Addictions: experts point to the difficulties of screening for alcohol conducted in pregnant women

Of addiction specialists, met in Congress, testified of hard alcohol screening conducted in pregnant women and the need for better management of this addiction.

Chairing a roundtable national conference of the French addiction Federation (FFA), Prof. Michel Lejoyeux mentioned in the preamble of the issues taken up at the hospital, noting that "the time was considered that addiction is not dealt with in the long term and not in the emergency was over. "

While stressing "the specifics of alcohol, still largely taboo," the psychiatrist said that the problem of addiction is addressed "to the three steps that are home to the emergency room, where are supported somatic and psychiatric complications these lines, hospitalization, during a interrécurente related disease, and registration at the exit of patients in a health care network. "

Professor Lejoyeux recommended that all addictive behavior is the subject of "a standardized assessment, psychotherapeutic intervention 'minimal', an identification of pathological and a proposal for immediate care and long-term." He also stressed the need for "a direct approach and uncompromising" with this issue.

Dr. Garo Mylène testified about his experience as a psychiatrist in a maternity hospital for "high risk pregnancies" and an early medico-social action center (CAMSP). She presented "symptoms and how alert" for the prevention or diagnosis of fetal alcohol-related disorders that then remains "widespread ignorance about the teams."

"Screening alcoholic behavior of pregnant women remains difficult because the product is shared between patients and caregivers taboo, unlike other addictive substances, and its misuse can be done well socially integrated women" she observes.

The psychiatrist also pointed to the lack of professional training "courses in obstetrics and gynecology for example where much time is devoted to screening trisomy 21, while their prevalence is equivalent to that of fetal alcohol syndrome ( SAF). "

A midwife CHU Montpellier in audience confirmed that "if training were solicited and repositories locally written," these initiatives were hardly highlighted and disseminated.

"This testing is a matter too rarely a clinical approach and much of the SAF, with malformations of fetuses, microencéphalies and facies characteristics are now diagnosed with ultrasounds in 3D," observed Dr. Garo.

Questioned by several doctors in the audience, she advocated to overcome the difficulty of dialogue on the subject in consultation, screening through symptoms such as multiple dependencies (tobacco, drugs), depression or behavioral disorders food.

The psychiatrist recommended that physicians advise from the preconception consultations on the need to stop any alcoholic beverages during pregnancy. "If the consultation of the fourth month is expected, it may already be too late."

In the room, a gynecologist expressed an inventory over five years in his service Dax (Landes), based on a comparison of patient records pregnant nonsmokers, smokers and polyaddictives.

"As soon as the criteria for significant growth retardation 'of the fetus and mean corpuscular volume (MCV) greater than 92 microns are aggregated, the alcoholic behavior is almost certain," she observed, while lamenting the lack of alcohologists in gynecology then "the smoking cessation clinics abound."

"However, it is necessary to help pregnant women stop smoking, the effects on the fetus related to tobacco, which certainly causes growth retardation, were not those of the cataclysmic scale, irreversible and debilitating , caused by alcohol, "said the gynecologist.

"It is very difficult to get into the maternity invested in this mission of prevention, where we sometimes look associations or physicians as Martians landing in the wrong place," said a alcohologist, responsible for a team link Evreux (Eure).

"It is the interest of the management of these addictions in general hospitals can mobilize multiple skills across different services," concluded Professor Lejoyeux.