Experts take sides over drinking in pregnancy

While debating whether small amounts of alcohol are safe during pregnancy, opposing British experts touch on individuals' rights, emerging evidence on the fetal risks of low levels of alcohol, and the need for a clear message. The debate is featured in the Oct. 27 issue of BMJ.

Arguing in support of women who choose light alcohol consumption if they wish, Patrick O'Brien, of the University College London Hospitals, points to findings from many authorities, including the Royal College of Obstetricians and Gynecologists, that low levels of consumption present little to no evidence of harm to the fetus. He also posits that a prohibitive warning from doctors, based on an absence of evidence, could lead to a loss of confidence in the medical profession.

"On the basis of the evidence we provide, many women will choose abstinence as the safest option. But that choice is the right of each individual woman," O'Brien writes.

On the other hand, evidence from animal and human research is mounting that even small amounts of alcohol may adversely affect the fetus, write Vivienne Nathanson and her colleagues at the British Medical Association in London, which recently began advising pregnant women to avoid alcohol completely. In addition, guidelines that recommend specific limits based on "units" or "standard drinks" can lead to confusion due to different glass sizes and measurement standards in public establishments versus homes.

"Given the current uncertainty regarding the level of risk to the developing fetus, the lack of clear guidelines, and the confusion about consumption levels, the only sensible message for women who are pregnant or planning a pregnancy must be complete abstinence from alcohol," Nathanson and colleagues conclude.

O'Brien P. Is it all right for women to drink small amounts of alcohol in pregnancy? Yes. BMJ. 2007;335:856; doi:10.1136/bmj.39371.381308.AD. (published online 27 October 2007).
Nathanson V, Jayesinghe N, Roycroft G. Is it all right for women to drink small amounts of alcohol in pregnancy? No. BMJ. 2007;335:857;doi:10.1136/bmj. 39356.489340.AD (published online 27 October 2007).