Fanning the Flames: Advice on Drinking in Pregnancy

The comments on JJ’s recent post on breastfeeding have strayed off-topic to a related and rather interesting question: is it okay for public health advice to be false if it’s perceived to benefit the public? To that end, I bring you the lingering tension between Nice, the Royal College of Obstetrics and Gynaecology, and the Royal College of Midwives; and the poor innocent beer producers forced to take sides.

In 2007, the National Institute of Clinical Excellence (Nice) changed the UK guidelines for advice on drinking during pregnancy.

  • Pre-2007 guidelines: Pregnant women are advised to limit their alcohol intake to no more than 1-2 units of alcohol, once or twice a week.
  • New Guidelines: Pregnant women and women trying to conceive should abstain from alcohol.

You are dying to know the big important new piece of scientific evidence that has prompted this change, aren’t you? Well don’t hold your breath. In fact, there was no new evidence*. So why the change?

Dr Gillian Leng, of Nice, said the advice was tightened partly because of the recognition of the harm excessive drinking was doing in society generally.

So, stop preggos drinking their 5 ounces of wine twice a week, so as to cut down on binge drinking. Makes sense, right? No; no it doesn’t. Let’s try again:

Mervi Jokinen, of the Royal College of Midwives, said: “We are concerned that many women will be unsure about what a unit of alcohol is, and therefore may drink more than the guidelines recommend.”

Does this make sense? Well, only if you’re keen on the idea that policy should be shaped—even bent and falsified—around the needs of that massive underclass of pregnant women who are innumerate. Beer, wine, and spirit bottles are all labelled as to their alcohol content. True, a glass in a pub is not, but if we’re worried about that (surely some innumerate people are nonpregnant, after all), why not change pub labelling, instead of giving deliberately misleading pregnancy advice—ESPECIALLY if your concern, Dr Leng, is binge drinking in society at large.

And what have obstetricians had to say about the change?

… the Royal College of Obstetricians and Gynaecologists said there was no evidence that drinking small amounts did any harm.

Oops. Looks like Doc is not willing to collude**. My heart aches for the poor babies of innumerate pregnant women for whom nothing further could possibly be done, now the two-units cat is out of the bag.

Of course, I could go on and on about this. Instead, I will entertain you with visual evidence of the discord. On the left is the French pictogram that, one by one on a voluntary basis, has become standard labelling for bottled beer in Britain since 2007. And on the right is a new maverick, caution-to-the-wind label from the Freeminer Brewery that has the NERVE, the AUDACITY to assume that its customers—even the pregnant ones—can do basic maths. (Or perhaps: that it’s their duty to print true things on their labels!) How vicious of them!

*Further, in the years leading up to and since 2007, several good studies have been published that support claims of alcohol safety in moderation, even above the 1-2 units once or twice limit.
**In fact, I was pregnant in 2006, and am again now. If anything, Doctors and most midwives seem more intent on letting women know that it’s okay to have a glass of an evening these days. So perhaps there is backlash within the profession.

I think I might be confused about how much a unit is. Hmm. How would I, silly pregnant lady that I am, determine how much a unit is...?...
bad pregnant woman! no no no! shoo!
bad pregnant woman! no no no! shoo!