Is it safe to drink alcohol in pregnancy – latest guidelines

We review the newest research and ask 7 experts to help you make sense of the guidelines on drinking and pregnancy

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Whether it’s OK or not to have an alcoholic drink when you’re pregnant can be a confusing and difficult decision –mainly because the official UK medical guidelines on alcohol and pregnancy are so unclear. And new, conflicting, scientific opinions keep appearing.

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In Jan 2016, the UK’s Chief Medical Officer recommended that women should avoid drinking any alcohol during pregnancy. This was reported by some newspapers and websites – and still is – as a change to current official guidelines for pregnant women. But it isn’t.

In May 2017, experts – including the leaders of the maternal rights campaign group Birthright and the British Pregnancy Advisory Service (BPAS) as well as academics specialising in parenting – stated that this super-strict recommendation has no basis in evidence.

They also say it goes so far that it risks making pregnant women hugely and unnecessarily anxious – even to the point that some of us, according to the BPAS, consider having a termination because of fears we have caused irreparable harm to our unborn baby.

So what are the latest official UK guidelines?

The UK Chief Medical Officers’ advice, which is published on the NHS website (2016), remains unchanged, stating:

Women who are pregnant or trying to conceive should avoid alcohol altogether.

But then…

However, if they do choose to drink, to minimise the risk to the baby, we recommend they should not drink more than 1-2 units once or twice a week and should not get drunk.

We think it’s not very helpful to say, Don’t drink – but if you do, only drink a little bit.

Wouldn’t it be more helpful to say, don’t drink or do drink a little – not both? We think it’s important that you know what the scientific evidence is, so you can make your own decision. We’ll keep updating this page whenever new scientifically-sound evidence is published – so you know this always reflects the latest thinking.

What the scientific evidence says

Not recommended – Drinking in your 1st trimester 

This is clear cut. All the expert medical organisations and health professionals recommend that you shouldn’t drink alcohol in your first trimester.

“The reason for advising women to avoid any alcohol in the first 12 weeks is that we know there is a slightly increased risk of miscarriage in those women who drink regularly in early pregnancy,” explains Dr Abigail Brun, a GP.

Not recommended – Drinking if you’re trying to get pregnant

Again, given the increased risk of miscarriage during early pregnancy, the advice is to avoid alcohol if you’re actively trying to conceive. Of course, lots of us get pregnant without realising – and the advice from the NHS is “not to worry unnecessarily as the risks of your baby being affected are likely to be low”. If you are concerned, have a chat with your doctor or midwife.

Harmful at any point during pregnancy – Heavy and possibly moderate drinking

There’s evidence that drinking heavily or even moderately (7 units a week) can lead to foetal damage, including Foetal Alcohol Spectrum Disorders, Foetal Alcohol Syndrome and miscarriage.

No evidence of any harm – Light drinking in your second and third trimesters

This is the controversial area. Although studies are being done all the time, as yet there is no medical proof that light drinking has any impact on your baby during your second and third trimesters.

Therefore many – but not all – health professionals will advise you that light drinking (1-2 drinks, once or twice a week) is fine in the 2nd and 3rd trimesters.

So what do the experts say?

The Midwife – Claire Friars, midwife for Tommy’s, the baby charity, says, “Too much alcohol during pregnancy can lead to Foetal Alcohol Syndrome, affecting the baby’s growth and mental ability, but this is usually only a problem in persistent heavy drinkers.

“Tommy’s follows the Government’s guidelines, which is to err on the side of caution and avoid alcohol. But if you do drink, stick to the guidelines of 1-2 units once or twice a week as there hasn’t been any research to show this is unsafe.”

The Doctor – GP Dr Harper says, “We know that heavy drinking definitely causes harm to an unborn baby, but experts are still debating whether low levels of alcohol have any effect.”

The British Medical Association (BMA) – In June 2015, the British Medical Association (BMA) called for pregnant women to abstain completely from drinking alcohol in any of their trimesters. The BMA is the professional association for doctors, so it’s an important opinion, but it is at odds with the current advice from the Royal College of Obstetricians and Gynaecologists (RCOG) and health watchdog NICE.

The Royal College of Obstetricians and Gynaecologists – RCOG updated its guidelines in February 2015, advising women not to drink alcohol during their first trimester or while trying to conceive. It stated that there is no evidence of a safe amount to drink during pregnancy, but reiterated that a rigorous check of scientific research over the past 15 years, shows there is no clear evidence that light drinking (1-2 units once or twice a week) in the second and third trimester does any harm to your baby.

The Watchdog (NICE) – Dr Gillian Leng, Deputy Chief Executive of NICE says, ‘We recommend that doctors and midwives should advise women to avoid drinking alcohol when trying to get pregnant and during the first three months of pregnancy.”

The Royal College of Midwives – The RCM states, “There is indeed no evidence to suggest that low levels of alcohol are harmful to the baby after the first three months of pregnancy. However, our advice is to remove all doubt and avoid alcohol whilst pregnant, and for women to stop drinking alcohol if they are trying to start a family.”

The National Childbirth Trust (NCT) – The NCT suggests pregnant women should follow Government guidelines. NCT says, “There is no doubt that there is a risk with alcohol, that the more you drink the higher the risk. But alcohol is just one of the risks during pregnancy.

“It’s very much a pregnant woman’s decision as to how much she drinks during pregnancy, as well as taking other risk factors into consideration such as whether to eat soft cheese or not.”

How many women drink alcohol during pregnancy?

