Pregnancy and alcohol

If you are pregnant or planning a pregnancy, not drinking is the safest option. Learn about the effects alcohol could have on your unborn baby and the risks associated with drinking during pregnancy.

This message has been endorsed by many organisations, including the Ministry of Health, the Health Promotion Agency, the New Zealand College of Midwives, the New Zealand Nurses Organisation, the Royal New Zealand College of General Practitioners, Family Planning, and the Paediatric Society of New Zealand.

On this page, you can find the following information:

What effects could alcohol have on my baby?
What is fetal alcohol spectrum disorder (FASD)?
Is drinking a glass of wine from time to time really a risk to my baby?
What do I do if I find out I'm pregnant and I've been drinking?
What is the low risk drinking advice?
What can I do to help myself?
Where can I get help and support?

Key points

Not drinking alcohol during pregnancy is the safest option.
During pregnancy, alcohol can be transferred to your baby through the placenta and umbilical cord affecting your pēpi's development.
This includes all types of alcoholic drinks including beer, wine, cider, spirits and ready-to-drinks (RTDs).
This can happen at any stage of pregnancy, even before a woman knows she is pregnant.
If you’re trying to get pregnant be alcohol-free.
If you do drink alcohol and there is a chance you could become pregnant use effective contraception (birth control).
Fetal Alcohol Spectrum Disorder (FASD) is a condition caused by the developing baby being exposed to alcohol. It has lifelong impacts on individuals, their whānau, carers and the wider community.
Prenatal exposure to alcohol can also increase the risk of miscarriage, stillbirth and premature birth.
It is never too late. Stopping your drinking will increase the chances that your baby will be born healthy.

What effects could alcohol have on my baby?

Alcohol is a teratogen (a substance that may cause foetal abnormality) and can be transferred prenatally through the placenta and umbilical cord affecting the normal development of your baby. When you are pregnant, every time you drink alcohol, your baby is drinking alcohol too. Your baby can’t break down alcohol as well as you can and exposure to alcohol can seriously affect their development.

Prenatal (before birth) alcohol exposure can increase the risk of:

miscarriage and stillbirth
low birth weight and premature birth
a range of life-long problems known as foetal alcohol spectrum disorder (FASD).

If you could be pregnant, stop drinking alcohol

(Counties Manukau Health, NZ, 2019)

What is fetal alcohol spectrum disorder (FASD)?

Fetal alcohol spectrum disorder (FASD) is a condition that can occur as a result of prenatal exposure to alcohol. Problems can include brain damage and physical birth defects. Problems may be seen after birth, or they may not be noticeable until the child is older, when they may have trouble learning or socialising or have behavioural problems. FASD can be difficult to diagnose because not all children live or experience FASD in the same way. FASD can create life long challenges, eg, learning, speech, attention span, language and aggression problems.

Imag: 123rf

Is drinking a glass of wine from time to time really a risk to my baby?

There is no known safe amount of alcohol, even small amounts of alcohol can harm a baby’s development. But it is not known at which point – if any – the risk completely disappears. Therefore, to avoid harming your baby/pēpi, it is best not to drink any alcohol at any stage during pregnancy. This includes the time around conception (getting pregnant).

What do I do if I find out that I'm pregnant and I've been drinking?

The first thing to do is stop drinking alcohol. It is never too late. Stopping your drinking will increase the chances that your baby will be born healthy.

If you are concerned or are unable to stop, talk with your midwife or GP. It is not usually possible to know if your baby will be affected until after birth or in childhood.

What is the low-risk drinking advice?

For women who could be pregnant, are pregnant or planning a pregnancy, stop drinking alcohol. There is no known safe level of alcohol at any stage of pregnancy.

For non-pregnant women, health professionals advise:

no more than 2 standard drinks daily
no more than 10 standard drinks a week
at least 2 alcohol-free days per week
no more than 4 standard drinks on any single occasion.

Read more about low-risk drinking advice.

What can I do to help myself?

If you are trying to get pregnant, stop drinking.
Sometimes it can be hard to say ‘no’ to an alcoholic drink, and you might not want to share the news that you are pregnant – especially if it’s early in the pregnancy.
If you are socialising or going to an event, ask a friend (who knows you're pregnant) to go with you. You can be alcohol-free together.
Switch your alcoholic drinks for non-alcoholic alternatives, such as juice or lime and soda. There are plenty of zero-alcohol drinks available. Water and milk are good choices.
When you're ready to share you're pregnancy news, let your whānau and friends know why you are not drinking and ask them to support you in this decision.

Where can I get help and support?

If stopping drinking is difficult for you, or you are concerned about your drinking, there are organisations and people who can help you. Your midwife or GP can discuss ways you can stay healthy during pregnancy, answer your questions, or put you in touch with others who can help.

The Alcohol Drug Helpline is also here for you. Contact them on 0800 787 797 or free text 8681, 24 hours, 7 days a week.

