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The problem of drinking in pregnancy – and what to do about it

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Last year, it was reported that the UK has one of the worst rates of drinking while pregnant in Europe. These figures come from a study which shows 41% of women in the UK drank alcohol during their pregnancy. Among UK women who drink any alcohol when pregnant, an estimated 19% drink more than seven units of alcohol on one occasion. This is defined as binge drinking.

Research has also found that the UK has one of the highest predicted prevalence of Foetal Alcohol Syndrome in the world. Foetal Alcohol Syndrome is the most severe form of Foetal Alcohol Spectrum Disorders, a group of conditions that can occur in a person whose mother drank alcohol during pregnancy.

Foetal Alcohol Spectrum Disorders include a range of physical, mental, behavioural and learning disabilities. In the UK, 61 cases are estimated to occur for every 10,000 births. This is significantly higher that the global average of 15 out of 10,000 births.

These numbers however, do not give a picture of either timing or levels of alcohol exposure. Australian research, for example, shows that many women drink in the period before they know they are pregnant, but far fewer women continue when they find out they are pregnant. Similarly, a Scottish survey reported that 12% of women drank after pregnancy confirmation – compared to 66% who drank before.

But of course, a limitation of these studies, as with any research study, is that they are restricted to individuals and may not be representative of the whole population.

Mixed messages

The fact then that a recent report by Public Health England on child health outcomes did not include alcohol as a contributing factor, seems very shortsighted. This is despite acknowledging that lifestyle factors are key determinants for child health in early years.

In the UK, there is no consistent system in place to monitor prevalence of alcohol use among pregnant women. Midwives ask about alcohol during the booking appointment, but it is not mandatory to record the information in a woman’s notes. Without confirmation of alcohol use during pregnancy, diagnosing Fetal Alcohol Spectrum Disorders and putting appropriate support in place, becomes much more difficult.

The advice given to pregnant women in the UK about drinking alcohol during pregnancy has changed over time. In 2016, the Chief Medical Officers in the UK updated their guidelines to recommend pregnant women abstain from alcohol. Previously the National Institute for Health and Care Excellence recommended women avoid alcohol, but limit their intake if they chose to drink. The reason for the change in recommendation was the uncertainty of whether drinking small amounts of alcohol is harmful. These guidelines align with many other countries, who also adopt the “precautionary principle”.

A study comparing experiences in England and Sweden showed both midwives and new parents in England thought small amounts of alcohol might not harm the baby. In Sweden – where only one in ten women drink any alcohol during pregnancy – any alcohol was seen as risky, indicating that abstinence was generally accepted.

Learning from others

A new Fetal Alcohol Spectrum Disorders strategy has been published in Australia and in Canada, a four-step prevention model has been adopted by public health and research institutions. The Canadian model focuses on women making informed decisions and pregnancy planning to reduce the risk of harm.

Although not perfect, the model has influenced prevention efforts across all levels – from preconception to supporting new mothers. There is good evidence that information on alcohol and contraception to women of reproductive age can help to prevent an alcohol-exposed pregnancy.

Australia and New Zealand recently voted in favour of mandatory pregnancy warning on alcohol containers. In Europe, it is compulsory for alcohol containers to carry warning labels in a handful of countries. There is no UK legislation on labelling, research shows that 95% of products carry a warning – most commonly a logo without text. Of course, warning labels aren’t a solution in themselves. Research shows that they can [stimulate conversations about alcohol] but we know less about how they affect behaviour.

Supportive alcohol policy

Across the UK, there are positive developments in general alcohol policy – actions that will also have an impact of alcohol use during pregnancy.

This includes the introduction of a minimum unit pricing on alcohol in Scotland and the updated Scottish Alcohol Framework . The UK government has also started the process on a new alcohol strategy, but more still needs to be done.

Consistent, comparable data collection and prioritising women who consume alcohol during pregnancy is a first step forward for prevention, as is a coordinated approach for future alcohol policy. This will ensure the UK will not lag behind in addressing this important public health issue and that women, partners and children receive timely and appropriate support, where needed.

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