Abstract
The issue of alcohol consumption during pregnancy has recently been the subject of fervid attention in the UK. This renewal of interest has been sparked, in part, by the publication of a systematic review which identified a lack of evidence over the risks of low levels of alcohol use in pregnancy (Mamluk et al., 2017 for an exegesis). The study’s reception in the popular press and among social media commentators has led, in turn, to the amplification of some long-standing debates within public health and medical sociology about the so-called ‘precautionary principle’, public awareness of alcohol units and serving sizes, the prevalence of fetal alcohol spectrum disorders (FASD) and the extent to which pregnancy is excessively ‘policed’ (see e.g., British Medical Association, 2016; Jones and Bellis, 2012; Popova et al., 2017). This complexity presents challenges for researchers, practitioners and policy-makers both in terms of making sense of attitudes to alcohol use in pregnancy, but also in the sense of formulating interventions that have the potential to influence women’s risk perception and behaviour (Peadon et al., 2011).
Into this veritable maelstrom of professional debate and public opinion, the reviewed study aims to explore self-reported beliefs and practice regarding drinking during pregnancy on the one hand, and the acceptability of antenatal screening on the other. In establishing the contextual ground for the authors’ enquiry, they observe that, in global terms, the UK is estimated to have one of the highest rates of alcohol use in pregnancy. Moreover, and crucially, they go on to make the point that ‘alcohol screening has the potential to help those who need support to stop or to reduce their consumption during pregnancy’. The follow-on effects of screening are thus understood to be essentially twofold: first, screening promotes new forms of knowledge and understanding about the adverse effects of alcohol in pregnancy, and, relatedly, it encourages behaviour change aimed at optimising the health and wellbeing of women and their infants.
As such, the overarching strength of the study resides in its accessibility. The authors do a useful job of weaving together the four main sections of the authors’ discussion – namely the background, methods, results and practical (and social) implications – in a way that is at once clear and informative. More particularly, we learn that the study underpinning the paper utilised a short prospective survey. In this regard, pregnant women and their partners attending antenatal clinics in the north-east of England were asked to respond to four questions, which encompassed (Q1) knowledge of safe levels of alcohol consumption in pregnancy, (Q2) alcohol cessation in pregnancy, (Q3) willingness to undertake blood tests in a future pregnancy and (Q4) the acceptability of meconium testing.
Data derived from just four questions – including free text responses from just two of the four (Q3 and Q4) – will inevitably yield little by way of nuanced insight or, for that matter, allow for detailed exposition. But where the reviewed study does succeed, however, is in providing strong evidence of the acceptability of the screening for alcohol in pregnancy (87.2% of respondents). In making sense of the combined statistical data and textual responses, the reviewed study attributes the acceptability of screening to two interrelated factors, namely, improved maternal and infant health on the one side, and feelings of safety and reassurance on the other. By way of caveat it is worth noting that it is standard policy within the participating NHS foundation trust to ask all women attending their first antenatal appointment about their alcohol use. Thus understood, the authors suggest that this positive orientation towards submitting to blood and/or meconium testing is directly attributable to the fact that the coupling of alcohol and pregnancy has been prioritised locally. The key point here is that pregnant women who participated in the study may be better informed about the risks of alcohol in pregnancy and thus more open to the idea of alcohol screening and brief intervention efforts than, say, their peers elsewhere in the UK.
The reviewed study avoids addressing a number of issues in depth (e.g. drink practices/local alcohol profiles). Perhaps most strikingly of all, the authors are strangely silent on the ethicality of alcohol screening in pregnancy (see Zizzo et al., 2013 for an important overview). The ethics of screening for biomarkers of prenatal alcohol exposure is largely relegated in importance to the observation that there is growing evidence of the technical feasibility of biomarker analysis. This seems like a missed opportunity, particularly if screening pregnant women for alcohol use becomes a ‘normalised’ and ‘accepted’ aspect of maternity care. It is, though, to the authors’ credit that the paper is clearly informed by an impulse to educate and raise awareness about the harms of alcohol use in pregnancy. Overall, then, the reviewed study’s contribution serves to expand the literature on alcohol and pregnancy, while also providing a valuable lens through which to begin to construct new forms of antenatal and postnatal support for women based on the precepts of informed decision-making and non-judgemental nursing practice.