Baby on board: Is there any safe alcohol limit during pregnancy?
Research reveals that almost eight in 10 Irish mums drank alcohol while they were pregnant, writes
NEARLY 80% of mums consumed alcohol at least once while pregnant, according to the findings of a new study exclusively revealed to Feelgood.
The research, conducted by the parenting website Mummypages.ie on 304 women, found that 77% of mums surveyed reported that they drank alcohol at least once at some stage during their pregnancy, while 54% said they had knowingly consumed alcohol at least once after they knew of their pregnancy.
More than 40% knowingly consumed alcohol at least once a month during their pregnancy, and of these, 67% consumed a maximum of one to two glasses of wine at that time while 23% consumed more than that amount of alcohol. A large proportion — nearly 70% — said they had consumed alcohol in the first trimester, while more than half drank alcohol in the third trimester.
“We are frequently contacted by expectant mums who are worried about the alcohol they consumed during the early weeks of their pregnancy, often when they did not even know they were pregnant,” says website spokeswoman Laura Erskine. “Leading medical professionals advise mums-to-be to abstain from drinking alcohol completely throughout their pregnancy, in particular, though during the first 12 weeks of pregnancy when the baby’s brain and major organs are forming and developing — a vital stage of your baby’s development.”
The message about pregnancy and alcohol from the Health Services Executive couldn’t be more clear-cut — don’t drink while pregnant.
However, while the HSE stance is unambiguous, it’s up against other research saying that very low levels of alcohol do not harm a foetus, while women can also receive conflicting advice from family and friends.
Last year, for example, a review of pooled research found little evidence that light drinking in pregnancy causes harm to babies (though the researchers were careful to stress that this was not proof that it’s OK to drink.) The review, published in the British Medical Journal, found limited evidence that light or occasional drinking in pregnancy — defined as up to four units a week — harmed unborn babies. However, the researchers also pointed out that few studies actually examined whether a few drinks a week caused complications for babies.
Furthermore, a Danish study of 1,628 pregnant women, published in thein 2012, found that a daily small alcoholic drink had no effect on a foetus, while a study by the Royal College of Obstetricians and Gynaecologists concluded that low to moderate drinking (10.5 units or seven glasses of wine a week) showed no adverse effects on a baby’s development.
In contrast, an international study published last year found that one in every 67 women who consumed alcohol during pregnancy would give birth to a child with Foetal Alcohol Syndrome (FAS) — a serious condition which can affect a child’s facial features, height, nervous system and intellectual capacity.
The author of that study, Dr Svetlana Popova, also warned that FAS was “only the tip of the iceberg” when it comes to the wide spectrum of harm caused by pregnancy drinking.
It was believed, she said, that for every child born with FAS, up to 10 more were being born with conditions related to Foetal Alcohol Spectrum Disorder (FASD), symptoms of which range from behavioural problems to memory and learning difficulties.
The study, conducted by the Centre for Addiction and Mental Health in Canada, which looked at research from 50 countries, also found Ireland had the world’s highest rate of women drinking alcohol while pregnant, even though public health campaigns here warn repeatedly of the risk to the baby.
The research showed 60.4% of Irish women continued to drink when they were expecting a baby, amounting to six times the global average of one in 10.
“You can get very conflicting messages from research,” acknowledges Dr Aoife Mulally, an obstetrician in the Coombe maternity hospital in Dublin. She points out that new studies are regularly published saying small amounts of alcohol are probably safe — “But it depends on your perception of risk.”
Many Irish people are in denial about the risks of alcohol on their health, she says, adding that this can extend to the potential risk of alcohol on the foetus. “I think that’s quite special to Ireland — it’s a cultural and a societal thing.”
It’s not necessarily a class issue either — a study carried out in Ireland in 2009 found that the majority of women who drank “moderate” amounts in pregnancy or around the time their baby was conceived — this is defined as one drink per day for a woman — “were professionals in their 30s with private health insurance,” says Dr Mulally.
The HSE advises women to avoid alcohol completely while pregnant, as it can cause neurological damage to a baby’s developing brain leading to behavioural, social, learning, and attention difficulties in childhood, adolescence, and in later life. Meanwhile, Alcohol Action Ireland warns that drinking more than three drinks a day increases the risk of miscarriage and more than 12 drinks a week increases the risk of premature birth.
With all these warnings, why do Irish women continue to drink more while pregnant than those of other nationalities?
“I think it comes back to the fact that drinking alcohol is a societal norm here,” says Dr Mary O’Mahony, a specialist in public health medicine and assistant director of Public Health at HSE South.
She points to the Screening for Pregnancy Endpoints (Scope) project which was carried out in Ireland as well as in Britain, Australia and New Zealand, between 2004 and 2011.
