An informal approach is the key to tackling drinking in pregnancy

Health professionals are being advised to take on a "conversational approach" and focus on building up a rapport when discussing alcohol intake with pregnant women.

It's estimated more than 40 percent of women in the UK consume alcohol during pregnancy – one of the highest rates in Europe – despite there being no known safe level in terms of the health of their unborn child.

The study conducted by the Universities of Stirling and Edinburgh found that a “flexible, conversational approach” was felt to be more successful in encouraging honest disclosure of drinking habits by pregnant women. This contrasts with previous research that has recommended using formal screening tools, such as structured questionnaires.

Dr Niamh Fitzgerald, Stirling’s Institute for Social Marketing who led the study, said: "Midwives used several strategies to facilitate honest disclosures, including taking a positive tone in conversations and exploring drinking habits prior to pregnancy or prior to when women realised they were pregnant. It was felt that these approaches helped build a trusting relationship between pregnant women and midwives and improved disclosure rates.

"However, we also heard reports that, in some cases where there had been initial improvements, the number of women disclosing drinking proceeded to decline. This trend coincided with the inclusion of additional, separate questions about parenting capacity – raising the possibility that other questions, asked at the same time as alcohol screening, may impact on disclosure rates."

Dr Fitzgerald added: "It was clear that implementation leaders felt that the use of screening questions had to be flexible and not simply asked verbatim to each woman. A flexible, conversational approach to discussing alcohol with pregnant women was considered superior to formal tools for identifying who might benefit from intervention and needs to be formally tested."

Alcohol use in pregnancy can cause harm to the developing foetus, including growth restrictions, low birth weight, pre-term birth, and foetal alcohol spectrum disorders. There is little evidence of harm from very low levels of drinking but increasing risks as greater amounts are drunk more often.

Dr Fitzgerald said: "This is the first study to explore in detail the experiences of SBI implementation leaders of a large-scale primary prevention programme to prevent harm caused by alcohol exposure during pregnancy.

"It adds to understanding of the detailed practical and ethical dilemmas involved in establishing alcohol SBI in the antenatal setting, and is likely to be relevant to other countries."

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