Everyone wants to do the best by their baby, but the messages about what’s safe or not when it comes to alcohol can be confusing. We look at the evidence.
Most pregnant women have heard that drinking alcohol can be harmful to their baby. Below is information to help you decide about drinking during pregnancy.
Why the concern about drinking in pregnancy?
Fetal Alcohol Syndrome (FAS) is a complex condition made up of severe developmental difficulties and some physical changes (BMA, 2016). Of babies born to women who consumed large amounts of alcohol in pregnancy, 4-5% will have FAS (BMA, 2016, p12).
The less severe condition of Fetal Alcohol Syndrome Disorder (FASD) is found in more babies. This could be between 2% and 5% of all babies, but there isn’t a consistent way of diagnosing it, so the actual number is unclear (BMA, 2016). Children with FASD can have learning difficulties, problems with behaviour, physical disability, and emotional and psychiatric problems (BMA, 2016).
Both FAS and FASD are linked with heavy alcohol consumption, particularly binge drinking, but also with other risk factors (BMA, 2016).
More than six units of alcohol a day is defined as 'binge drinking,' and the incidence of this is increasing (BMA, 2016). However, the majority of women do not drink during pregnancy, or drink at very low levels (Mardby et al, 2017). Research also shows that women drink less in the second trimester, when they are aware of their pregnancy, than in the first (BMA, 2016), including binge drinking (BPAS, 2015).
What is the official guidance?
The UK Chief Medical Officer (CMO) has recommended that 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 Department of Health gives the risks of drinking alcohol during pregnancy as including low birth weight, preterm birth, and small size for gestational age. It also goes on to say that these risks "may be increased in mothers drinking above 1-2 units a day (Department of Health, 2016)" which is the same guide as for the general population of adults.
The Department of Health are concerned about women underestimating their actual consumption, they feel it is safer to recommend no alcohol at all during pregnancy.
The Royal College of Obstetricians and Gynaecologists also follow the CMO guidance. They refer to there being no safe level of drinking in pregnancy (RCOG, 2018).
Will drinking during pregnancy harm my baby?
If you drink during pregnancy, some alcohol will pass through the placenta to your baby (RCOG, 2018). Your baby's liver cannot process alcohol yet (NHS Choices 2018a). The more you drink, the greater the risk of harm to your baby (RCOG, 2018).
There is clear evidence that heavy drinking can affect the baby (BMA, 2016). This could include miscarriage, low birth weight, premature labour, still birth, and increased incidence of illnesses in infancy and childhood (RCOG, 2018; WHO, 2016).
However, evidence for low to moderate drinking is inconsistent and inconclusive (BMA, 2016). Some research found no negative effects on your baby, while others suggest potential negative effects (BMA, 2016).
So there is no clear evidence to suggest that drinking small amounts of alcohol during pregnancy is harmful or safe. Of course, while 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). This has led to guidance that the only way to be sure there is no effect on your baby is to avoid alcohol altogether (NHS, 2018a; RCOG, 2018; Department of Health, 2016).
More large-scale studies need to be carried out to look into the effects of light to moderate drinking during pregnancy. When these studies have been done, women will have more information on which to base their own decisions about alcohol consumption.
How much alcohol during pregnancy is regarded as ‘too much’?
Scientists have been unable to find a level of alcohol consumption in pregnancy that either causes or does not cause harm to the baby. Because pregnancy is a complicated process, the idea of a ‘safe’ amount of alcohol is irrelevant because what may be safe in one person may be risky in another (BMA, 2016).
To give a very rough guide:
‘low’ consumption might be up to 2 units per week
‘moderate’ is the normal adult recommendation of up to 2 units per day
‘binge’ drinking is 6 or more units in a day
It’s a good idea to remind yourself how much a unit is, as it can be smaller than you expect. For example, in restaurants a ‘small’ glass of wine is usually 175ml, but you can ask for 125ml instead.
One unit of alcohol is 10ml of pure alcohol. So, for example:
Single 25ml shot of spirit like vodka or gin = 1 unit
275ml bottle of alcopop = 1.5 units
Small 125ml glass of wine = 1.5 units
330ml bottle of lager, beer or cider = 1.7 units
440ml can of lager, beer or cider = 2 units
Pint of lower-strength lager, beer or cider = 2 units
Standard 175ml glass of wine = 2.1 units
Pint of higher-strength lager, beer or cider = 3 units
Large 250ml glass of wine = 3 units (NHS, 2018b)
Remember that 'home' measures might be larger than these, so take that into consideration.
I had been drinking before I knew I was pregnant: what does this mean for my baby?
The only known chance of any harm to your baby is if you’ve been drinking large amounts of alcohol frequently before you knew you were pregnant or during your pregnancy (BMA, 2016).
If you are worried about how much you have been drinking when pregnant, talk to your doctor or midwife.
What does the law say?
In 2014 the UK Court confirmed that a pregnant woman has no legal duty of care to her baby (BMA, 2016, p66). This was a legal test of whether a child can make a claim against a mother who drank in pregnancy, resulting in FASD. In UK law, the baby has no legal rights, and the pregnant woman or person can make their own decisions about their body.
