New alcohol guidelines for pregnant women: where's the evidence?

New government advice

The Department of Health issued this statement on 25th May:

Pregnant women or those trying to conceive are being advised to avoid drinking alcohol, and not to get drunk. Women who do choose to drink, before and during pregnancy, should drink no more than one to two units of alcohol once or twice a week.

The new guidelines have been introduced by the Department of Health to provide stronger, consistent advice for the whole of the UK.

Deputy Chief Medical Officer Dr Fiona Adshead said: ‘We have strengthened our advice to women to help ensure that no one underestimates the risk to the developing foetus of drinking above the recommended safe levels.

Our advice is simple: avoid alcohol if pregnant or trying to conceive.’

The National Organisation on Foetal Alcohol Syndrome estimates that there are more than 6,000 children born each year with Foetal Alcohol Spectrum Disorder, as a result of their mother’s alcohol consumption.

Previous advice, as clearly stated in DH's 2006 booklet 'How much is too much when you're having a baby?'  was pregnant women can drink up to 1 to 2 units of alcohol no more than once or twice a week. 

Advice from other bodies

The Royal College of Obstetricians and Gynaecologists' 2006 statement Alcohol consumption and the outcomes of pregnancy, here, reviews the evidence and concludes:

• The consumption of alcohol offers no benefits in relation to the outcomes of pregnancy. Under reporting of alcohol consumption is thought to be widespread, such that adverse effects in the offspring may not always be recognised.

• It is important for GPs, obstetricians and midwives to devise ways of identifying women who may suffer from problem drinking, during or before any pregnancy, at a time when potentially beneficial interventions can be offered.

• On the other hand, there is considerable doubt as to whether infrequent and low levels of alcohol consumption during pregnancy convey any long-term harm, in particular after the first trimester of pregnancy.

• It is important that long-term prospective cohort studies be conducted to address the questions discussed in this statement.

In June 2007, the British Medical Association published Fetal Alcohol Spectrum Disorders - a guide for healthcare professionals, here.  It says this about consumption levels:

• Women who are pregnant,or who are considering a pregnancy,should be advised not to consume any alcohol.

• The UK health departments should work in partnership with relevant stakeholder organisations to revise current guidance on sensible drinking (see appendix 3).They should ensure that consistent and clear advice is given to healthcare professionals and the general public regarding the sensible drinking message and the risks of alcohol consumption during pregnancy. (This was written before DH revised the guidance.)

The fall out

DH are not claiming there is new evidence to support the new, simpler message.  So why change the advice?  The arguments for (anything that safeguards children is a good idea) and against (there's no evidence for this advice; why patronise pregnant women) are set out in this audio from BBC Radio 4's Women's Hour.   

There are also fears that we may be heading towards the situation in America, where women who drink during pregnancy have been charged with attempted murder, see for example here.

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