Practice Pregnancy Plus

Pregnancy and alcohol misuse

BMJ 2009; 338 doi: (Published 30 March 2009) Cite this as: BMJ 2009;338:b845
  1. Irene Guerrini, consultant psychiatrist in addictions1,
  2. Siobhan Jackson, borough lead in substance misuse2,
  3. Francis Keaney, consultant psychiatrist in addictions3
  1. 1Bexley Substance Misuse Service, South London and Maudsley NHS Foundation Trust, Kent DA8 1RQ
  2. 2Beresford Project, Greenwich and Antenatal Clinic, Queen Elizabeth Hospital Woolwich, South London and Maudsley NHS Foundation Trust, Woolwich, London SE18 6LZ
  3. 3South London and Maudsley NHS Foundation Trust, The Maudsley Hospital, Denmark Hill, London SE5 8AZ
  1. Correspondence to: I Guerrini irene.guerrini{at}
  • Accepted 4 November 2008

How does alcohol misuse affect pregnancy and babies’ outcomes, and how is the problem managed in pregnant women?

The debate about alcohol use in pregnancy is still wide open, even though ethanol is well known to be teratogenic and fetotoxic when consumed in excess during pregnancy. A consensus has not been reached about the “safe limit,” mainly because of a lack of scientific evidence.


A 32 year old woman was referred to an outpatient substance misuse centre to be treated for her alcohol misuse. The patient had had a baby six months before. The child was born at term but was small for gestational age. However, no other features of fetal alcohol spectrum disorder were highlighted at birth. The mother had been drinking excessively since the beginning of the pregnancy but she denied drinking on a daily basis and denied having had any withdrawal symptoms. Because of the mother’s alcohol misuse and problematic relationship with her husband, the child was given into voluntary foster care when he was 5 months old.

The health visitor and the paediatrician in charge of the baby’s care noticed a progressive deterioration in the child’s behaviour; at the age of 18 months the child was very hyperactive. His mother engaged well with the community service although she continued to under-report her problematic use of alcohol. A few months later she became pregnant again. She agreed to inpatient alcohol detoxification and to residential rehabilitation.

In 2007 the Department of Health published a revision of the recommendations about alcohol use in pregnancy. The revised advice says “Pregnant women or women trying to conceive should avoid drinking alcohol. If they do choose to drink, to minimise the risk to the baby, they should not drink more than one to two units of alcohol once or twice a week …

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