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Women who are pregnant or trying to conceive should not drink any alcohol, guidance from the BMA recommends.
Complying with the guidance would eliminate fetal alcohol spectrum disorders, which include fetal alcohol syndrome and can lead to learning and physical disabilities and behavioural problems, notes the report.
Fetal alcohol syndrome is the most clinically recognisable type of fetal alcohol disorder and is characterised by abnormal facial features, growth deficiency, intellectual disabilities, and hyperactivity. In 2002-3 a total of 128 cases were recorded in England. However, there is no reliable evidence on the incidence of fetal alcohol spectrum disorders in the United Kingdom, something which needs to change, says the BMA.
The report calls on all UK health departments to routinely collect data on fetal alcohol syndrome and for further research to establish the full extent of fetal alcohol spectrum disorder.
Raja Mukherjee, a consultant psychiatrist for people with learning disabilities at the Surrey and Border Partnership NHS Trust, said, “You can manage [fetal acohol spectrum disorders] but you can never cure them, and if you compare this to the potential that these children could have had, there is a deficit that, unlike a genetic condition, is 100% preventable.”
The report calls on doctors and other health professionals to take careful histories of women during pregnancy. “People should be more prepared to make the diagnosis, not just of [fetal alcohol syndrome] but of the spectrum of disorders,” said Vivienne Nathanson, the BMA's head of science and ethics. “It is a diagnosis of exclusion, but it is a really important one to help the woman and the baby.”
Healthcare staff should monitor all pregnant women with suspected or confirmed history of alcohol consumption at low to moderate levels and offer them brief intervention counselling early on, the report recommends. Those known to be at high risk of drinking larger amounts should be referred to specialist services.
The BMA guidance is in line with the latest advice from the Department of Health in England.
But it differs from that given by the Royal College of Obstetricians and Gynaecologists, which says, “There is no evidence of harm from low levels of alcohol consumption, defined as no more than one or two units once or twice a week.”
“The difference [between the two sets of guidance] is more apparent than real,” pointed out Sir Charles George, chairman of the BMA board of science. Both are advising not to drink alcohol at all, but the royal college guidance states there is no evidence of harm for less than two units per week, he said.
However, there is a danger that the lack of evidence will be misinterpreted, said Professor Nathanson. Because many people are unaware how many units they are actually drinking and because of stronger drinks and pubs serving larger measures, women can end up drinking more than they intend, she said.
The UK's binge drinking culture and high rates of teenage pregnancy also indicate that many women are continuing to drink during early pregancy without being aware of the harm they are doing to their baby.
The BMA spent a year compiling the report only to have it pre-empted by the Department of Health's recommendations 10 days earlier. The department did not consult the BMA before putting out its revised guidance.
“We are not unhappy with what they have said,” said Professor Nathanson, but she added that the goverment should go further. All healthcare professionals should have fully funded training to pick up and manage fetal alcohol spectrum disorders and health departments should produce guidance on its identification, referral, and management.
The BMA's report is at www.bma.org.uk.