It is in a child’s best interests for a prospective mother not to drink alcohol while pregnant due to the risk of developmental brain disorders to the child. Yet two out of three women in Ireland continue to drink alcohol during their pregnancy. The advice from the country’s Chief Medical Officerⁱ is clear: 

Given the harmful drinking patterns in Ireland and the propensity to binge drink, there is a substantial risk of neurological damage to the foetus resulting in Foetal Alcohol Spectrum Disorders (FASD). Therefore, it is in the child’s best interest for a pregnant woman not to drink alcohol during pregnancy. 

A study of women who attended the Coombe Women’s Hospitalⁱⁱ found that almost two-thirds (63%) of the 43,318 women surveyed said they drank alcohol during their pregnancy. The situation is put into stark relief when the number of women who stopped drinking during pregnancy 13.2% is contrasted with the almost 50% who gave up smoking. What the numbers suggest is that women are making choices based on what they perceive as greater risk to their own health and that of their child’s. 

Why is it surprising that women in Ireland continue to drink during their pregnancies? In the most recent European study of 15 and 16-year-olds more Irish girls (44%) than boys (42%) reported ‘binge’ drinking during the past month.ⁱⁱⁱ Over half (54%) said they were drunk at least once by the age of 16. Frequent and heavy drinking has become the norm with Ireland near the top of the European poll when it comes to the amount we drink in a year, and the amount we drink in a session.^iv Ireland has the third highest per adult consumption rate out of 26 EU countries.

While women may receive information telling them that alcohol should be avoided during pregnancy that information is outweighed by the extent of alcohol marketing which adds to the cultural acceptability and normalising of problem levels of alcohol use. Alcohol is marketed and sold in supermarkets, petrol stations and convenience stores as if it were just another grocery so that it has become an everyday item in the family shopping basket. Anecdotal evidence suggests that women receive either little information or contradictory information on alcohol during pregnancy from a number of sources including health care providers.

What are the Fetal Alcohol Spectrum Disorders? And what are the risks?

Alcohol consumption can lead to disorders in how the brain develops in the womb as the placenta does not act as a barrier to alcohol. The foetus is especially vulnerable to brain injury at particular stages of its development. Damage can occur particularly in the first three months of pregnancy, and also from the seventh month of pregnancy on when the brain experiences a growth spurt. This damage can later show up in the form of behavioural, social, learning and attention difficulties in childhood, adolescence and throughout adulthood. As such, there can be lifelong consequences for an individual with any of the conditions among the FASD.

Fetal Alcohol Syndrome (FAS), is the rarest, but most easily recognised condition on the spectrum, and presents in the child of a mother who drank heavily during the first trimester of pregnancy. FAS affects a child’s facial features and height, as well as their central nervous system.^v Partial Fetal Alcohol Syndrome, (pFAS), Alcohol Related Neurodevelopmental Disorder (ARND), and Alcohol Related Birth Defects are far less easily diagnosed, but experts in the United States say that ARND is 10 times more prevalent than FAS. Due to difficulties in recognition and diagnosis of ARND, those affected are less likely to receive early diagnosis and appropriate treatment, often resulting in poor outcomes for those with the condition.

Drinking heavily during pregnancy can also increase the chances of complications during pregnancy and childbirth, as well as increasing the risk of miscarriage and stillbirth. A leaflet on women and alcohol published by the Health Promotion Unit advises^vi that there is no known safe level of alcohol use during pregnancy and that women should stop drinking during this time. It makes the following points: 

• More than three drinks a day increases the risk of miscarriage
   
• More than 12 drinks in a week increases the risk of premature birth
   
• Sudden high levels of alcohol damages the developing brain

The Way Forward

Women need information on the risks associated with the consumption of alcohol during pregnancy.  

• Alcohol Action Ireland recommends that a national social marketing campaign be launched by the Health Service Executive to raise awareness about the risks associated with drinking during pregnancy
   
• Medical professionals, including GPs and public health nurses, need to be informed and updated on the advice of the Chief Medical Officer regarding alcohol use during pregnancy so as to enable them to raise awareness of the risks of alcohol use with their patients
   
• Labelling of alcoholic drinks is also important. Alcohol Action Ireland calls for the introduction of the legislation necessary to put warning labels about the risks associated with alcohol use during pregnancy on alcoholic drinks. Promotional materials for alcohol should also contain health warnings
   
• Alcohol Action Ireland calls for the Department of Health and Children to monitor closely the current voluntary code for the separation of alcohol from groceries where they are sold on the one premises. The scope, terms of reference and results of this monitoring process should be made public. It is our belief that the separation of alcohol from groceries should be on a legislative footing by commencing Section 9 of the Intoxicating Liquor Act 2008, which ensures segregation of alcohol from food and non-alcoholic beverages in convenience stores, petrol stations, supermarkets and any other place where the two sets of commodities are sold

ⁱ www.dohc.ie

ⁱⁱ Barry S, Kearney A, Lawlor E, McNamee E and Barry J (2006) The Coombe Women’s Hospital study of alcohol, smoking and illicit drug use, 1988–           2005. Dublin: Coombe Women’s Hospital

ⁱⁱⁱ Hibell B, Andersson B, Bjarnason T, Ahlström S, Balakireva O, Kokkevi A, Morgan M (2009) The ESPAD Report 2007. Alcohol and Other Drug Use     Among Students in 35 European Countries. The Swedish Council for  Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe. Stockholm:  Sweden

^iv TNS Opinion and Social (2007) Attitudes Towards Alcohol. Special Eurobarometer 272b/Wave 66.2. Brussels: European Commission; Hope (2007) Alcohol Consumption in Ireland 1986-2006. Health Service Executive – Alcohol Implementation Group

^v Mongan D, Reynolds S, Fanagan S and Long J (2007) Health Related Consequences of Problem Alcohol Use. Overview 6. Dublin: Health Research Board

^vi Health Promotion Unit (2003) Little Book of Women and Alcohol: Take a Closer Look at What Drink is Doing to  You