Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently ‘safe’ levels of alcohol during pregnancy? A systematic review and meta-analyses
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  • Published on:
    The Importance of Methodological Rigor and Communication of Information
    • Jason L. Salemi, PhD, MPH, Assistant Professor of Epidemiology Department of Family and Community Medicine, Baylor College of Medicine
    • Other Contributors:
      • Roger J. Zoorob, MD, MPH, Professor and Chair

    Dr. Mamluk and colleagues’ recent systematic review and publication in BMJ Open (1) carries with it a provocative title and over the past week its conclusions have garnered substantial attention by news organizations such as CNN (2), Newsweek (3), and the New York Post (4). Although we agree completely with the authors’ assertion that there is a significant gap in the literature concerning low levels of maternal alcohol consumption during pregnancy, we have some substantial concerns regarding misleading statements in the paper and inconsistencies between the methodology that was stated versus that which was conducted.

    First, in the introduction, the authors claim that “Internationally, clinical guidelines recommend that pregnant women should abstain from heavy or ‘binge’ drinking”. Although technically correct, it is misleading since the messaging reported in the authors’ cited reference actually shows that nearly every country advises abstaining from any alcohol consumption during pregnancy – not just heavy or binge drinking. Furthermore, the authors state that “…UK guidelines advised women to avoid drinking alcohol while trying to conceive, and in the first trimester, but at the same time indicated that consumption should be restricted to within ‘1 to 2 UK units, one or twice a week.” Their statement makes it seem as though the UK message is contradictory regarding maternal alcohol consumption during pregnancy – it is not. In the 2016 UK Chief Medical Officers’ Lo...

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    Conflict of Interest:
    None declared.
  • Published on:
    Liquor lobby cited (incorrectly) in article
    • Dr Nicki Jackson, Executive Director Alcohol Healthwatch
    • Other Contributors:
      • Christine Rogan, Health Promotion Advisor - FASD

    It is concerning to read on page 1 of the introduction that “Internationally, clinical guidelines recommend that pregnant women should abstain from heavy or ‘binge’ drinking'". The reference cites the liquor industry social aspects organisation [] as their source, which we admit find rather unusual. What is more unfortunate is the authors then misrepresent the content found on the industry website. Rather than the guidelines recommending the avoidance of heavy drinking, all of the 54 countries’ guidelines for alcohol and pregnancy advise abstinence, and the only exception is Bulgaria which offers a low-risk level for pregnant women who do choose to consume. This appears contradictory to the statement made by the authors in their introduction.

    Conflict of Interest:
    None declared.