Prenatal Alcohol Exposure: Guidance for Midwives

Prenatal alcohol exposure is a risk factor for a number of adverse pregnancy outcomes including spontaneous abortion, stillbirth, preterm birth, fetal growth restriction and low birth weight, and can result in lifelong cognitive, behavioral and neurodevelopmental disabilities for the child. Although the fetus is most vulnerable to structural damage due to the effects of alcohol exposure in the first trimester, exposure to alcohol throughout the duration of pregnancy has been associated with poorer pregnancy outcomes. On this basis, many countries, including Australia, have issued national guidelines recommending that it is safest for women who are pregnant or planning a pregnancy not to consume alcohol.

Despite such guidelines, approximately 10% of women globally consume alcohol at any time during pregnancy, with higher prevalence estimates reported in countries with high alcohol consumption rates in the general population (e.g. Ireland: 60%; Denmark: 46%; United Kingdom: 41%). In Australia, prospective cohort studies and national surveys have reported the prevalence of alcohol consumption at various times during pregnancy to be between 28 and 72%.

For example, a prospective cohort study of 1570 pregnant women found that 59% of women reported any alcohol consumption during pregnancy with 32% reporting consumption in the second and/or third trimester. Similarly, a national survey conducted in 2016 found that half of the pregnant women consumed alcohol before knowing they were pregnant. 25% continued consuming alcohol following knowledge of their pregnancy. Among those women who consumed alcohol during pregnancy, most reported drinking at a frequency of monthly or less (81%) and an average of one to two standard drinks per occasion (97%).


Antenatal clinical guidelines


Antenatal clinical guidelines recommend that during initial and subsequent antenatal visits all pregnant women: have their alcohol consumption assessed; be advised that it is safest not to consume alcohol during pregnancy and of the potential risks of consumption.


Alcohol exposure during pregnancy can have negative maternal and infant outcomes. Due to a lack of clear evidence of a ‘safe’ threshold for Prenatal alcohol exposure. The UK Chief Medical Officers (CMOs) revised their guidance in 2016 to advise pregnant women to abstain completely from alcohol. Furthermore, primary prevention in antenatal care. This is through screening and brief intervention has been set as a priority by the World Health Organization (WHO). Midwives are key to achieving these aims. However, little is known about the extent to which UK midwives are aware of, and implement, the CMO guidelines.




The aim of this study was to explore knowledge and implementation of the CMO guidelines amongst UK midwives. A mixed-methods design explore implementation barriers and midwives’ beliefs about addressing alcohol during antenatal care with pregnant women. The study drew on the Theoretical Domains Framework (TDF). It includes

i) an online survey and

ii) interviews and focus groups with midwives.




The final survey sample for the quantitative phase was 842 and for the qualitative phase 22. The survey showed that 58% of midwives were aware of the CMO guidelines. Of whom 91% reported that alcohol abstinence was advised within the guidelines. However, a variety of other responses were also in line with previous national guidelines.



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