There is currently a lot of buzz in the nutrition world and in the media around the UK’s advice on consuming alcohol during pregnancy. It’s thought that the current advice we give may be confusing to pregnant women and needs to be clearer.
Different medical bodies make slightly different recommendations, which is really the crux of the problem, with many people suggesting recommendations need to be consistent.
For example, NICE (The National Institute for Health and Care Excellence) who provides national guidance and advice to improve health and social care in the UK recommend abstaining from alcohol whilst trying to conceive and during the first 12 weeks of pregnancy. Thereafter they recommend: “not more than one or two units, not more than once or twice a week does not appear to be harmful.”
On the other hand the Department of Health (DH) suggests: “If you’re pregnant, or planning to become pregnant, you should avoid alcohol altogether. But, if you do opt to have a drink, you should stick to no more than one or two units of alcohol once or twice a week to minimise the risk to your baby.”
So what’s the deal and would it be simpler to merely recommend abstaining from alcohol completely? Would this make it clearer for members of the public to understand? Let’s have a look at some of the facts from a recent Head to Head in the British Medical Journal:
- There is no evidence that alcohol is beneficial to embryonic and fetal development
- Alcohol is the leading preventable cause of birth defects and developmental and learning disability
- Current advice is confusing for parents and few pregnant woman or professionals may understand the concept of a “unit” of alcohol
- The alcohol amount and times during gestation at which fetal damage may occur is not known and likely to vary from pregnancy to pregnancy
- As each pregnant women is individual it can never be known what stage or amount is going to put them at most risk; the only ethical advice that can be given is abstinence from alcohol during pregnancy
- Pregnant women must know that there is no threshold of alcohol consumption that is certain to be ‘safe’ – including that recommended by NICE and DH
- In America their advice is clearer, stating: “there is no known safe amount of alcohol to drink while pregnant, no safe time to drink and no safe kind of alcohol.”
- Additionally, in Canada, Denmark, France, Norway, Israel, Mexico, Australia, Ireland, New Zealand, Spain, the Netherlands, and Scotland women are recommended to completely abstain from alcohol during pregnancy
- Alcohol is not essential to the health or wellbeing of a pregnant woman and is known to be harmful to her baby. Alcohol is not a drug that would ever be “prescribed” in pregnancy, and it is not a drug that should ever be advised
However, the other side of the coin…
- How common are fetal alcohol spectrum disorders and what proportion of these cases can reasonably be attributed to alcohol use?
- We should respect our patients’ autonomy and recognise that it is our responsibility to find a way of imparting the information in a way that is understandable to them, then support them in coming to a decision
- Recommending freedom of choice for parents who decide to drink alcohol
- We need to resolve these inconsistencies in our evidence first and then provide clearer information to the public
To read the full article see the BMJ Head to Head document here.
From my perspective I do believe that a clear recommendation is needed – especially for general public health guidance. We currently recommend not smoking during pregnancy – shouldn’t advice around another drug, that we know can be harmful to a growing foetus, be the same? If we don’t know the impact but we know it has no benefit, surely we should err on the side of caution, especially as people will often make their own choices despite guidelines anyway? Individuality and freedom of choice is important, but a clear public health message would help pregnant women make a more informed choice about drinking alcohol during pregnancy.
Would love to have comments and thoughts from readers too…