Should women consume alcohol during pregnancy?

October 06, 2015

In The BMJ this week, experts discuss the evidence and current guidelines on the controversial topic of alcohol consumption during pregnancy.

"Alcohol is not essential to the health or well being of a pregnant woman and is known to be harmful to her baby," argue Mary Mather, a retired paediatrician, and Kate Wiles, a doctoral research fellow in obstetric medicine at Guys and St Thomas NHS Trust.

They say "the only ethical advice that can be given is complete abstinence from alcohol in pregnancy."

Infants can suffer from fetal alcohol syndrome, mental retardation, development and behavioural abnormalities, and low birth weight. But how and when fetal damage occurs is unknown and will vary according to each individual pregnancy, they explain.

"Pregnant women must know there is no evidence of a threshold level of alcohol consumption in pregnancy below which there can be certainty that exposure is safe," they argue. They also say that "current guidance flies in the face of evidence and international consensus," adding that these present a "contradictory, confusing barrage of mixed messages."

The Department of Health, NICE and the Royal College of Obstetricians and Gynaecologists (RCOG) make inconsistent suggestions on the number of alcohol units that are safe for pregnant women.

Furthermore, few pregnant women or healthcare professionals understand what a unit of alcohol means, and "choose to drink" is open to misinterpretation. Many pregnant women drink alcohol during pregnancy and put their babies at risk, they say.

Meanwhile, many countries including Canada, Denmark, Norway, Australia, Ireland, the Netherlands and Scotland advise against alcohol consumption completely.

Guidelines need to be clear, consistent and acknowledge that no evidence shows that alcohol consumption below a certain level is safe, they argue. "Until this is provided, pregnant women in England and Wales will remain unable to make an informed choice about their use of alcohol in pregnancy."

Patrick O-Brien, a consultant and honorary senior lecturer in obstetrics and gynaecology at University College London Hospital agrees that "we have produced a raft of conflicting guidance for women."

However, he says that "this is our failing, not theirs," and the solution is not to consequently advise pregnant women to abstain from alcohol consumption. Instead, "we need to resolve these inconsistencies, then present the evidence in a clear and unambiguous way."

Guidelines must also acknowledge that in some areas evidence cannot provide a definite answer, he adds. There is no robust evidence that drinking within advised limits after 12 weeks of pregnancy is harmful for the fetus, but there can never be a 100% guarantee that any lower limit is safe.

In addition, he says there is considerable uncertainty around the blurred edges of robust evidence on the effects of alcohol consumption on fetal development, and how many associated conditions can be reasonably attributed to alcohol use.

And again, instead of telling women to abstain because the evidence is not certain, healthcare professionals should explain the current evidence and its limitations, and help pregnant women to make a decision, he insists.

"If they perceive that we have been making value judgements on their behalf, or professing certainty where none exists, we are certain to lose their trust," he concludes.
-end-


BMJ

Related Pregnancy Articles from Brightsurf:

COVID-19 has a prolonged effect for many during pregnancy
Symptoms for pregnant women with COVID-19 can be prolonged, lasting two months or longer for a quarter of the women who participated in a national study led by UC San Francisco and UCLA.

Relaxed through pregnancy
A group of researchers from Charité - Universitätsmedizin Berlin have been able to show that maternal psychological wellbeing during pregnancy has a positive effect on newborn infants.

Trajectories of antidepressant medication use during pregnancy
In an analysis of women who started pregnancy when taking antidepressant medications, investigators identified three trajectories of antidepressant dispensing during pregnancy: more than half stopped their treatment, a quarter maintained their treatment throughout pregnancy, and one-fifth discontinued it for a minimum of three months and then resumed it during the postpartum period.

Are women using e-cigarettes during preconception and/or pregnancy?
A new study of 1,365 racially/ethnically diverse, low-income pregnant women found that 4% reported e-cigarette use.

A better pregnancy test for whales
To determine whale pregnancy, researchers have relied on visual cues or hormone tests of blubber collected via darts, but the results were often inconclusive.

Cannabis use during pregnancy
The large health care system Kaiser Permanente Northern California provides universal screening for prenatal cannabis use in women during pregnancy by self-report and urine toxicology testing.

Questions and answers about cannabis use during pregnancy
A new study shows that women have many medical questions about the use of cannabis both before and during pregnancy, and during the postpartum period while breastfeeding.

The effect of taking antidepressants during pregnancy
Exposure to antidepressants during pregnancy and the first weeks of life can alter sensory processing well into adulthood, according to research in mice recently published in eNeuro.

Is ivermectin safe during pregnancy?
Is it safe to give ivermectin to pregnant women? To answer this question, researchers from the Barcelona Institute for Global Health (ISGlobal), an institution supported by 'la Caixa,' conducted a systematic review and meta-analysis of studies that reported cases of accidental exposure to the drug among pregnant women.

Going to sleep on your back in late pregnancy
This study looked at whether going to sleep on your back in the third trimester of pregnancy was associated with average lower birth weights.

Read More: Pregnancy News and Pregnancy Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.