Changes in alcohol consumption in pregnant Australian women between 2007 and 2011

To the Editor: Further to the letter by Batagol1 regarding the National Health and Medical Research Council (NHMRC) guidelines on alcohol consumption during pregnancy,2 I believe that the guidelines should emphasise the basic principles of embryology and teratology. The first 2 weeks after conception (2–4 weeks after the last prepregnancy menstrual period, when women are unaware that they have conceived) are known as the “all-or-none period” — a phase during which teratogens will either cause non-viability or do no harm at all. Exposure to teratogens during this period does not cause birth defects because the cleavage-stage embryo consists of undifferentiated stem cells without significant vascular connection to the maternal circulation. Thus, women can always be reassured after such early alcohol exposure.3

The NHMRC statement “The risk to the fetus from low level drinking is likely to be low”2 is not overly reassuring and may be misinterpreted by anxious women for whom a pregnancy is confirmed after inadvertent alcohol exposure.

It is clear there are two very different groups of women with alcohol exposure during pregnancy. First, there are the chronic heavy drinkers who, by definition, cannot make informed choices about their alcohol intake, and thereby risk their own and their babies' health; these women are a minority. Second, there are responsible women who are made to feel guilty about levels of alcohol exposure that are often trivial; these women are the majority.

It is misleading and offensive for this latter group to be vilified along with the alcohol-dependent women, so that, because of flimsy data, they fear that they have harmed their babies. It is also condescending that authorities believe that by stating that low-level alcohol consumption during early pregnancy is not harmful, they are somehow giving all pregnant women carte blanche to drink. This implies that responsible women (ie, most women) are not smart enough to understand the difference between reassurance after early low-level inadvertent exposure and advice that no alcohol should be consumed once a pregnancy is confirmed.

The Australian guidelines regarding low-level alcohol exposure in early pregnancy should be unequivocally reassuring. They should be made clear to consumers and health professionals alike.