Pregnant women enjoying the occasional tipple will now incur the wrath of grapes, due to new alcohol guidelines from the National Health and Medical Research Council (NHMRC).
The guidelines issue a “last drinks” call for women who are either pregnant, planning a pregnancy or breastfeeding, advising them that the safest option is to consume no alcohol at all.
This updates the NHMRC’s 2001 guidelines which told pregnant women: “…if you average less than one drink per day, there will be no measurable impact on the physical and mental development of your child.”
So what new evidence has come to light to cause the NHMRC to change their recommendation?
It may come as a surprise to women wishing to make an informed decision about their alcohol intake, that the NHMRC decision was (in its own words), “not based on the fact that substantial new evidence had emerged since the previous guidelines were published, but on limitations of the existing evidence.”
In other words, the NHMRC found no evidence that low levels of alcohol consumption cause any harms at all during pregnancy. In fact, the research it cites to support its recommendation includes several studies which fail to show any link between low levels of alcohol exposure and birth-related problems.
For example, one systematic review of studies involving 130,810 pregnancies found: “…no increase … in fetal malformations at or soon after birth with moderate maternal alcohol consumption.”
Another review of 46 studies in the area concluded that: “Overall, there was no convincing evidence that low-moderate maternal alcohol intake conferred an increased risk of miscarriage, still birth, prematurity, intrauterine growth restriction (or small for gestational age at birth) and birth defects, including FAS.”
So why did the NHMRC change its earlier advice on limiting (rather than eliminating) alcohol consumption in pregnancy and while breastfeeding?
Perhaps council members believe that pregnant women can’t be trusted to stick to a limit and if allowed one or two drinks a week, will quickly sink into a Bridget Jones-like state of depravity? This is despite the evidence that the majority of women who consume alcohol do so at low-risk levels.
Perhaps the recommendation is based on an assumption that because high levels of alcohol are dangerous in pregnancy and while breastfeeding, low levels must also cause (proportionally smaller) problems?
This assumption is also flawed. There are numerous examples of substances which should be avoided in high doses but which are harmless — or even beneficial — at lower levels.
Vitamin A is harmful to fetuses in large doses but a small amount is essential for normal development. Carbon monoxide, pesticides and radiation are all toxic at certain levels but are not thought to cause problems at low levels of exposure, for example when walking down the street, eating non-organic food and using a computer.
Clearly, the NHMRC’s decision is not just about the risk of low level alcohol consumption. A review of the medical literature reveals that there are more pregnant women (and unborn babies) harmed through car accidents than through low levels of alcohol consumption. Yet the NHMRC is not advising pregnant women to stay away from cars.
In fact, if pregnant women were advised against undertaking every activity which posed an unproven but theoretical risk to them and their unborn babies, they could barely participate at all in normal life.
This inconsistency could lead to longer term problems if it undermines the credibility of the NHMRC and leads women to mistrust other government health advice.
The new guidelines are also problematic in other ways.
By putting the woman who relaxes with an occasional glass of wine in the same category as the one who can’t get out of bed without downing a double scotch, attention will be diverted from the very real and tragic cases of women who harm themselves and their babies through unsafe levels of alcohol consumption.
There is a real risk that the minority of women who drink at high levels during pregnancy will decide that complete abstinence is an unattainable goal and so fail to reduce their alcohol intake to low-risk levels.
The guidelines may also discourage women from breastfeeding because they believe they will harm their babies if they consume small amounts of alcohol. Almost certainly the benefits of breastfeeding would outweigh the risks (if any) of very low levels of alcohol consumption.
Reducing the serious harms associated with unsafe alcohol use should be a high priority for our community. However, promoting a blanket ban on alcohol use in pregnancy and while breastfeeding will do little to achieve this. Instead, the NHMRC should focus on giving Australian women the information and tools they need to make responsible choices around alcohol use and give their children the best possible start in life.
I’d drink to that.
Jennifer Doggett has previously managed a youth alcohol program which is supported with funds from the alcohol industry. She is currently breastfeeding her 10 week old baby.