Alcohol Withdrawal During Pregnancy
A pregnant woman at risk of withdrawal is typically drinking six standard drinks or more on most days. Physiological tolerance/dependence has occurred, and she will meet criteria for an alcohol use disorder.
If a woman is drinking at these levels and she abruptly reduces or stops drinking she may experience alcohol withdrawal. This can occur anytime during her pregnancy as well as during labour and after delivery.
If the woman has been drinking heavily shortly before delivery or has undergone withdrawal during labour or delivery, the newborn is at risk of acute alcohol withdrawal. Onset of withdrawal for the newborn may begin 24 to 48 hours after delivery, depending on the time of the mother’s last drink.
Caring for a Pregnant Woman in Alcohol Withdrawal
A pregnant woman at risk of alcohol withdrawal should be closely monitored and may need to be hospitalised at any stage of gestation, as alcohol withdrawal alone is potentially fatal, and there are additional risks to her health and that of her foetus at this time. Ideally her antenatal care plan will mean that her baby will be delivered in a hospital where both she and baby can receive specialised midwifery and medical care, as well as longer-term health and social support.
The woman requires close observation and careful monitoring, generally using a withdrawal scale (see Chapter 8), and supportive nursing and medical care to reduce risk of complications for her and baby related to withdrawal (see Chapter 8).
Guidelines for Treating a Pregnant Woman at Risk of Withdrawal
Guidelines for treating a pregnant woman at risk of withdrawal include:
- If she starts withdrawing, she needs immediate specialist medical and nursing care in a well-equipped hospital.
- She needs to be closely observed and monitored for any progression of signs and symptoms, and medically treated to prevent and manage any complications to her and the foetus.
- She will need medical and nursing care for at least 5 days after the onset of withdrawal and, depending on any other factors or co-existing medical conditions, potentially longer.
- It is important to inform the receiving clinical team about her drinking history, the time of her last drink, her blood alcohol concentration when examined, vital signs and withdrawal scores (see Chapter 8 and Appendix).
It is particularly important to report any history of alcohol withdrawal complications such as seizures or hallucinations, or delirium tremens, and risk of thiamine deficiency leading to Wernicke’s encephalopathy.
Urgent consideration should be given to starting nutritional assessment and management. Parenteral thiamine supplementation should be commenced before administration of any glucose (see Chapter 8). Folate supplementation should be given (also parenterally, if doubts about likely absorption of oral tablets), as alcohol misuse is associated with folate deficiency, which is a well-documented factor in neural tube defects. Other vitamin deficiencies should be considered as well as overall protein and calorie status. These deficiencies typically respond well to the availability of a balanced diet in hospital once withdrawal has resolved but may necessitate a longer hospital admission.
Once she has recovered from acute withdrawal and is willing, she should undergo a full drinking history and comprehensive assessment, including assessment of her family and any other children in the home. A comprehensive care plan should be developed, informed by clinical guidelines for management of pregnancy (Clinical Practice Guidelines: Pregnancy care)1 and substance use in pregnancy (Clinical guidelines for the management of substance use during pregnancy, birth and the postnatal period)2.
The specialist medical and nursing team need to ensure the woman’s general practitioner, obstetrician and/or midwife are notified immediately, and offer them clear guidelines on her assessment, stabilisation, medical, nursing and psychological management and support needs.
| Chapter |
Recommendation |
Grade of recommendation |
| 14.6 |
Alcohol withdrawal during pregnancy should be managed in a general hospital, ideally in a high-risk maternity unit in consultation with a specialist drugs-in-pregnancy team. Diazepam may be given as needed to control withdrawal. Nutritional intervention should be initiated, including parenteral thiamine, folate replacement and assessment for other supplementation. |
GPP |