The study found 80% of women in Ireland drank at some point in their pregnancy compared to 65% in Britain, 38% in Australia and 53% in New Zealand. Around 80% of the 1,774 women recruited to the Irish part of the study had consumed some alcohol in the first 15 weeks of pregnancy. More than 20% reported drinking moderate to heavy amounts of alcohol at 15 weeks of pregnancy, while 31% of women admitted to two or more episodes of binge drinking in the first 15 weeks, compared with just 4% of women in New Zealand.
“It’s habitual — it’s the normal routine for Ireland. There’s a social norm that about two-fifths of pregnancies here are unplanned and a lot of these women may not know they’re pregnant at the time of drinking or they don’t know the level of harm it causes,” says Dr O’Mahony.
“There is a lack of awareness and they don’t always get advice about drinking when they’re accessing medical care.”
She believes that the culture here can result in pregnant women feeling pressured to drink alcohol, particularly during the early stages.
“If they’re on a night out and don’t want to disclose that they’re pregnant, they may feel pressured to drink because otherwise they’ll be asked straight out if they’re pregnant,” she adds.
“There’s a mindset about alcohol that we need to change. It needs to be in support of not drinking, and of treating not-drinking as the norm. Drinking during pregnancy needs to become at least as unacceptable as drink driving.”
Many pregnant women still wonder if one glass is safe. Dr Mulally says some patients will argue this point, saying there’s no evidence that a small amount of alcohol is damaging. In response, she points out that there’s no evidence that a small amount is safe.
“Although the research says there’s no evidence of harm from low-level drinking we don’t know what is a safe amount. All we can tell patients is that the only safe amount of alcohol is none.”
People often, she says, differ in their perception of what a unit of alcohol is, or how much constitutes a glass of wine.
So how does alcohol affect a developing foetus?
Michele Savage, who founded Foetal Alcohol Spectrum Disorder Ireland in 2003/2004 to provide information and support to people raising children with symptoms of the condition, says the impact on a child can be significant. She stands behind the HSE message of no alcohol consumption during pregnancy as a result of what she has seen through her work with the organisation.
“I’ve come across children who have been exposed to alcohol prenatally and the difference between them and typical children can be significant.
“There may be behavioural problems and problems with maths and comprehension. There’s difficulty in learning from experience.
“Whether parents are the child’s birth parents, adoptive parents or foster parents, the challenges around parenting such children are quite significant.
“These are life-long difficulties — they will not grow out of it.”
High levels of alcohol consumption during pregnancy can cause Foetal Alcohol Syndrome which, explains Dr Mulally, is “a severe developmental problem where a baby is born with very clear facial features and goes on to have intellectual disability and developmental delays.”
Foetal Alcohol Syndrome is characterised by distinctive facial features and physical defects to problems with the brain and central nervous system which result in everything from intellectual disability and difficulty with reasoning and problem solving to poor judgement and poor coordination and balance, to social and behavioural issues.
Ireland has one of the highest prevalence rates of FAS in the world, at 89.7 per 10,000 people, according to a Canadian study published last year.
Also, Ireland has the third highest incidence of Foetal Alcohol Spectrum Disorder in the world. FASD is brain damage due to prenatal exposure to alcohol — yet the condition is 100% preventable, explains Dr O’Mahony.
FASD could result, she warns, from what many of us would regard as “moderate” consumption of alcohol, which is defined as one unit of alcohol a day for women.
“Drinking during pregnancy can cause conditions such as ADD, memory deficit, hyperactivity, difficulty with abstract concepts such as maths, time and numbers, poor problem-solving skills. Children may also have difficulty learning from the consequences of their actions. In other words, they often keep making the same mistakes — showing poor judgment, immature behaviour and poor impulse control.
“FASD is associated with physical mental, educational, social and behaviour difficulties and can lead to disrupted school.”
Dr O’Mahony also points out that people who have been exposed to alcohol in the womb are more likely to abuse alcohol themselves and to come into contact with the law.
“It is never too late to give up drinking while pregnant in order to give your baby the best chance of a good outcome.”
Drinking while pregnant
- 77% of mothers cited that they consumed alcohol at least once at some stage during their pregnancy.
- 54% of Irish mothers knowingly consumed alcohol at least once after they knew of their pregnancy.
- 43% of Irish mothers knowingly consumed alcohol at least once a month during pregnancy.
- 67% consumed a maximum of one or two glasses of wine at this time. 23% consumed more than this amount of alcohol.
- 68% of mothers drank alcohol in their first trimester; 28% consumed alcohol in their second trimester; 53% consumed alcohol in their third trimester.
