Maternity Teams

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New!

Alcohol and Pregnancy resources

out now

Maternity teams are a pivotal point of medical contact for pregnant women

What are the risks of prenatal alcohol exposure?

Miscarriage
Premature birth
Stillbirth
FASD (Fetal Alcohol Spectrum Disorder)

To learn more about FASD click here.

The effective conversations that you have about alcohol and pregnancy can help to reduce the harm caused by prenatal alcohol exposure, including FASD.

What can the Maternity Team do?

Your role is to ASSIST:

Ask ALL pregnant women about alcohol use

Say it’s safest to avoid alcohol in each appointment

Support this with written advice

Indicate the risks associated with prenatal alcohol exposure

Stop and record any maternal alcohol history

Try to help via signposting to further support and referrals

Healthcare professionals are required to give pregnant women information about the risks associated with drinking alcohol in pregnancy. This should be both verbal and written and throughout the pregnancy, not just at the first appointment (NICE QS204, 2022). Leaflets are available to support this.

Check out our new leaflets – they are specifically designed to meet current guidelines.

There is no ‘safe’ level of alcohol to drink when pregnant

Guidance from the UK Chief Medical Officers regarding alcohol and pregnancy states:

If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.

It is essential that the advice provided by healthcare professionals is up to date, consistent and evidence-based, in addition to the advice provided on other lifestyle choices such as drugs, smoking and nutrition.

Healthcare professionals are also required to ask throughout pregnancy whether there has been any alcohol use and to record it in the maternal notes. This is in order to offer personalised care for the mother but also to aid diagnosis of FASD in the child if they are affected. Early intervention is the most effective way of improving the outcome for both mother and baby. An empathetic, non-judgemental approach encourages a positive response. No matter whether a woman is newly pregnant or nearly full-term, her baby will always benefit when she stops drinking.

However, It is critical for regular or dependent drinkers to have a supervised withdrawal from alcohol.

It is also important for mothers-to-be to have support from those around them such as a partner, close family members and friends. When everyone is informed about the risks, better support can be in place for pregnant women.

It is important to be compassionate and to take a no-shame, no-blame approach when talking about prenatal alcohol exposure. Women may have had an alcohol exposed pregnancy for many reasons, and your support may prevent further harm.

National FASD

Asking about Alcohol in Pregnancy

Hear from Midwife Laney Holland about the importance of asking about Prenatal Alcohol Exposure (PAE).

What to record

Document any confirmed alcohol exposure in the maternity health record, including quantity and type of alcoholic drinks as well as the frequency and pattern.

It’s a sensitive conversation – what should I say?

Use blame-free, non-stigmatising language to discuss alcohol-exposed pregnancies. See for example: FASD: Preferred UK Language Guide.

When asking pregnant women about their alcohol you may want to use some of the Alcohol and Pregnancy tools such as the Table-top guide. (Click here to see our new resources and for information on how to order them.)
Advise women about the risks of drinking, including discussion about special occasions and emphasise the positive benefits of cutting out alcohol at any time during their pregnancy.
Obtain current educational materials on FASD and provide them to patients. All pregnant women should be given printed take-home info on the risks of alcohol in pregnancy, targeted at hard to reach groups.
Refer women who are using alcohol to appropriate specialists

Want to know more about how to have effective conversations about alcohol and pregnancy?

Access the free expert-reviewed Alcohol and Pregnancy e-course on the National FASD e-school.

The risks of harm are significant

Some pregnant women will need more information about the risks of harm caused by alcohol in pregnancy in order to make informed decisions.

It is believed that the fetus is affected by alcohol in two ways.

Ethanol (alcohol), a teratogenic compound, crosses the placenta and can cause:

disruption of cellular energy
impairment of cell acquisition/ dysregulation of developmental timing
altered regulation of gene expression
disrupted cell-to-cell interaction
interference with growth factor signalling or other cell signalling pathways
cell damage/cell death
secondary sources of damage, including placenta function or other intra-uterine factors.

Persistent change in fetal behaviour

This includes changes in fetal breathing movements even at low levels of alcohol use
Development of the fetal startle reflex is affected, again even at low levels

Current guidance and policy

UK Chief Medical Officers

UK-wide guidance based on latest scientific evidence

“If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.”

