Head To Head

Should women abstain from alcohol throughout pregnancy?

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5232 (Published 06 October 2015) Cite this as: BMJ 2015;351:h5232
  1. Mary Mather, retired consultant paediatrician, London,
  2. Kate Wiles, NIHR doctoral research fellow, Biomedical Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London ,
  3. Patrick O’Brien, consultant honorary senior lecturer in obstetrics and gynaecology, University College London Hospitals, London, UK
  1. Correspondence to: M Mather marymather{at}doctors.org.uk, P O’Brien patrick.obrien{at}uclh.nhs.uk

Everyone agrees that current advice on alcohol is inconsistent and confusing, but whereas Mary Mather and Kate Wiles conclude we should move to a clear recommendation to abstain, Patrick O’Brien thinks it is wrong to assume pregnant women cannot understand the evidence

Yes—Mary Mather and Kate Wiles

No advisory body in England and Wales gives a clear recommendation to abstain from alcohol in pregnancy. The Department of Health recommends that pregnant women should avoid alcohol but undermines the advice by giving an apparently “safe” level for alcohol in pregnancy: that if a woman “chooses to drink” she should drink no more four units a week.1 The National Institute for Health and Care Excellence (NICE) emphasises avoiding drinking alcohol in the first three months of pregnancy because of an association with miscarriage.2 The Royal College of Obstetricians and Gynaecologists states that small amounts of alcohol have not been shown to be harmful.3

International consensus

Current guidance flies in the face of evidence and international consensus. The US surgeon general first advised women not to drink in pregnancy in 1981. Current US guidance states “that there is no known safe amount of alcohol to drink while pregnant, no safe time to drink and no safe kind of alcohol.”4 Pregnant women in Canada, Denmark, France, Norway, Israel, Mexico, Australia, Ireland, New Zealand, Spain, the Netherlands, and Scotland are advised to abstain from alcohol.5

Nearly 4000 papers have now been published confirming the teratogenicity of alcohol. There is no evidence that alcohol is beneficial to embryonic and fetal development. Teratogenicity has been conclusively shown in clinical, behavioural, and epidemiological studies, and undisputed teratogenic effects include fetal alcohol syndrome, mental retardation, a spectrum of developmental and behavioural abnormalities, and low birth weight.6

Worldwide estimates are that at least 1% of live births are affected by prenatal …

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