Background Due to the social and medical preoccupation with consumption of alcohol during pregnancy, public health policy has steadily sought to influence and shape maternal behaviour through increasingly coercive means. Throughout the last decade a clear policy framework aimed at addressing alcohol consumption during pregnancy has emerged. While institutional responses began with a ‘simplified’ message through the Chief Medical Officer’s guidance of abstinence only, the precautionary principle has since been further operationalised, leading to the introduction of mandatory screening to enforce ‘guidance’.

Aim/Objectives To explore the influence of prevailing attitudes towards maternal alcohol consumption in the treatment of evidence within relevant policy; to highlight the implications for pregnant women.

Methods A document analysis, informed by socio-cultural theory, of the introduction of key policy documents; namely: UK Chief Medical Officers’ Low-Risk Alcohol Guidelines (2016), Scottish Intercollegiate Guidelines Network (SIGN) Guideline 156: Children and Young People Exposed Prenatally to Alcohol (2019), National Institute for Health and Care Excellence (NICE) Draft Quality Standards on FASD (2020).

Results Using a detailed exploration of ideas of risk, uncertainty and trust, we argue that policy documents, which facilitate action against any drinking in pregnancy, have relied upon the explicit removal of evidence relating to alcohol consumption and impaired foetal development from policy (SIGN 2019, NICE 2020), which legitimates the use of mandatory screening for alcohol under the guise of ‘routine antenatal care’. This transformation of guidance into mandate is hinged on a lack of trust in women’s ability to comprehend and act on the available evidence relating to alcohol consumption and harm.

Conclusions Our analysis highlights the importance of socio-cultural theory in understanding both the feasibility of actual and proposed policy responses to alcohol consumption during pregnancy, and the potential implications of this framework for women– including an erosion of trust in relationships with healthcare practitioners.