Assessing pregnant women’s compliance with different alcohol guidelines: an 11-year prospective study

Jennifer R Powers, Deborah J Loxton, Lucy A Burns, Anthony Shakeshaft, Elizabeth J Elliott and Adrian J Dunlop
Med J Aust 2010; 192 (12): 690-693.


Objective: To assess women’s compliance with different Australian guidelines on alcohol intake during pregnancy and examine factors that might influence compliance.

Design, setting and participants: We analysed prospective, population-based data on women aged 22–33 years who were pregnant before October 2001, when guidelines recommended zero alcohol (n = 419), or were first pregnant after October 2001, when guidelines recommended low alcohol intake (n = 829). Data were obtained from surveys conducted in 1996, 2000, 2003 and 2006 as part of the Australian Longitudinal Study on Women’s Health.

Main outcome measures: Relative risks (RRs) for zero alcohol intake, low alcohol intake and compliance with alcohol guidelines, estimated by a modified Poisson regression model with robust error variance.

Results: About 80% of women consumed alcohol during pregnancy under zero and low alcohol guidelines. Compliance with zero alcohol guidelines or low alcohol guidelines (up to two drinks per day and less than seven drinks per week) was the same for women who were pregnant before October 2001 and women who were first pregnant after October 2001 (20% v 17% for compliance with zero alcohol guidelines, P > 0.01; 75% v 80% for compliance with low alcohol guidelines, P > 0.01). Over 90% of women drank alcohol before pregnancy and prior alcohol intake had a strong effect on alcohol intake during pregnancy, even at low levels (RR for zero alcohol, 0.21 [95% CI, 0.16–0.28]; RR for low alcohol, 0.91 [95% CI, 0.86–0.96]). RR for compliance with guidelines was 3.54 (95% CI, 2.85–4.40) for women who were pregnant while low alcohol intake was recommended, compared with those who were pregnant while zero alcohol guidelines were in place.

Conclusion: The October 2001 change in alcohol guidelines does not appear to have changed behaviour. Risks associated with different levels of alcohol intake during pregnancy need to be clearly established and communicated.

  • Jennifer R Powers1
  • Deborah J Loxton1
  • Lucy A Burns2
  • Anthony Shakeshaft2,3
  • Elizabeth J Elliott4
  • Adrian J Dunlop5

  • 1 University of Newcastle, Newcastle, NSW.
  • 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.
  • 3 The Sax Institute, Sydney, NSW.
  • 4 University of Sydney, Sydney, NSW.
  • 5 Hunter New England Area Health Service, Newcastle, NSW.


The research on which this paper is based was conducted as part of the ALSWH, the University of Newcastle and the University of Queensland. We are grateful to the Australian Department of Health and Ageing for funding, and to the women who provided the survey data. We thank Emma Black for her comments on a draft of this article. The study was supported by a NSW Health Drug and Alcohol Research Grant. Elizabeth Elliott is supported by a National Health and Medical Research Council Practitioner Fellowship (No. 457084).

Competing interests:

Adrian Dunlop received a speaker’s fee and travel assistance from Schering-Plough France in 2007 and a speaker’s fee from Reckitt Benckiser in 2004.

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