Intended for healthcare professionals

Rapid response to:

Head To Head

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:

Impartial information about alcohol during pregnancy or another modern witch hunt?

O’Brien rightly rejects bullying intelligent, autonomous, adults just because they are pregnant.(1) The answer to his question “just how common are fetal alcohol spectrum disorders …?”(1) is that alcohol during pregnancy is the foremost cause of preventable mental impairment in Western countries.(2) Moreover, as too few clinicians diagnose prenatal exposure to alcohol at birth, it then becomes too late to offer secondary prevention and treat efficiently when school teachers observe learning difficulties or violent behaviour.

O’Brien recognises medical professionals’ duty to respect patients’ rights (1), but misses the deliberate confusion of many people by the alcohol industry. Alcohol is one of the most significant ‘fast moving consumer goods’ marketed today. Fraudulent scientific publications (3) plus more than £800 million spent annually in the UK on advertising alcohol (4) successfully promote addictive carcinogens and teratogens as a healthy lifestyle choice.

Drinking alcohol is a high risk behaviour. Not a single guideline recommends drinking alcohol. If someone drinks alcohol, all guidelines recommend moderation. The American College of Cardiology quotes Saint Augustine’s wisdom, that “complete abstinence is easier than perfect moderation”.(5) The only people who appear to expect moderate use of an addictive substance are those who support the failed “Responsibility Deal”.(6)

Good advice should be non-stigmatising. It is not reasonable to ask pregnant women to be superhuman, when that standard is not the social norm. We are all members of communities and populations that are drinking more. A kind, child-friendly society might be one in which we all cut our drinking in order to help avoid fetal alcohol syndrome; one that offered effective interventions, rather than just pointing the usual finger of blame. Instead of demonising vulnerable women who can’t stop their problem drinking, what about the government stepping up to the public health challenge?

1 Mather M, Wiles K, O’Brien P. Should women abstain from alcohol throughout pregnancy? BMJ 2015;351:h5232.

2 Braillon A, Dubois G. Alcohol and public health. Lancet. 2005;365:1387.

3 Roehr B. Cardiovascular researcher fabricated data in studies of red wine. BMJ 2012; 344: e406.

4 Institute of Alcohol Studies. Marketing and alcohol. Factsheet. May 2013. Available at http://www.ias.org.uk/uploads/pdf/Factsheets/Marketing%20and%20alcohol%2... . Accessed 10 Oct 2015

5 American College of Cardiology. Available at https://www.acc.org/latest-in-cardiology/articles/2015/01/05/13/06/alcoh.... Accessed 10 Oct 2015

6 Limb M. Public health body quits responsibility deal over government's failure to act on tobacco and alcohol. BMJ. 2013;347:f4590.

Competing interests: No competing interests

12 October 2015
Alain Braillon
senior consultant
Susan Bewley Professor of Complex Obstetrics, Women’s Health Academic Centre King's College London, St Thomas' Hospital, London. UK
University Hospital. 80000 Amiens. France