Alcohol and pregnancy: clarifying the advice given to pregnant women
Many news outlets last week reported on the inaccuracy of advice given to pregnant women about how much alcohol is acceptable, and whether singular instances of binge drinking in the early stages of pregnancy affect child health. Elliot Gardner investigates the issue, and hears the response from the BPAS and RCM.
There has been some confusion in the last week about the amount of alcohol that is ‘acceptable’ for pregnant women to drink at various stages of the prenatal period. In the UK the official advice from chief medical officer (CMO) Dame Sally Davies is that pregnant women should not drink alcohol at all, though this information was changed as recently as August of last year, with the previous guidelines being that pregnant women should not drink more than 1-2 units of alcohol more than once or twice a week.
For alcoholic drinks producers and retailers, knowing how much their customers should be drinking is of prime importance, so understandably last week’s news is of vital concern.
The problems arose when attendees at the ‘Policing Pregnancy: Who Should be a Mother?’ event held at Canterbury Christ Church University were presented evidence claiming that isolated incidences of drinking, even binge drinking, have not been shown to cause long-term harm to either mother or baby. It is clear that the consistent heavy drinking of alcohol during pregnancy can result in the destructive ‘foetal alcohol syndrome’, but there is now conflicting advice on whether small and infrequent amounts will cause any damage to mother or child at all.
Advice without evidence – a “problematic approach”
The British Pregnancy Advisory Service (BPAS) takes issue with the revised advice of the CMO; with director of external affairs Clare Murphy saying that the major point of concern is the overstatement of risk, amounting to what she calls a “problematic approach”.
“It’s problematic because you cross a line where it becomes acceptable to tell people something that’s not true, that any small amount of alcohol in pregnancy can cause harm so best to avoid drinking any alcohol at all in pregnancy… I can see the attractiveness of that as a message of simplicity but I think we need to ask ourselves whether it’s right to convey information that isn’t evidence based on the basis that you can’t trust people with the evidence.”
According to Murphy, while you can see the intention behind the reissue of alcohol in pregnancy advice, the CMO’s guidelines imply that women can’t be trusted. She also claims that BPAS even sees women so concerned about episodes of binge-drinking they partook in before they knew they were pregnant that it’s a significant source of anxiety, with some women even considering an abortion in the fear that they have damaged the health of their child. When pushed though, Murphy did admit that concerns related to drinking were usually one of several factors influencing women’s’ choices, rather than the sole foundation of the decision to abort.
Regardless, the stance of BPAS is that there needs to be more reassurance to women that instances of uninformed binge-drinking in the early stages of pregnancy are unlikely to have caused harm to their baby, with Murphy citing a recent study found in the British Journal of Obstetrics and Gynaecology that found no evidence of negative childhood outcome among women who had drunk excessively on a few occasions in the early stages of pregnancy.
As a final point, Clare was also asked to comment on the views of the director of the Centre for Parenting Studies at the University of Kent Ellie Lee, who was quoted as saying that the “exclusion of women from ordinary activities on the basis of ‘precaution’ can more properly be called sexist than benign.” Murphy agreed, saying that “It’s treating pregnant women as people who are unable to make good informed choices in a way that we wouldn't treat any other group of people, so yes I do think it’s sexist.”
The other side of the argument has been picked up by the Royal College of Midwives (RCM), with professional policy advisor Janet Fyle reiterating that the RCM stands by the advice of the CMO. Though she appeared concerned that the RCM was misrepresented in the media’s reports last week.
“We say avoid. If you look at our statement we always say avoid. There was some furore last week about the fact we've been giving women the wrong information - it isn’t true. You cannot do research whereby you put a group of women and say 'let’s feed you with alcohol and see what happens to you and your baby' and then observe the woman and the baby having symptom upon symptom and fitting after birth.” Says Fyle, but you can, observe women of childbearing age and observe the effects of alcohol on them physically and mentally.
Fyle clarifies that this is a cumulative effect, and a couple of glasses of wine at a friend’s wedding aren’t likely to cause harm, but highlights that you never know who does or doesn’t have problems with alcohol.
“I think the Chief Medical Officer's advice has been misinterpreted” she says, “We urged the Chief Medical Officer to advise women to avoid alcohol, which she did. But one thing that complicated it, that we've never been in agreement with, was saying 'this many units are alright'.”
When asked to comment on the views of BPAS, Fyle quickly stated that the RCM stands by its own position, and cannot comment on the views of other organisations as their intent is not always clear. The RCM’s advice to women who are concerned about past or current alcohol use is to speak to their midwife, obstetrician, or GP. She did state, however that “we don’t know of women that have been going to have abortions large-scale because they've been drinking.”