Pregnant women should decide themselves if they want to drink alcohol

Pat O'Brien, a consultant obstetrician from the Institute for Women's Health at University College London Hospitals, said it was not the role of the medical profession to make a "value judgment" on whether women should drink.

Given the lack of evidence on the issue, women should be trusted to make a choice, he said.

Foetal alcohol syndrome, which can cause learning difficulties and other disorders, is serious and is clearly a consequence of drinking heavily, he said.

But, he argued, there is still no evidence that low to moderate alcohol intake in pregnancy has any long-term effects.

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Confusion has arisen over whether women should drink in pregnancy after the health watchdog, the National Institute for Health and Clinical Excellence (NICE), issued draft guidance recently saying it was okay for mums-to-be to drink small amounts.

It said pregnant women could consume up to 1.5 units of alcohol a day after the first three months of pregnancy.

NICE said there was "no consistent evidence" to show a small amount of alcohol damaged unborn children.

However, this contradicted advice from the Department of Health in May, which said pregnant women and those trying to conceive should cut out alcohol altogether.

Today, Mr O'Brien, went "head to head" over the issue with other experts in the British Medical Journal (BMJ).

He wrote: "I'm not trying to argue that low levels of alcohol are definitely safe."

"What I am arguing is that we should respect the autonomy of pregnant women. We have a duty to be open and honest with the people we advise."

"Women are entitled to decide for themselves (and their babies); some are more risk averse than others and will wish to abstain completely."

He said there were potential disadvantages to a complete ban on drinking in pregnancy.

"Firstly, the strong advice not to drink implies a certainty and confidence in the evidence that simply does not exist," he said.

"There is a danger that our stance is perceived as paternalistic and will lead to a loss of confidence in medical advice."

"Secondly, I have already seen how it has frightened women who followed the safe limit advice earlier in their pregnancy or in a previous pregnancy, only to be told now that this was potentially harmful."

Mr O'Brien also argued that the ban was likely to lead to women not admitting having drunk alcohol in pregnancy for fear of being judged.

"It is not our role, having acknowledged our lack of evidence in this area, to make a value judgment (for that is what it is - not a medical judgment) on behalf of our patients, let alone healthy pregnant women," he said.

The Department of Health's May advice came after research found that, under the old guidance, 9 per cent of pregnant women drank more than the recommended amount.

The original guidance said women should drink no more than one to two units of alcohol once or twice a week, but the Department found this was being misinterpreted.

Dr Vivienne Nathanson, director of professional activities at the British Medical Association (BMA), has argued that the safest thing was for women not to drink in pregnancy.

The Royal College of Obstetricians and Gynaecologists also believed the "safest option" was for pregnant women to abstain.

Dr Nathanson and two BMA colleagues wrote in the BMJ that alcohol can adversely affect the reproductive process in several ways, including infertility, miscarriage, premature deliveries, stillbirth and low birthweight babies.

They said alcohol "readily crosses the placenta", adding: "Because the foetus does not have a developed blood filtration system, it is unprotected."

The experts argued there was evidence emerging of low to moderate levels of consumption affecting the foetus.

"Studies examining the effects of alcohol on the foetus have shown that acute exposure to one to two units of alcohol causes a rapid decrease in foetal breathing.

"Studies examining the effects of chronic consumption indicate that low to moderate levels of exposure (two to five units a week) delay the development of the foetus's nervous system and may have a permanent effect."

Countries such as the US, Canada, France, New Zealand, and Australia have adopted the abstinence message, they went on.

They argued that current UK guidelines on sensible drinking can also be misinterpreted as people may not clearly understand what units or standard drinks are.

Given the uncertainty over risks to the developing baby and such confusion, "the only sensible message for women who are pregnant or planning a pregnancy must be complete abstinence from alcohol", they said.

A small 125ml glass of red or white wine is just under 1.5 units, according to the Department of Health. Half a pint of 5 per cent lager or strong cider or a bottle of alcopop were also 1.5 units.

A 25ml measure of spirits is one unit.