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Should women abstain from alcohol throughout pregnancy?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5232 (Published 06 October 2015) Cite this as: BMJ 2015;351:h5232

Rapid Response:

Re: Should women abstain from alcohol throughout pregnancy?

As the article rightly pointed out, the guidances available on drinking alcohol during pregnancy are at best, confusing and at worst, contradictory.

However, there are clear documented clinical evidences that alcohol, even at low levels, can cause harm to the foetus. Foetal alcohol syndrome disorder is a collection of symptoms where babies born to mothers who drink alcohol at some point of their pregnancy may develop, such as learning or behavioural problems or physical abnormalities. Critics claim that this only happens when the mother binge drinks but studies have shown though low levels of drinking may not cause growth abnormalities, it can affect the behavioural development of a child.

Because drinking alcohol is so ingrained in our culture, critics try to find an acceptable level alcohol drinking so that even pregnant woman are not totally cut off from this socially acceptable activity. But the truth is that no one knows unequivocally what is the safe level of the alcohol that does no harm to the foetus. Do we have a guideline that says to smoking mothers that it is fine to have a few puffs of cigarette a day when pregnant? There would be an outcry! It's unthinkable! Why then do we have guidelines that say it is permissible to drink a small amount during pregnancy, fully aware that alcohol is a well known teratogen?

In this day and age where we talk about picking the best genes for our babies or 'genetically-enhanced babies', shouldn't we first take the natural and ethically acceptable stance of advising mothers to abstain totally from alcohol throughout pregnancy to give our children the best chance of having a healthy normal development? Giving unclear or seemingly contradictory advice only serves to undercut the very purpose of having a guideline.

References:

McHugh, RK; Wigderson, S; Greenfield, SF (June 2014). "Epidemiology of substance use in reproductive-age women.". Obstetrics and gynecology clinics of North America 41 (2): 177–89.

Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, Janisse J, Martier S, Sokol RJ. Pediatrics. 2001 Aug; 108(2):E34.

Competing interests: No competing interests

07 October 2015
Jeffrey Luk
Gastroenterology Registrar
Heath Park, Cardiff