Pregnant women who drink alcohol deserve compassion – not judgement

Higher consumption of alcohol is often related to mental problems like depression and anxiety, writes Ian Hamilton

Women’s health is still not treated on a par to men’s health (Getty Images/iStockphoto)

Should you drink when trying to conceive? And what about once you are pregnant? To try and answer these questions, as well as provide information for women, the National Institute for Health and Care Excellence (NICE) has published new guidance.

While it’s obvious that avoiding alcohol altogether will minimise the risk of harm to the fetus, this is not always a realistic option. The overall aim is to reduce the risk of Fetal Alcohol Spectrum Disorder (FASD). FASD is a wide ranging condition which can include hundreds of symptoms, from cognitive problems through to damage to vital organs like the kidneys and heart.

The guidelines state that pregnant women should “discuss the risks of drinking in pregnancy with their midwife or healthcare professional at antenatal appointments throughout their pregnancy”. They also urge healthcare professionals to explain, “the benefits to the baby of avoiding alcohol, including preventing fetal alcohol spectrum disorder (FASD), and advises that the safest approach is to not drink alcohol at all”.

If a pregnant woman is worried about already having drunk alcohol during pregnancy or want support to stop drinking, they should be reassured and offered further help, the guidelines add.

Unfortunately, the UK has the fourth highest rate of FASD in the world. Three in four women drink during pregnancy, one in three of these binge drink – defined as consuming six units of alcohol or two large glasses of wine in a single session. Recent estimates suggest up to 17 per cent of children could have features of FASD, such as small eyes, a thin top lip and a smooth philtrum (the line that runs from the top lip to the nose).

It’s worth emphasising that some women will have huge difficulty in stopping alcohol consumption due to physical and or psychological dependence. They may want to abstain, and the pregnancy may add to their stress and feelings of guilt, providing the perfect feedback loop as they may then use alcohol to dampen these unpleasant thoughts and feelings.

Pregnancy can throw up unforeseen problems even when everything is going to plan. Changes to body image, lack of confidence about parenting and concerns about work and money. Those drinking at dangerous levels need compassion, understanding and options. So far, all three have been in short supply for too many women struggling with pregnancy and drinking.

It’s understandable why new NICE guidance encourages midwifes and GPs to routinely ask a woman how much she is drinking during her pregnancy. But given the lack of time available in appointments, they risk missing other (connected) issues.

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For example, higher consumption of alcohol is often related to mental problems like depression and anxiety. It could be more effective to make that the focus of scarce appointment time – rather than going through tick-box-driven conversations about alcohol.

The greater risk is that women – after being probed about their drinking at their first appointment when pregnant – could then avoid all future contact with what they perceive as judgemental health professionals.

The British Medical Association and some MPs have called to investigate the true scale of FASD in the UK. Without this, we can only rely on estimates; which may undercount the scale of the problem.

The fact we have only one specialist clinic in the country tells you how seriously this problem is taken, and also provides a clear example of how, despite significant need, women’s health is still not treated on a par to men’s health.

Ian Hamilton lectures in mental health at the Department of Health Sciences, University of York