alcohol use during pregnancy in Australia and other English-speaking countries, 2006.

It is well accepted that heavy alcohol consumption during pregnancy is a risk factor for fetal alcohol spectrum disorder, but research findings for exposure to low to moderate alcohol levels during pregnancy are equivocal, allowing a range of interpretations. The 2001 guideline from the National Health and Medical Research Council (NHMRC) for low-risk drinking for "women who are pregnant or might soon become pregnant" recommends fewer than seven standard drinks per week, and no more than two standard drinks on any one day. This position has polarised health professional and consumer opinion in Australia.

Homocysteine and cardiovascular disease: a 17-year follow-up study in Busselton.

Study Objective: Prospective assessment of serum homocysteine level in relation to risk of coronary heart disease (CHD) and stroke.

Design: Case-cohort study with 17 years follow up.

Methods: Homocysteine was measured from stored serum.