A LEADING Australian paediatrician has compared drinking small amounts of alcohol in pregnancy with drinking “a little bit of thalidomide”, after research she co-authored linked prenatal alcohol exposure with changes in babies’ head shapes.

Professor Elizabeth Elliott, professor of Paediatrics and Child Health at the University of Sydney, told MJA InSight that it was unfathomable why over 60% of Australian women drank alcohol during pregnancy, suggesting that they may be getting mixed messages from their doctors.

“Many doctors are unwilling to advise women not to drink during pregnancy, saying that one drink is not going to hurt,” she said. “That may be true for some women, but you don’t know which women will have one drink and go on to have 10 drinks, and you don’t know which babies or which mothers metabolise alcohol in such a way that it is more likely to cause harm.

“Alcohol goes straight across the placenta to the baby; would you give a newborn baby a glass of wine?” she said. “Or would you say to a pregnant woman, ‘just have a little bit of thalidomide’?”

Professor Elliot is the co-author of a prospective cohort study in JAMA Pediatrics which found that even low level drinking – not exceeding two standard drinks per occasion or seven standard drinks a week – was associated with subtle facial changes in the same region as those seen in fetal alcohol syndrome (FAS).

The study used three-dimensional craniofacial imaging to assess 415 1-year-olds born in public maternity hospitals in Melbourne, whose mothers had been surveyed throughout their pregnancy about their alcohol use and other habits.

Despite public health advice that women abstain from alcohol in pregnancy, 78% of the children’s mothers had reported drinking at least some alcohol. However, 40% of these stopped after the first trimester.

The study found “aspects of a craniofacial phenotype with almost any level of prenatal alcohol exposure,” even when the mothers reported only drinking small amounts in the first trimester.

The craniofacial differences were concentrated around the midface, nose, lips and eyes, the study found, with midfacial recession and an upturned nasal tip among those exposed to alcohol prenatally.

FAS is diagnosed when cognitive impairment occurs together with abnormalities of growth and a characteristic facial phenotype. As the latest study did not assess cognitive outcomes, the authors said it was not known whether the craniofacial differences they found were of diagnostic or predictive value.

However, Professor Elliott commented: “A baby’s facial development mirrors the development of the brain, and so facial changes could be an early marker for alcohol effects on the brain”.

The study found that the craniofacial differences were most pronounced in children of mothers who said that they felt the effects of alcohol quickly, with the authors suggesting that this may be a proxy for alcohol metabolism.

The study’s findings were consistent with previous human studies that used less objective measures of facial abnormalities, and also with mouse studies of the craniofacial effects of first trimester exposure to ethanol, the authors noted.

Dr Will Milford, speaking on behalf of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said that the study reinforced the message that the safest option for women pregnant or planning a pregnancy was to abstain from drinking.

“We still don’t know if there is a safe threshold for drinking alcohol in pregnancy,” he said.

However, he also stressed that the latest findings should not panic women.

“The study has proved an association – which may or may not be causal – between any prenatal alcohol exposure and changes in facial features, the ramifications of which remain unknown,” he said.

“I think the cut-off for low alcohol intake in this study was still actually quite high,” he said. “It would be good to break down that ‘low intake’ bracket, which probably covers a range of use, from a shandy to a couple of glasses of wine.”

Dr Milford said that warnings about drinking in pregnancy must be expressed sensitively so that women were not “overcome by guilt”.

“We don’t want to make women so fearful or worried that they come to us saying they are considering termination of pregnancy because they had a significant alcohol intake before they knew they were pregnant,” he said.


To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.



11 thoughts on ““Mixed messages” sent about alcohol in pregnancy

  1. Anonymous says:

    I don’t know why I continue to be surprised when women blame the doctor or researchers for their independent findings. It’s not Professor Elliot ‘s fault that alcohol affects the shape of your babies head. Given the shameful responses on this page is it any wonder doctors might not want to advise women not to drink during pregnancy.

  2. Peter C says:

    We need a sense of perspective here. Many things are poisons in high doses, and not in low doses, yet we still use them Not to differentiate between dose, threshhold and effect is disingenuous and does nothing to improve the debate or the science. It is emotive.

    To liken alcohol to Thalidomide is also unhelpful. They are not at all comparable. Small doses of Thalidomide would never be reasonable.

