Alcohol consumption for women trying to conceive

In Britain, approximately 12.5% of women experience difficulty trying to conceive within 12 months,1 and rates are similar in other developed countries.2 Infertility can be a devastating experience for couples, with high levels of psychological strain and even risk of suicide.3 This can result in millions of women going through a heart breaking, all consuming process, who will inevitably look for lifestyle modifications, including their alcohol consumption, to improve their chances of having a baby.

The paper by Mikkelsen and colleagues (doi:10.1136/bmj.i4262) will offer some reassurances.4 In a prospective study of more than 6000 Danish women from the general population who were trying to get pregnant, they found that those who were drinking up to 14 “servings” of alcohol a week (equivalent to just over two bottles of wine a week) had no difference in conception rates within 12 months compared with women drinking none. Does this mean that women enduring the stress of trying to conceive should not feel guilty for having a drink?

Mikkelsen and colleagues found some evidence to suggest that women in their study who were drinking more than 14 servings a week experienced reduced fecundity, but the certainty is not clear owing to low power (only 1.2% of the sample drank more than 14 servings).4 Furthermore, the authors were not able to assess the effect of binge drinking on ability to conceive. Paradoxically, we know that intoxication is associated with an increase in unplanned pregnancy,5 presumably as a result of not using contraceptives. However, it is hypothesised that heavy irregular drinking may disrupt menstrual cycles.6

Then there is the tricky problem of the blurring of time between trying to conceive and actually being pregnant. Humans are not usually able to pinpoint the exact moment of conception, and most pregnancies are not confirmed until at least two weeks after a missed period. So confusion exists here. Although it may be safe for a woman to drink alcohol when she is trying to conceive, she is advised not to drink during pregnancy. The recent advice from the UK chief medical officers is that, “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”7

For women trying to conceive, improving their physical health makes sense, and this may include a reduction in alcohol intake. However, the latest evidence from this Danish study is that total abstinence may not be necessary to maximise conception rates. The decision whether to consume alcohol is a woman’s individual choice and one that may involve weighing up the possible harm and associated guilt of drinking during (unknown) early pregnancy.8 The partner’s drinking habit must also be considered. Unfortunately, this was not included in the Danish study as data were not collected on men’s alcohol intake; however, as the authors note, heavy alcohol intake may affect sperm quality.9

Given that it can take many months to become pregnant, a woman may choose not to abstain from drinking for the duration. If alcohol is consumed moderately, it seems that this may not affect fertility. However, it would be wise to avoid binge drinking, both for the potential disruption to menstrual cycles and also for the potential harm to a baby during early pregnancy. If a couple are experiencing difficulty in conceiving, it makes sense for both partners to cut down on their alcohol intake. However, as with many things in life, moderation is key and avoiding guilt can only be a good thing during what can be a very stressful time.