A symbol of truth - why alcohol industry is hellbent on keeping people in the dark over risk of FASD

This is the simple message the alcohol industry does not want you to see – a warning symbol to inform the public of the danger of alcohol consumption when pregnant.

In their opposition to Ireland’s alcohol health information labelling, it is important to ask why the industry does not want the public to see messages informing the public about the health dangers of alcohol, such as alcohol causes liver disease, there is a direct link between alcohol and fatal cancers, and the dangers of alcohol consumption when pregnant.

The simple reason is that alcohol is no ordinary commodity – it is a regulated, toxic, and psychoactive substance of which there is no safe amount that does not affect health.[1] Moreover, not only does alcohol harm those who consume it, but consumption during pregnancy is the leading preventable cause of neurodevelopment disorder.[2]

Public knowledge of alcohol harms, however, is low but with increasing awareness, through health information labelling,[3] the industry fears a reduction in the sales of their products. Indeed, leading producers such as Heineken have noted that health information labelling, informing the public of the health harms of alcohol, is a significant risk to their profits.[4]

Above: from Heineken’s Report of the Executive Board 2024

What is Foetal Alcohol Spectrum Disorder (FASD)?

Foetal Alcohol Spectrum Disorder (FASD) is a group of disorders caused by prenatal alcohol exposure and are associated with a range of lifelong physical, mental, learning/educational, social, and behavioural difficulties.[5] FASD comprises Foetal Alcohol Syndrome (FAS), partial Foetal Alcohol Syndrome, Alcohol Related Birth Defects, and DSM-5 Neurodevelopmental Disorder – Prenatal alcohol exposure.[6] The symptoms of FASD may vary from child to child but are lifelong.[7]

FASD is often an invisible disability, yet prenatal alcohol exposure is the leading preventable cause of neurodevelopmental disorder. According to the HSE, only a small proportion of children with FASD have visible facial features (facial dysmorphia), with the majority of children with FASD having no visible signs of disability at birth.[8] Indeed, difficulties due to FASD may not manifest until preschool or school age.

Shockingly, there are no standard diagnostic policies or guidelines for diagnosing or treating children with FASD in Ireland. There is no national strategy for the prevention of FASD or for the response to children and adults with FASD.

There are, however, a number of policies and strategies that include actions to reduce alcohol use in pregnancy and prevent FASD.[9] Indeed, one such policy is alcohol health information labelling, but as we will see later in this blog, the implementation of that policy is now under threat from the alcohol industry.

What causes FASD?

FASD is caused by the consumption of any amount of alcohol at any time from 6 weeks before conception (either parent) and for the duration of the pregnancy.

Alcohol is a teratogen, a substance that negatively affects the embryo and foetus during pregnancy.[10] Resultantly, FASD is caused by prenatal alcohol exposure and is associated with a range of lifelong physical, mental, educational, social, and behavioural difficulties. Therefore, no amount of alcohol is safe when planning to conceive or during pregnancy.[11]

Alcohol has an adverse effect on the developing brain, and on body organs, and the greater the amount of alcohol that has been consumed during pregnancy, the greater the risk to the development of the embryo and foetus.

As Dr Mary T O’Mahoney, a public health consultant and fellow of the Royal College of Physicians of Ireland (RCPI), has stated – “No amount of alcohol at any stage of pregnancy is safe for your baby.”[12] The World Health Organization (WHO) has called for action on the prevention of alcohol use in pregnancy and the prevention of FASD in its Global Action Plan on Alcohol.

Paternal alcohol consumption

A father’s alcohol consumption has long been overshadowed by the focus on what a mother drinks.[13] However, people may not realise that paternal alcohol consumption prior to pregnancy can increase the likelihood of FASD.[14] This is of particular concern as men drink more, are more likely to binge drink, are more likely to develop alcohol use disorder than women.[15]

Historically, research on fertility and reproduction has been female focused with little attention or examination on the male side.[16] However, there is a growing body of research into the role of paternal alcohol consumption pre-pregnancy, with several studies pointing to the role a father’s drinking prior to conception plays in the development of FASD.[17]

Maternal alcohol consumption

As previously outlined, alcohol use can result in harm not only to the drinker, but also to other individuals associated with the drinker.[18] A classic example of this harm to others is the harm caused by consuming alcohol during pregnancy.

Alcohol is a teratogen, a substance that negatively affects an embryo and foetus during pregnancy, that can readily cross the placenta, resulting in damage to the brain and other organs of the developing embryo and foetus.[19] Therefore, it is crucial for the public to know that there is no evidence-based, defined, safe amount of alcohol that can be consumed during pregnancy to prevent a child being born with FASD.[20]

How common is FASD?

International studies confirm that the higher the alcohol consumption in a country, the higher the rates of FASD.[21] This association between prenatal alcohol exposure and FASD is strong and consistent from study to study, in all countries, nationalities, ethnic and socio-economic groups.[22]

An estimated 10% of pregnancies globally are exposed to alcohol.[23] In Ireland, the figure is considerably higher with four in five of first pregnancies being exposed to alcohol and nearly one in two (45%) exposed at high-risk levels.[24]

Unsurprisingly, with such high levels of alcohol consumption during pregnancy Ireland has the third highest level of FASD in the world, possibly affecting up to 7.4% of the population as highlighted by the HSE.[25] The best available evidence estimates that about 600 Irish babies are born each year with Foetal Alcohol Syndrome (FAS), with a further 9-10 times this number of babies born annually who have other conditions associated with FASD.[26]

This compares against an estimated global prevalence rate of 0.8%,[27] while the WHO European Region had the highest prevalence at 19.8 per 1000 population.[28] The higher rate for Europe, as with Ireland, is unsurprising given Europe is the area with the highest alcohol consumption per capita globally.[29]

Preventing FASD

FASD is preventable through avoiding alcohol before conception and during pregnancy. However, this requires the efforts of government and the HSE at a national level.

