pregnancy, drinking, alcohol in pregnancy

Everyone wants to do the best by their baby, but it can be difficult to know what’s safe or not when it comes to alcohol. We look at what’s recommended.

Most pregnant women are aware that drinking alcohol can be harmful to their baby. But advice about whether it’s okay to have the odd drink can be confusing. Below are the recommendations on whether or not you should drink at all during pregnancy.

Is it safe to drink a little during pregnancy?

The advice is – no, not really. Research has shown that even drinking small amounts of alcohol could potentially be harmful for your baby (Andersen et al, 2012, Sundelin-Wahlsten et al., 2017; Department of Health, 2016, Lundsberg et al., 1997). The UK Chief Medical Officer has therefore recommended that, as a precaution, you shouldn’t drink alcohol at all during your pregnancy. This is also the case if you’re trying to get pregnant (Department of Health, 2016).

The Royal College of Obstetricians and Gynaecologists also back this up. They advise against drinking if you think you could become pregnant, or if you’re breastfeeding (RCOG, 2018).

How about after the first trimester?

Again, unfortunately not. Guidelines say that pregnant women should avoid drinking alcohol in the first three months of pregnancy. This is because it may be associated with an increased risk of miscarriage (NICE, 2008). This doesn’t necessarily mean it’s fine to drink from three months onwards. It’s still safer not to drink alcohol later in pregnancy.

I have been drinking while I was pregnant: what does this mean for my baby?

The risk of harm to your baby is likely to be low if you’ve only drunk small amounts of alcohol before you knew you were pregnant or during your pregnancy (Department of Health, 2016).

So, if you find out you’re pregnant after already having drunk during early pregnancy, don’t worry too much but try and avoid drinking any more.

It is unlikely in most cases that your baby has been affected (Department of Health, 2016). If you are worried about how much you have been drinking when pregnant, talk to your doctor or midwife.

Will drinking during pregnancy harm my baby?

If you drink alcohol during pregnancy, some alcohol will pass through the placenta to your baby (RCOG, 2018). Alcohol is a teratogen (a substance that can cause birth defects) which the baby’s liver cannot process yet (NHS Choices 2018). So drinking alcohol during pregnancy can affect the way your baby develops. The more you drink, the greater the risk of harm to your baby (RCOG, 2018).

There is evidence that drinking alcohol can have a negative impact on your baby’s health, both before birth and in their first few years (Department of Health, 2016). Drinking a moderate amount of alcohol might lead to an increased risk of miscarriage in the first trimester (Andersen et al., 2012) or having a short baby or a baby with low birth weight (Sundelin-Wahlsten et al., 2017; Department of Health, 2016). There is also an increased risk of stillbirth (Aliyu et al., 2008), as well as an increased risk of premature labour (Lundsberg et al., 1997).

Alcohol use can also cause the placenta to not work as well as it should. This is known as foetal growth restriction (RCOG, 2018).

Even low amounts of alcohol consumption can lead to some of these risk effects, such as the increased risk of miscarriage in the first trimester, the risk of preterm labour, and the effects on birth weight and size.

But my friend told me she sometimes had a glass of wine when she was pregnant…

Previously guidelines suggested that it might be okay to have one or two units such as a small glass of wine or half a pint of beer, once or twice a week during pregnancy. But the current guidelines are that this is not recommended.

Why do some people say that drinking small amounts of alcohol during pregnancy is safe then? 

Studies into drinking alcohol in pregnancy have had mixed results. Some haven’t been able to find convincing evidence that drinking small amounts of alcohol in pregnancy is bad for your baby (Henderson, Gray, & Brocklehurst, 2007; Mumluk et al., 2017).

One review found that low-to-moderate alcohol consumption during pregnancy was linked with a slightly increased risk of having a small baby. But it couldn’t prove that it affected birth weight or the risk of premature birth (Mumluk et al., 2017).

Because of this, some people have said there is no evidence to suggest that drinking small amounts of alcohol during pregnancy is harmful. But this is misleading. Just because drinking small amounts of alcohol might not harm some babies, it doesn’t mean that there is no risk for other babies (Mills et al., 2017).

For example, it’s possible that the effects of alcohol use are different depending on how many months pregnant the mum is when she has a drink. Or it could depend on individual differences in how she metabolises, i.e. breaks down, alcohol.

It may also be the case that light drinking might result in more subtle effects that cannot be detected by small-scale studies.

More large-scale studies need to be carried out to look into the effects of light to moderate drinking during pregnancy. Until these studies have been done, the safest approach is not to drink alcohol at all.

What are the risks of heavy alcohol consumption?

Excessive drinking on a regular basis during pregnancy can cause foetal alcohol spectrum disorder (FASD) or foetal alcohol syndrome (FAS) (RCOG, 2018). While FASD is less severe than FAS, children with FASD can have learning difficulties, problems with behaviour, physical disability, and emotional and psychiatric problems that last a lifetime.

Whether or not a baby is affected mildly or severely with FASD is directly linked to how much and how often a mum drinks during pregnancy. Heavy drinking of alcohol or drinking alcohol regularly in pregnancy is harmful for babies and may result in FAS, the more serious condition (RCOG, 2018).