We ran a MFM survey in 2014, asking more than 1100 women whether they drank during pregnancy.

  • 45% said they had drunk alcohol while pregnant
  • 24% of those who did drink said they stopped when they discovered they were pregnant

Three MFMers share their experiences of deciding to drink lightly after their first trimester

“During my first pregnancy I drank hardly anything. But in my current pregnancy, wine and cider has been my major craving, which has been really tough. I drank nothing during first trimester, but did allow myself small glasses once or twice a week after about 20 weeks if it got desperate! I did try not to make it a weekly habit” Christine 

“I’m in my third trimester with my second child and occasionally I do have a drink. Even then it’s something like a shandy or a glass of wine with lemonade, and after one glass I don’t have any more.” DarkStar 

“I went to a dinner party the other night and had one glass of wine. I don’t drink at lot or heavily. I know most people completely avoid all alcohol and I do most of the time when pregnant, but I don’t deprive myself of one glass at a special occasion.” Linz0209 

Tell me more about other mums’ decisions on whether to drink during pregnancy

What if you drank before you realised you were pregnant?

Dr Harper encourages you not to panic if you had a drink before you were aware of your pregnancy. “Every month in my work as a GP, I see women who are very happy to discover they’re pregnant, but concerned that they had a few drinks before finding out,” she says. “Once you do know you’re pregnant, it’s a different matter.”

Tell me more about drinking before you realised you were pregnant

What happens when you drink alcohol?

Your baby is nourished through your placenta. Any alcohol that you drink enters your bloodstream as a chemical known as acetaldehyde, and is then passed onto your baby via your placenta.

In her book Expecting Better: Why the conventional pregnancy wisdom is wrong and what you really need to know Emily Oster explains: “Your baby can actually process some alcohol, but not as much as an adult (obviously). If too much acetaldehyde is passed to the baby, it can get into his tissues and impact development.”

So what’s the safest way to drink?

According to Oster, if you do choose to drink during pregnancy, it’s safest to drink slowly.  “If you drink slowly, your liver can keep up and little acetaldehyde gets sent to the foetus… This means that the speed with which you drink really matters” she says. Drinking with a meal may help you to pace yourself.

When we put this theory to Dr Brun, she says she’s unaware of any evidence for the theory that drinking slowly with a meal would be less harmful to the unborn baby.

How much is a unit of alcohol?

One UK unit is 10ml (or eight grams) of pure alcohol. Look at the label of your drink for the letters ABV, which means Alcohol By Volume. This indicates the strength of the alcohol present.

You will find one unit in of alcohol in:

  • Half a standard (175ml) glass of wine at 11.5% ABV
  • Half a pint of beer, lager or cider at 3.5% alcohol by volume (ABV: you can find this on the label)
  • A single measure (25ml) of spirit, such as whisky, gin, rum or vodka, at 40% ABV

Unsure of how many units there are in a specific drink? Use the drinkaware calculator to find out 

You may find that you don’t want to drink

One of the most common early symptoms of pregnancy is nausea. Some mums-to-be also experience a strange metallic taste in their mouth, which can alter the taste of food and drink. As a result, you may find that alcohol is the last thing you want, particularly during the first 3 months of pregnancy.

One MFMer says, “My nausea was so bad that I didn’t feel like having an alcoholic drink until more than 4 months into my pregnancy. After that I only ever felt like having a small beer if I did drink.” Lorna

Tell me more about early pregnancy symptoms

So how much is too much?

When does ‘light drinking’ become excess drinking, or binge drinking? NICE guidelines tell you not to get drunk or consume more than 7.5 units on one occasion:

Women should be advised not get drunk or binge drink (drinking more than 7.5 UK units of alcohol on a single occasion) while they are pregnant because this can harm their unborn baby

One MFMer puts it like this:“Hopefully mums are sensible and realise that a glass of champagne at a wedding is fine but shots of tequila at the weekend are most definitely not!” Kayley Stoke

What happens to your baby if you drink too much?

Sustained heavy alcohol use through pregnancy can cause serious, lifelong damage to an unborn baby:

Foetal alcohol syndrome

Children and adults with foetal alcohol syndrome (FAS) suffer a range of problems, from facial abnormalities to behavioural and learning disorders. Visit fasaware.co.uk to find out more.

Foetal alcohol spectrum disorder

Binge drinking (occasional heavy drinking) and drinking more than the recommended levels during pregnancy have also been linked to foetal alcohol spectrum disorder (FASD) – a condition where children suffer some, but not all, of the symptoms of FAS. Visit fasdtrust.co.uk to find out more.

A landmark UK court case in February 2014 saw the mother of a six-year old girl born with foetal alcohol spectrum disorder (due to her mother’s excess drinking during pregnancy) taken to court for “poisoning” her child. If the case succeeds, harming a child by consuming alcohol during pregnancy could become a crime.

In a nutshell – is alcohol safe?

Of course, it’s your decision, but we can clarify that, from 15 years of research, the evidence shows:

  • Binge drinking (7.5 units or more on one occasion) is harmful to your baby
  • Sustained heavy drinking (7.5 units or more) is harmful
  • Drinking in your first trimester does increase the risk of miscarriage
  • There is no evidence that light drinking (1-2 drinks, once or twice a week) in your 2nd and 3rd trimester will damage your unborn baby or affect your pregnancy
  • There’s some evidence that moderate drinking (7 units per week) can be harmful to your baby
  • Of course, if you want to remove all risk, avoid drinking alcohol altogether in pregnancy

Read more…

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