Central to preventing FASD is a whole-of-government strategy to drive evidence-based measures that lead to a reduction in FASD and to drive appropriate assessment and intervention strategies when the diagnosis is suspected or made.[30] Presently there is no such national strategy in Ireland for the prevention of FASD or for the response to children and adults with FASD.

The most effective measure to achieve a reduction in the incidence of FASD is to reduce the population’s alcohol-per-capita consumption, and the foremost way to achieve this is to apply the WHOs ‘Best Buys’ on alcohol.[31] These are controls on price, advertising/marketing, and availability of alcohol. Such interventions are the most effective public policy measures that governments can take to offset at least some of the harm, such as FASD, caused by alcohol.

In addition, communications campaigns, routine screening and brief interventions by healthcare professionals, healthcare supports for pregnant women, training and professional development supports for staff, and research and public health surveillance, as well as timely diagnosis and treatment for children with FASD is required.

A final core preventive measure is pregnancy warning labels on alcohol products to inform the public of the dangers of alcohol when pregnant. This is exactly what Ireland’s alcohol health information labelling intends to do from May 2026. However, these warning labels are again under threat from the alcohol industry.

It is unconscionable, but unsurprising, that Big Alcohol opposes health information labelling aimed at informing the public of the risks related to alcohol and pregnancy. The industry simply does not want people to know that there is no amount of alcohol that’s known to be safe to drink during pregnancy, and if you drink during pregnancy, you place your baby at risk of FASD.[32]

It is essential that women are supported to have an alcohol-free pregnancy, and that the health service provides people with consistent advice about alcohol use in pregnancy. While FASD is entirely preventable, if alcohol is avoided in pregnancy, it needs to be acknowledged that some women will need additional supports to abstain, and they should be supported to access these.[33]

Supporting those with FASD

Presently there is no national strategy or model of care for children and adults with FASD. As a result, many do not receive the care and support they need.

Therefore, it is essential that the Department of Health and the HSE develop a model of care and statutory guidelines for FASD. As part of the model of care there is a need for the state to adopt the International Classification of Function, a validated tool for standard needs assessment, and provide interventions and supports to children and adults with FASD.

The development and roll-out of supports for those with FASD must also be done in a regionally balanced manner so that they exist in every part of the state. Furthermore, it is essential that supports provide for adults and young people when they reach 18 years old.

Above: an illustration of alcohol health information label

The importance of alcohol health information labelling

Alcohol health information labelling is central to informing the public of the dangers of alcohol consumption when pregnant and is strongly recommended by healthcare and medical professionals. Unsurprisingly, the alcohol industry has fought tooth and nail against the introduction of alcohol labelling. Recently, the industry has sought to use EU-US trade difficulties in order to lobby for labelling to be postponed or rescinded. To achieve this, Big Alcohol has again claimed, incorrectly, that labelling will harm Irish exports. Unfortunately, some in the media and government appear to have fallen for this ruse.

The reality is that labelling is a health matter and has absolutely nothing to do with exports; indeed, the regulations place no burden whatsoever on export businesses as the measures only apply to goods sold in Ireland. While in relation to imports, small producers, or home-produced products, the legal onus is on retailers of alcohol, not manufacturers, to ensure products are labelled.[34] Therefore, a supermarket or off-licence can simply add a sticker to the product. It should also be noted that alcohol producers already produce a range of labels for different markets including the USA which has its own specific conditions.

Such attempts to derail labelling of alcohol products are nothing new. The alcohol industry opposed the introduction of mandatory, visible pregnancy warning labelling regulations in Australia and New Zealand for over 20 years.[35] These were finally passed in 2020, coming into effect in August 2023. Even now there is a distinct issue with non-compliance with the regulations with studies indicating that only 63% of products are displaying the label despite a generous 3-year lead-in period.[36]

It is now seven years since the Public Health (Alcohol) Act legislated for pregnancy warnings on alcohol products, so it is imperative that there is no delay and that these public health measures adhere to the legally set timeframe. We cannot allow the alcohol industry to delay, for decades, such important messages as they did in Australia.

Alcohol health information labelling is essential for empowering people to make informed decisions in relation to alcohol and their health. The warning not to consume alcohol when pregnant can help reduce incidences of FASD in Ireland. There can be no deviation from the timeline for its introduction.

[1] https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health

[2] https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/alcohol-programme/hse-position-on-prevention-of-fasd.pdf

[3] https://www.who.int/publications/i/item/9789240044449

[4] https://www.theheinekencompany.com/sites/heineken-corp/files/2025-02/heineken_n_v_annual_report_2024_final_20feb2025.pdf

[5] https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/alcohol-programme/hse-position-on-prevention-of-fasd.pdf

[6] https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/alcohol-programme/hse-position-on-prevention-of-fasd.pdf

[7] https://www.mayoclinic.org/diseases-conditions/foetal-alcohol-syndrome/symptoms-causes/syc-20352901#:~:text=Issues%20with%20behavior%20and%20with,Quickly%20changing%20moods.

[8] https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/alcohol-programme/hse-position-on-prevention-of-fasd.pdf

[9] https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/alcohol-programme/hse-position-on-prevention-of-fasd.pdf

[10] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30021-9/fulltext

[11] https://www.fasdireland.ie/What

[12] https://www.thetimes.com/world/ireland-world/article/our-secret-shame-so-many-babies-affected-by-mothers-drinking-hrmxbxnfl