Pregnant Drinker with Glass of WineI was really surprised earlier this week to see news articles stating that mothers-to-be can safely have 12 drinks a week in early pregnancy. The NHS website give a different view

Pregnant women can binge drink safely,” according to a report in today’s Metro. Expectant mothers should be able to “down up to 12 alcoholic beverages a week knowing it will have no ill effect on their offspring before the age of five”, the paper continued. Reports in several other papers were in agreement, with the Daily Mail claiming that a drink a day would not harm the baby’s development and the Daily Express reporting that 12 drinks a week is safe in pregnancy. So should pregnant women heave a sigh of relief and down a large glass of Chardonnay? Unfortunately, no.

The newspaper reports are based on a series of studies of women and their five-year-old children. The studies looked at the effect of different drinking patterns in early-to-mid pregnancy on the child’s intelligence, attention and other mental functions, such as planning and organisational ability.

An analysis of the five studies found that, overall, there was no effect of low-to-moderate weekly alcohol consumption on children’s neurodevelopment at the age of five. The research also didn’t find any association between binge drinking – defined here as five or more drinks on a single occasion – and children’s neurodevelopment. However, one of the studies did find a significant association between nine or more drinks a week and the risk of a low attention score in the child.

These studies are a valuable addition to the research on drinking in pregnancy and appear to provide some evidence that the occasional drink may not affect these particular neurodevelopmental outcomes in the child. However, they do not give the green light to an alcoholic free-for-all during pregnancy, as much of the media seems to imply. The research is in only a relatively small sample of pregnant women, and has not examined the wide breadth of potential adverse effects that alcohol could have upon the developing baby.

Heavy drinking in pregnancy is known to increase the risk of problems such as miscarriage, and is also known to increase risk of foetal alcohol syndrome (FAS) or its milder form of foetal alcohol spectrum disorder (FASD). FAS and FASD can encompass a wide range of problems in the child, from birth defects to learning and behavioural difficulties and problems with movement and co-ordination.

There is still uncertainty about what constitutes a “safe” level of alcohol during pregnancy, if any amount is safe. The research does not alter the current advice in the UK for women who are pregnant or planning to get pregnant. The Department of Health (DH) advises that alcohol is to be avoided in pregnancy if possible, while the independent National Institute for Health and Clinical Excellence (NICE) specifically advises women to avoid alcohol in the first three months of pregnancy because of the risk of miscarriage. If women choose to drink alcohol during pregnancy they are advised to drink no more than one to two UK units once or twice a week. The DH advises that women should not get drunk, which NICE also says may be harmful. A unit equals half a pint of standard-strength lager or beer, or one shot (25ml) of spirits, while one small (125ml) glass of wine is equal to 1.5 UK units.

Where did the story come from?

The five studies that form the basis for these reports were carried out by US, Norwegian and Danish researchers. Funding was provided by the US Centers for Disease Control and Prevention (CDC) and various other organisations. The studies were published in the peer-reviewed British Journal of Obstetrics and Gynaecology (BJOG). The studies comprised research into:

  • the effects of low-to-moderate alcohol in early pregnancy upon IQ in five-year-olds
  • the effects of binge drinking in early pregnancy upon general intelligence in five-year-olds
  • the effects of low-to-moderate alcohol or binge drinking in early pregnancy upon selective and sustained attention in five-year-olds
  • the effects of low-to-moderate alcohol or binge drinking in early pregnancy upon executive function (for example, ability to plan or organise) in five-year-olds
  • a combined analysis looking at the effect of different alcohol consumption during early-to-mid pregnancy and effects upon the child’s intelligence, attention and executive function

This Behind the Headlines appraisal focuses on the last study of these, which summaries the other four reports.

Coverage in the media was confusing, potentially misleading and damaging. Several papers, such as the Metro and the Mail, claim that binge and heavy drinking during pregnancy is safe, while the BBC and the Telegraph report that low or moderate drinking does “no harm” to the child. The claim made by the Express and the Mail that pregnant women can safely consume 12 alcoholic drinks a week is particularly worrying. Heavy drinking is known to have a risk of affecting the development of the foetus, and one of the studies did demonstrate that nine or more drinks a week was associated with a lower attention span in five-year-olds.

While the details of this study were generally reported fairly accurately, the general conclusion in all national media sources – that there is a safe level of alcohol in pregnancy – is not borne out by the evidence on miscarriages and foetal alcohol syndrome. The research simply shows that in this small Danish sample, children surviving to the age of five show no significant neurodevelopmental damage at that age.

Advice on alcohol in pregnancy

  • The Department of Health advises that alcohol should be avoided in pregnancy if possible.
  • The National Institute for Health and Clinical Excellence (NICE) advises women who are pregnant to avoid alcohol in the first three months in particular, because of the increased risk of miscarriage.
  • If women choose to drink alcohol during pregnancy they are advised to drink no more than one to two UK units once or twice a week, and avoid getting drunk. A unit equals half a pint of standard strength lager or beer, one shot (25ml) of spirits, while one small (125ml) glass of wine is equal to 1.5 UK units.

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