  3. Anonymous says:

    A woman’s right, guilt, responsibility, common sense …….. Each to his own. I personally think 9 months of no alcohol is but a small price to pay for my baby’s health. I know we are told a drink now and then does not matter but for me my baby is way too precious. I would rather have a hot chocolate instead.

  4. Anne Malatt says:

    I am not offended by Evelyn’s stance, and I am a woman. Let’s just speak for ourselves and not make assumptions on behalf of others.
    There is plenty of evidence to suggest that alcohol is harmful, and that there is no safe level of alcohol consumption, at any age.
    It is not about making people feeling guilty about what they have done and that cannot be changed, but about providing them with facts, so they can make true choices, for themselves and for their unborn children.
    Whether you choose to drink or not is up to you, but don’t think that it is not harmful, for women or for their unborn children. And it is up to us as medical practitioners to be responsible in providing that information, not sugar-coating it to make ourselves and others feel better about our choices.

  5. Anonymous says:

    your stance is the one that offends most women. there is no evidence that once in a while, a samll dose is harmful, and yet your stance makes them guilty that they had some when they were pregnant. Sorry to hear that your children have FASD, glad it is not FAS. how do you know their problems are due to alcohol and not a whole lot of other factors which ended up in their adoption? Dont tell other people to grow up. Dont call 2 standard drinks a day low intake – bacause it is not. It is regular intake.

  6. Evelyn Mora says:

    Why would you want to risk it at all? I am raising two children (adopted family) and both have FASD….I would never tell another mother “it’s ok to have a drink now and then”….but, hey…each to their own right? I hope you never see a child suffer from an FASD. No child deserves this brain damage caused by a mother who wants to assert her rights….What happens to the unborn child’s right to being born without brain damage? Grow up…drink after the child is born…

  7. Anonymous says:

    seems ridiculous to call low up to 2 std drinks daily low intake. I think women are more interested in whether a glass occaionally ie for special occasion will matter. i think that statements akin to ‘have a little bit of Thalidmide’ do a great diservice to getting the message accross as it smaks of scaremongering.
    when doing a study like this, why not set out a thresholod which is more realistic ie no more than 1 stad drink on a drinking occasion, no more than once a week is low? or twice a week ?
    lets look at a population where women dont drink vs a population where women do drink eg Japanese or Iranian vs French : im not sure that i mind the craniofacial ‘deformities’ or subtle neurological deficits of the latter group.

  8. Ron Batagol, Pharmacist and Obstetric Medicines Information Consultant says:

    Of course, we all advise against alcohol use during pregnancy, since we know that with high-level alcohol use, there is the danger of fetal alcohol syndrome occurring.

    However, I also agree with Dr Milford that the warnings about drinking in pregnancy must be expressed sensitively so that women were not “overcome by guilt”, and that “we don’t want to make women so fearful or worried that they come to us saying they are considering termination of pregnancy because they had a significant alcohol intake before they knew they were pregnant.” I wrote specifically about the importance of reassurance following inadvertent low-level exposure to alcohol in pregnancy, in a letter to the MJA in 2014 (1), noting that our NHMRC Guidelines fail to reassure women who had inadvertently had low-level alcohol exposure in early pregnancy, in the way that the national guidelines in the U.S.A and Canada do, which provide the reassuring advice that “low level consumption is not a cause for pregnancy termination”.

    (1) Changes in alcohol consumption in pregnant Australian women between 2007 and 2011
    Ronald P Batagol. Med J Aust 2014; 200: 391-392

  9. Anonymous says:

    A bit disingenuous.

    “two standard drinks per occasion or seven standard drinks a week” is a huge amount of alcohol!

    I wonder if the authors needed to up and up the cutoff until they could detect a difference in the data?

    I don’t know any GP who is saying seven standard drinks per week is fine.

  10. Anonymous says:

    I’m pleased I had my children in the days when obstetricians told us a glass of wine at night would relax us, when the Private Obstetric wards served wine to their inpatients, and heaven forbid, we may even have had biscuits with Camembert or Brie! And although I may be biased, I don’t think my offspring have funny shaped heads, or seemed to have suffered any ill effects from what now would be considered the outrageous behaviour of their Mother!

  11. Jules Black says:

    If 60% of Australian women drink alcohol sometime in their pregnancy, are 60% of Australian babies being born with “funny looking heads”?

Leave a Reply

Your email address will not be published. Required fields are marked *