Children with FAS usually have severe physical and mental disability. For example they can be short, have heart defects, unusual facial features, and learning and behavioural difficulties (NOFAS UK nd). For more information, see the resources available from NOFAS (National Organisation for Foetal Alcohol Syndrome-UK) at: www.nofas-uk.org

Even if you don’t drink regularly, your baby can be affected if you binge drink (Niclasen et al 2014)

How much alcohol during pregnancy is regarded as ‘too much’?

Scientists have been unable to find a level of alcohol consumption in pregnancy below which it is certain that there will be no harm to the baby.

In other words, there is no evidence-based ‘safe’ level of drinking alcohol in pregnancy (NHS Choices, 2018). Therefore, it is best to avoid alcohol altogether.

Tips on avoiding alcohol when you’re pregnant

If you normally enjoy a drink, it can be tempting to want one when other people are drinking around you.

It may help to ask your partner, friends and family to support you by not offering to buy, pour, or prepare you drinks. It can help if your partner stops drinking too, or at least cuts down themselves when you’re pregnant.

You may also want to avoid bars and clubs and other places associated with drinking alcohol. (Brown & Tricky, 2018). If you are socialising, most people should understand that you’re pregnant and avoiding alcohol. There are plenty of delicious non-alcoholic drinks out there – gone are the days when you’d have to sip orange juice all evening.

If you drink a lot and are worried about alcoholism and how to cut down, talk to your midwife or family doctor. Alternatively, you might prefer to call one of the helplines listed below.

 

Getting support

Confidential help and support is available from local counselling services (look in the telephone directory or contact Drinkline on 0800 917 8282). You can also talk to your midwife if you have any concerns about your drinking around the time of conception or in early pregnancy.

This page was last reviewed in November 2019.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

NHS choices offers  information on alcohol and pregnancy. The Change for Life campaign also has a page on pregnancy and alcohol

Drinkline is the national alcohol helpline. If you're worried about your drinking, you can call the free number 24 hours a day: 0800 917 8282

Alcoholics Anonymous (AA) is a self-help group for anyone with alcohol problems. National Helpline number 0845 769 7555. There are also regular support groups.

Al-Anon Family Groups offer support and understanding to the families and friends of problem drinkers, whether they're still drinking or not.

Addaction is a UK-wide treatment agency that helps individuals and families with the effects of drug and alcohol misuse.

Adfam is a national charity working with families affected by drugs and alcohol. Adfam operates an online message board and database of local support groups.

Aliyu, M. H., Wilson, R. E., Zoorob, R., Chakrabarty, S., Alio, A. P., Kirby, R. S., & Salihu, H. M. (2008). Alcohol consumption during pregnancy and the risk of early stillbirth among singletons. Alcohol, 42(5), 369-374.

Andersen, A. M. N., Andersen, P. K., Olsen, J., Grønbæk, M., & Strandberg-Larsen, K. (2012). Moderate alcohol intake during pregnancy and risk of fetal death. International Journal of Epidemiology, 41(2), 405-413.

Brown, R. and Trickey H., Devising and communicating public health alcohol guidance for expectant and new mothers: a scoping report. Alcohol Research UK, forthcoming.

Department of Health (2016). UK Chief Medical Officers’ Alcohol Guidelines Review: summary of the proposed new guidelines. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uplo… (Accessed May 2018).

Henderson, J., Gray, R., & Brocklehurst, P. (2007). Systematic review of effects of low–moderate prenatal alcohol exposure on pregnancy outcome. BJOG: An International Journal of Obstetrics & Gynaecology, 114(3), 243-252.

Lundsberg, L. S., Bracken, M. B., & Saftlas, A. F. (1997). Low-to-moderate gestational alcohol use and intrauterine growth retardation, low birthweight, and preterm delivery. Annals of epidemiology, 7(7), 498-508.

Mills, H., De Vivo, M. and Beedie, C. (2017) Why absence of evidence of risk is not the same as evidence for absence of risk. CCCU Expert Comment. Available at: http://create.canterbury.ac.uk/15871/ (Accessed May 2018).

Mamluk, L., Edwards, H. B., Savović, J., Leach, V., Jones, T., Moore, T. H., ... & Smith, G. D. (2017). Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently ‘safe’levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ open, 7(7), e015410.

NHS Choices (2018). Drinking alcohol while pregnant. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/alcohol-medicines-drug… (Accessed May 2018).

NICE (2008). Antenatal care for uncomplicated pregnancies. Available at: https://www.nice.org.uk/guidance/cg62/chapter/1-Guidance#lifestyle-considerations (Accessed May 2018).

Niclasen et al (2014) Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years? Available at: https://link.springer.com/article/10.1007/s00787-013-0511-x

NOFAS UK (nd) Feotal Alcohol Spectrum Disorder. Information for Parents, Carers and Professionals.  http://www.nofasuk.org/documents/2011.331%20NOFAS%20Factsheets%20Generi…

RCOG (2018). Alcohol and pregnancy. Available at: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf (Accessed May 2018).

Sundelin‐Wahlsten, V., Hallberg, G., & Helander, A. (2017). Higher alcohol consumption in early pregnancy or low‐to‐moderate drinking during pregnancy may affect children's behaviour and development at one year and six months. Acta Paediatrica, 106(3), 446-453.

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