Drinking in pregnancy guidance

Wednesday March 26 2008

Women should not drink any alcohol during pregnancy, newspapers report today. They say that the NHS standards “watchdog” has changed its advice for pregnant women, recommending they should drink no alcohol during the first three months of pregnancy, and if they choose to drink after this period, to have a maximum of two units once or twice a week.

During pregnancy, alcohol can pass freely from the placenta to the unborn baby and it is known that excess alcohol can harm the foetus. There is general agreement that women should not drink excessively during pregnancy. However, it is difficult to investigate the effects of alcohol on unborn children and it is therefore not clear what level of drinking is harmful to a pregnant woman and her baby. The publication of the new guidelines means that a pregnant woman will be told the new advice the first time she sees a doctor or nurse.

What are NICE guidelines?

The National Institute for Health and Clinical Excellence (NICE) is an independent organisation responsible for giving national guidance on the promotion of good health and the prevention and treatment of ill health. The guidelines are developed by groups of health professionals, scientists and others who may have relevant views, such as patients and carers. NICE looks at the available evidence on the best way of treating or managing a condition and makes recommendations based on this evidence. Doctors, nurses and other healthcare professionals in the NHS are expected to follow NICE’s clinical guidelines.

NICE has changed its recommendations about drinking alcohol during pregnancy as part of an update to its antenatal guidelines. This provides advice about all stages of pregnancy care, including screening, testing and check-ups.

What are the new guidelines for drinking during pregnancy?

NICE’s actual wording is as follows:

  • Pregnant women and women planning a pregnancy should be advised to avoid drinking alcohol in the first three months of pregnancy if possible because it may be associated with an increased risk of miscarriage.
  • If women choose to drink alcohol during pregnancy they should be advised to drink no more than one to two UK units once or twice a week (one unit equals half a pint of ordinary strength lager or beer, or one shot [25 ml] of spirits. One small [125 ml] glass of wine is equal to 1.5 UK units). Although there is uncertainty regarding a safe level of alcohol consumption in pregnancy, at this low level there is no evidence of harm to the unborn baby.
  • Women should be informed that getting drunk or binge drinking during pregnancy (defined as more than five standard drinks or 7.5 UK units on a single occasion) may be harmful to the unborn baby.

Who are they aimed at?

The guidelines are intended for use by clinicians and pregnant women. They state that advice about alcohol consumption should be given to pregnant women during their first contact with a healthcare professional.

Why have they changed?

The latest guidelines are an update of a document published in 2003. The revisions are based on the medical consensus of the review group.

What else do the guidelines say?

As well as information about drinking alcohol during pregnancy, the antenatal guidelines contain other updated advice for healthcare professionals, including:

  • At their first official check-up, pregnant women should be told the importance of keeping adequate vitamin D levels for their own and their baby’s health during pregnancy and while breast feeding. Women can be advised to take ten micrograms of vitamin D per day.
  • All pregnant women should be offered screening for sickle-cell diseases, thalassaemias and Down’s syndrome.
  • It is recommended that all women are screened for gestational diabetes.

Sir Muir Gray adds...

It is very unlikely that there is a lower threshold below which there is no risk of harm. The distribution of risks is usually continuous; that is, if a risk can be demonstrated at a high level of exposure there is almost always a risk at all levels of exposure. However, the demonstration of that risk is difficult.

Analysis by NHS Choices
Edited by NHS Website