To the Editor: I refer to the article by Cameron and colleagues.1 As a member of successive Therapeutic Goods Administration Advisory Committees on Prescribing Medicines in Pregnancy (1989–2005), I thoroughly endorse the authors' concerns about the teratogenic effects of excessive alcohol consumption during pregnancy, and support wholeheartedly the advice that, ideally, avoiding alcohol during pregnancy is best.
However, I am concerned that, as stated in my submission to the National Health and Medical Research Council (NHMRC),2 the current guidelines rely on poorly designed studies to support the implication that there are residual risks to the fetus from a pregnant woman consuming alcohol at a low level, by advising: “The risk to the fetus from low level drinking is likely to be low”.3 A large recent prospective cohort study conducted in the United Kingdom did not produce evidence of harm with low-level use.4
When women are provided with advice after intermittent low-level exposure to alcohol in pregnancy, they must also be given reassurance to avoid the prospect of unnecessary anxiety or contemplation of unwarranted termination.
Significantly, peak overseas health advisory groups, including the National Institute for Health and Care Excellence in the UK, and obstetric organisations in the United States and Canada have expressed concern about the potential for unwarranted terminations being contemplated by women following low-level alcohol use in pregnancy. The Society of Obstetricians and Gynaecologists of Canada have specifically published reassuring advice: “Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for termination of pregnancy”.5 The time is overdue for the NHMRC to provide a similar statement to provide greater reassurance to women who have consumed low levels of alcohol during pregnancy.
- 1. Cameron CM, Davey TM, Kendall E, et al. Changes in alcohol consumption in pregnant Australian women between 2007 and 2011. Med J Aust 2013; 199: 355-357. <MJA full text>
- 2. Batagol R. Alcohol guidelines public consultation and submissions — submission 44. Canberra: National Health and Medical Research Council, 2008. http://www.nhmrc.gov.au/your-health/alcohol-guidelines/alcohol-guidelines-public-consultation-and-submissions (accessed Mar 2014).
- 3. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. http://www.nhmrc.gov.au/guidelines/publications/ds10 (accessed Mar 2014).
- 4. Kelly Y, Iacovou M, Quigley MA, et al. Light drinking versus abstinence in pregnancy — behavioural and cognitive outcomes in 7-year-old children: a longitudinal cohort study. BJOG 2013; 120: 1340-1347.
- 5. Carson G, Cox LV, Crane J, et al. Alcohol use and pregnancy consensus guidelines. J Obstet Gynaecol Can 2010; 32 (8 Suppl 3): S1-S31.
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