PHE (Now OHID)

“Health visitors and midwives have reported anxiety about discussing alcohol and a lack knowledge about alcohol screening and guidance…Frontline staff should:

undertake training in alcohol identification and FASD awareness
be aware of alcohol: applying all our health guidance;
advise women trying to become pregnant that the safest approach is not to drink alcohol at all
record alcohol intake throughout pregnancy, not just at booking appointment
make every contact count in terms of encouraging women to abstain from alcohol use during pregnancy and where necessary referring to further, specialist, support (including specialist clinical support to withdraw from alcohol)

SIGN 156

Guidance in effect across Scotland, England and Wales

“The number of type(s) of alcoholic beverages consumed (dose), the pattern of drinking and the frequency of drinking in pregnancy should all be documented by the midwife in the antenatal notes and communicated to the GP and Health Visitor in Transfer of Care documentation.”

NICE

Measures to improve quality of care across England and Wales (and best practice nationally)

“Midwives and other healthcare professionals should give women clear and consistent advice on avoiding alcohol throughout pregnancy, and explain the benefits of this, including preventing fetal alcohol spectrum disorder (FASD) and reducing the risks of low birth weight, preterm birth and the baby being small for gestational age…Pregnant women are asked about their alcohol use throughout their pregnancy and this is recorded.”

DHSC

FASD Health Needs Assessment for England

“Successful behaviour change interventions…need to alter or work with…psychosocial determinants to enhance the autonomy of an individual and increase the chance of an intervention bringing about a positive change in their life.”

UK Chief Medical Officers

UK-wide guidance based on latest scientific evidence

"If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk."

Find out more

PHE (Now OHID)

"Health visitors and midwives have reported anxiety about discussing alcohol and a lack knowledge about alcohol screening and guidance...Frontline staff should:

• undertake training in alcohol identification and FASD awareness • be aware of alcohol: applying all our health guidance; • advise women trying to become pregnant that the safest approach is not to drink alcohol at all • record alcohol intake throughout pregnancy, not just at booking appointment • make every contact count in terms of encouraging women to abstain from alcohol use during pregnancy and where necessary referring to further, specialist, support (including specialist clinical support to withdraw from alcohol)

Find out more

SIGN 156

Guidance in effect across Scotland, England and Wales

"The number of type(s) of alcoholic beverages consumed (dose), the pattern of drinking and the frequency of drinking in pregnancy should all be documented by the midwife in the antenatal notes and communicated to the GP and Health Visitor in Transfer of Care documentation.”

Find out more

NICE

Measures to improve quality of care across England and Wales (and best practice nationally)

"Midwives and other healthcare professionals should give women clear and consistent advice on avoiding alcohol throughout pregnancy, and explain the benefits of this, including preventing fetal alcohol spectrum disorder (FASD) and reducing the risks of low birth weight, preterm birth and the baby being small for gestational age…Pregnant women are asked about their alcohol use throughout their pregnancy and this is recorded.”

Find out more

DHSC

FASD Health Needs Assessment for England

“Successful behaviour change interventions…need to alter or work with…psychosocial determinants to enhance the autonomy of an individual and increase the chance of an intervention bringing about a positive change in their life.”

Find out more

Whilst this page follows DHSC usage and refers to pregnant women, this information applies to all pregnant people and National FASD fully supports non-discriminatory healthcare for all.

New resources for Maternity Teams!

Our new Alcohol and Pregnancy Toolkit is now available (including a free e-course).

Please feel to subscribe to our mailing list at the bottom of the page to stay up-to-date!

Further reading on our Website

NICE

Department of Health and Social Care

CCGs and NHS Trusts

Innovation/Best Practice

External Links

Public Health England - Maternity high impact area: Reducing the incidence of harms caused by alcohol in pregnancy

PHE’s document on alcohol in pregnancy

NICE Quality Standard on FASD

This includes statements on talking with pregnant women about alcohol and identifying alcohol-exposed pregnancies.

Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives

September 2021 journal article by Danijela Dozet, Larry Burd & Svetlana Popova in the International Journal of Mental Health and Addiction

Scottish SIGN 156 Guidance

Children and young people exposed prenatally to alcohol

BMA Report on Alcohol in Pregnancy

(2016)

Drymester

Helping parents-to-be go alcohol-free – from the Greater Manchester Integrated Care Partnership

Be Your Baby’s Hero

Blackpool’s Better Start Programme

With special thanks to Diageo GB for making our Maternity Teams project possible.

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The National Organisation for FASD, The Priory, High Street
Ware, Hertfordshire. SG12 9AL
England

Helpline: 0208 458 5951

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