Physicians are urged to ask pregnant women difficult questions about their drinking as part of efforts to reduce the number of children born with fetal alcohol spectrum disorder (FASD).
The condition, which is related to brain damage caused by exposure to alcohol in the fetus, is recognized as the leading avoidable cause of birth defects and developmental and learning disabilities throughout the world.
People with the disorder may have problems with memory, attention, reasoning and impulsivity.
But Australian experts say that the fact that doctors do not routinely ask pregnant women about their alcohol use means that risky behaviors are not identified and that women are not provided with information that may lead them to stop drinking.
"We, as doctors, have been doing something wrong by not asking, or not asking enough to get the story," Gold Coast pediatrician Doug Shelton said at a FASD event in Melbourne earlier this week.
"The difference is achieved by having the courage to ask with care and respect and in a way without prejudice and without guilt about the consumption of alcohol during pregnancy."
Stereotypes and stigma
Jane Halliday, professor of pediatrics and lead researcher at the Murdoch Children's Research Institute, said raising the issue could be a challenge for doctors "because there is this association of guilt and stigma with drinking during pregnancy."
"Then people are a bit reluctant to ask about that."
It is believed that up to 5% of the Australian population has FASD and one in three people in juvenile justice facilities is affected, where indigenous youth outnumber non-indigenous youth.
The first Australian FASD prevalence study, conducted in an Aboriginal community in Western Australia in 2012, found a prevalence rate of 12% among children. Critics of the study have noted its high-risk population and small sample size, in which fifty-five percent of the 127 pregnant women studied drank during pregnancy.
The executive director of Muriel Aboriginal Child Care Agency Muriel, Muriel Bamblett, said that not asking future mothers about their alcohol consumption is endangering the health of children.
"I think a lot of doctors are worried about asking the question, particularly the Aboriginal women," he said.
"But it should not be something to avoid or not ask."
The experience of a mother
Anne Russell has two children in their thirties, both with FASD.
When she became pregnant in the 1980s, doctors did not suggest that she avoid alcohol. Far from there.
One suggested that Mrs. Russell, who is from Cairns, go to the pub for a celebration cup.
"I took the pregnancy vitamins that were available at that time," he said.
"I stopped smoking, how little I smoked".
"I did not take other drugs."
"I remember even asking my doctor if I could take Panadol."
"But alcohol was not on anyone's radar, including mine, and I did not drink more or less than my teammates."
Mrs. Russell's children were not diagnosed until her adolescence.
She wants the disorder to have been detected before.
"If my first child had been diagnosed when I was young, my second child would not have FASD," he said.
"Avoiding that would have changed the lives of all of us."
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FASD is described as a hidden condition because it is often overlooked, ignored or attributed to another condition.
The characteristics of the disorder are very similar to other conditions, such as attention deficit hyperactivity disorder and autism, which is why it is often misdiagnosed.
"There is a lack of experience and ability to really diagnose the condition," said Professor Halliday.
"It requires a multidisciplinary approach, and there simply are not trained people who know it."
Early diagnosis can protect a child from some of the negative implications of the condition.
"I've seen what can happen and how a young person's trajectory can change if they have an early diagnosis," said Professor Muriel Bamblett.
"Identifying that much earlier understands the behavior, and then you can include a treatment plan."
For more information visit nofasd.org.au
Insight: Drinking during pregnancy (2013)