Alcohol intake during pregnancy and lactation

Despite the current National Health and Medical Research Foundation's (NHMRC) recommendations that the safest option during pregnancy and breastfeeding is not to drink alcohol (1), recent surveys indicate that women continue to drink during this time (2,3).

Alcohol is not recommended during pregnancy because of the adverse effect it can have on the infant's physical, mental and behavioural growth and development. Low birth weight is a common outcome in infants affected by alcohol. During breast feeding alcohol passes into  breast milk and may reduce supply. It may also make the infant irritable and affect sleeping patterns. As it is not known what level of alcohol intake poses no risk to the infant, the NHMRC has taken the safe option of no alcohol.

A survey conducted by the Alcohol Education & Rehabilitation Foundation (AER) on community attitudes about alcohol, found 1 in 3 women drank while pregnant and breastfeeding, despite the fact that 90% of survey respondants thought alcohol should be avoided in pregnancy and 87% while breast feeding. The  survey also found that  8%  of respondants thought it acceptable to drink while pregnant and 9% while breastfeeding (2).

Another study, published in the Medical Journal of Australia, looked at women's alcohol intake during pregnancy using data from the Australian Longitudinal Study on Women's Health undertaken in 1996, 2000, 2003, and 2006 (3). During these times, there were 2 different sets of guidelines for alcohol intake during pregnancy. Prior to 2001 women were advised not to drink while after 2001 low alcohol intake was permitted - up to 2 standard drinks per day or 7 per week. The study found that the guidelines had little effect on intake during pregnancy,  prior alcohol intake before pregnancy having the strongest influence. As the great majority of women in Australia drink alcohol before falling pregnancy, it is not surprising that they continue to drink while pregnant. Compared to those who didn't drink before pregnancy, those who did drink were five times less likely not to drink while pregnant.

These two studies  highlight the need to clarifiy and communicate to women the current recommendations for drinking during pregnancy and breastfeeding. As the guidelines have changed 3 times in the period 1996 to 2009 many in the community, including health professionals, may be unaware of what is current, and women may be receiving inconsistent messages. While we know the adverse effects of high alcohol intake on infants, evidence is lacking on the effects of low to moderate alcohol intakes. This lack of evidence means women are not convinced  they need to avoid alcohol altogether.  Further research is needed on the risks associated with varying levels of alcohol intake.

References.

1. NHMRC 2009. Australian Guidelines to reduce health risks form drinking alcohol. http://www.nhmrc.gov.au/publications/synopses/ds10syn.htm

2. Alcohol Education & Rehabilitation Foundation 2010. AER Research. One third of women consume alcohol when pregnant - Media Release  http://www.aerf.com.au/showcase/releases.aspx

3. Powers JR, Loxton DJ et al. Assessing pregnant women's compliance with different alcohol guidelines: an 11-year prospective study. MJA 2010;192(12):690-693