Tips on avoiding alcohol when you’re pregnant
Many pregnant women find they go off alcohol. However, if you haven't, but still want to avoid it, what could you do?
Your partner, friends and family can support you by not offering to buy, pour, or prepare you drinks (Brown & Trickey, 2018). 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 & Trickey, 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.
Confidential help and support is available from local and national counselling services. 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 2021.
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.
The NHS offers information on cutting down alcohol (NHS, 2018c).
Alcoholics Anonymous (AA) is concerned with the personal recovery and continued sobriety of individual alcoholics who ask for help. National Helpline number 0800 917 7650 https://www.alcoholics-anonymous.org.uk/
Al-Anon Family Groups are there for anyone whose life is or has been affected by someone else’s drinking. 0800 0086 811 https://www.al-anonuk.org.uk/
With You is a UK-wide treatment agency that delivers support and raise awareness around drugs, alcohol and mental health 0808 801 0750 https://www.wearewithyou.org.uk/
Adfam empower family members and carers to prevent drug and alcohol abuse threatening family relationships and wellbeing. https://adfam.org.uk/
Drinkline 0300 123 1110 (9am-8pm, weekends 11am-4pm)
Abernethy C, McCall KE, Cooper G, et al (2018) Determining the pattern and prevalence of alcohol consumption in pregnancy by measuring biomarkers in meconium
Archives of Disease in Childhood - Fetal and Neonatal Edition 103:F216-F220. Available at: https://fn.bmj.com/content/103/3/F216 (Accessed 9 Dec 21)
Brown, R. and Trickey H., (2018) Devising and communicating public health alcohol guidance for expectant and new mothers: a scoping report. Alcohol Research UK. Available at: https://alcoholchange.org.uk/publication/communicating-public-health-alcohol-guidance-for-expectant-mothers-a-scoping-report-1 (Accessed 9 Dec 21)
BMA (2016) Alcohol and pregnancy: preventing and managing fetal alcohol spectrum disorders. Available at: https://www.bma.org.uk/media/2082/fetal-alcohol-spectrum-disorders-report-feb2016.pdf (Accessed 8 Dec 21)
BPAS (2015) BPAS comment on BMJ Open study examining prevalence of alcohol use in pregnancy. Available at: https://www.bpas.org/about-our-charity/press-office/press-releases/bpas-comment-on-bmj-open-study-examining-prevalence-of-alcohol-use-in-pregnancy-1/ (Accessed 8 Dec 21)
BPAS (2016) BPAS comment on newborns in Scotland being tested for alcohol. Available at: https://www.bpas.org/about-our-charity/press-office/press-releases/bpas-comment-on-newborns-in-scotland-being-tested-for-alcohol/ (Accessed 9 Dec 21)
BPAS (2021) BPAS comment on the World Health Organisations Draft Global Alcohol Action Plan 2022-2030. Available at: https://www.bpas.org/about-our-charity/press-office/press-releases/bpas-comment-on-the-world-health-organization-s-draft-global-alcohol-action-plan-2022-2030/ (Accessed 8 Dec 21)
BPAS (No date) Alcohol in pregnancy – what are the issues? Available at: https://www.bpas.org/get-involved/campaigns/briefings/alcohol-in-pregnancy/ (Accessed 9 Dec 21)
Department of Health (2016) UK Chief Medical Officers’ Low Risk Drinking Guidelines. Available at: https://www.gov.uk/government/consultations/health-risks-from-alcohol-new-guidelines (Accessed 8 Dec 21) p8
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).
NHS (2018a). Drinking alcohol while pregnant. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/alcohol-medicines-drug… (Accessed Dec 2021).
NHS. (2018b) Alcohol units. Available at: https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/ [Accessed 1st June 2018]
NHS. (2018c) Tips on cutting down. Available at: https://www.nhs.uk/live-well/alcohol-support/tips-on-cutting-down-alcohol/ [Accessed 1st March 2018]
NICE (2021) Antenatal care NG201. Available at: https://www.nice.org.uk/guidance/ng201/chapter/Recommendations (Accessed 9 Dec 21)
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 Dec 2021).
WHO (2016) Prevention of Harm Caused by Alcohol Exposure in Pregnancy. Available from: https://www.euro.who.int/__data/assets/pdf_file/0005/318074/Prevention-harm-caused-alcohol-exposure-pregnancy.pdf (Accessed 11 Dec 21)
WHO (2021) Global alcohol Action Plan 2022-2030 to strengthen implementation of the Global Strategy to Reduce the Harmful use of Alcohol (First Draft). Available from: https://cdn.who.int/media/docs/default-source/alcohol/action-plan-on-alcohol_first-draft-final_formatted.pdf [Accessed 11 Dec 21)
Zhou Q, Song L, Chen J, Wang Q, Shen H, Zhang S, Li X. (2021) Association of Preconception Paternal Alcohol Consumption With Increased Fetal Birth Defect Risk. Available from: https://doi.org/10.1001/jamapediatrics.2021.0291