Otherwise you can contact these organisations:

Community Alcohol and Drug Services Free phone 0800 845 1818
Support for family and friends Al-Anon
12 Step Plan Alcoholics Anonymous
Alcohol & Drug addiction services, including the Bridge programme

Learn more

Alcohol and pregnancy Health Promotion Agency, NZ
Alcohol – pregnancy and babies Ministry of Health, NZ
FASD Counties Manukau Health, NZ
Drinking alcohol while pregnant NHS Choices, UK

References

Alcohol and pregnancy – a practical guide for health professionals Ministry of Health, NZ, 2010
Australian guidelines to reduce health risks from drinking alcohol National Health and Medical Research Council, Australia, 2020
Understanding FASD Fetal Alcohol Spectrum Disorder Care Action Network, NZ

Credits: Health Navigator Editorial Team. Reviewed By: Luisa Silailai, Programme Manager for Alcohol Harm Minimisation and accredited DAPAANZ Clinical Supervisor/Alcohol and other Drugs and Problem Gambling Clinician. Last reviewed: 15 Jun 2022 Page last updated: 21 Nov 2022

Evidence and research from the NZ Health Promotion Agency (HPA)

HPA undertakes a range of research and evaluation activities to inform its alcohol and pregnancy work. Below is a list of evidence summaries, research reports about alcohol and pregnancy, and evaluations of services working to prevent and reduce harms caused by antenatal alcohol use.

Alcohol and Pregnancy – summary of evidence outlines why alcohol use is an issue during pregnancy, New Zealand statistics and approaches to reducing alcohol use in pregnancy.

Drinking alcohol during pregnancy, a literature review undertaken by HPA in 2014, reviews recent New Zealand and international published research on alcohol and pregnancy.

Drinking alcohol during pregnancy – an overview and new research, in the June 2015 issue of AlcoholNZ, provides a succinct overview of the alcohol and pregnancy evidence and key findings from the HPA literature review and qualitative research projects.

Evaluation of the Early Pregnancy Assessment Approach (Whakauae Research for Māori Health and Development, 2015) – The Whanganui Regional Health Network’s Early Pregnancy Assessment Approach (EPAA) is designed to improve identification and management of early pregnancy risk factors within the primary care setting. It is a comprehensive model that includes an early pregnancy screening tool for general practice, maternity support roles and strengthened referral pathways and information sharing between general practice and other health and social services. This implementation evaluation was commissioned by HPA in 2015. It describes the EPAA, identifies successes and challenges of early implementation in Whanganui and provides recommendations for wider implementation of the EPAA.

Evaluation of the Hawke’s Bay DHB Developmental Assessment Programme FASD Assessment Pathway (Health and Safety Developments, 2015) – The Hawke’s Bay District Health Board (DHB) Developmental Assessment Programme (DAP) provides multi-disciplinary diagnostic assessments of children with complex developmental and behavioural concerns. One component of the DAP is a Fetal Alcohol Spectrum Disorder (FASD) Assessment Pathway for children with developmental and behavioural issues potentially related to prenatal alcohol exposure. This process evaluation of the DAP FASD Assessment Pathway was commissioned by HPA in 2015. It describes core components and delivery mechanisms of the FASD Assessment Pathway, identifies key implementation successes and challenges and outlines considerations for replication of an FASD Assessment Pathway in other regions.

Insights from women about drinking alcohol during pregnancy, qualitative research undertaken by HPA in 2014, explores factors that influence alcohol drinking practices during pregnancy among different groups of New Zealand women.

Evaluation of the Waitematā DHB CADS Pregnancy and Parenting Service (Health and Safety Developments, 2015) – Reducing harm for children affected by parental addiction and reducing unequal access to addiction services are key priorities for the HPA. Waitematā DHB Community Alcohol and Drug Service (CADS) Pregnancy and Parenting Service (PPS) provides an intensive assertive outreach case coordination service for parents of children aged under three-years-old and pregnant women who are experiencing problems with alcohol and other drugs. This process evaluation was commissioned by HPA to understand more about the PPS model, identify implementation successes and challenges and explore considerations for service replication in other regions.

Consumer awareness and understanding of alcohol pregnancy warning labels (Colmar Brunton, Social Research Agency, 2016) – This research was funded buy HPA and uses an online survey to find out about consumer awareness, recall and knowledge of current alcohol pregnancy warning labels. The research highlights the important role of alcohol warning labelling in raising awareness of the risks and harms of drinking alcohol while pregnant (or when planning a pregnancy).

Read more about alcohol and pregnancy from the HPA

Information for healthcare providers on pregnancy - alcohol

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Alcohol and pregnancy – a practical guide for health professionals

The Ministry of Health advises that there is no known safe level of alcohol use at any stage of pregnancy. This includes the time around conception. The best advice is for a woman to stop drinking alcohol if she could be pregnant, is pregnant or is trying to get pregnant. This advice is supported by the Health Promotion Agency.

Advising women not to drink alcohol when pregnant or planning to be pregnant, explaining the consequences and supporting drinkers to stop when pregnant are simple prevention tasks that can have a big impact. Health professionals have a key role in providing this advice (often called brief interventions) as well as the ideal opportunity to do so.

The following three-step process (Alcohol ABC) can be used as an intervention guide when working with women who are planning a pregnancy or who are pregnant.

Ask about alcohol use, and record and assess the level of alcohol consumption.
Provide brief advice that there are no known safe levels of alcohol use during pregnancy.
Offer counselling or a referral to alcohol support services.

Useful resources

ABC Alcohol for Pregnancy provides a practical, three-step guide to help primary care health professionals address alcohol use in pregnancy in their conversations with women.
Hazards of alcohol use by pregnant women and women of reproductive age encourages health professionals to ask women about their alcohol use and advise them not to drink alcohol if they are pregnant or planning a pregnancy.
Alcohol and pregnancy consensus statement New Zealand College of Midwives, 2018.
Changes in alcohol consumption during pregnancy Growing up in New Zealand study (GUiNZ), 2015
Healthy Start Professional Development programmes Healthy Start Professional Development
Alcohol, Pregnancy and FASD – learning programme for midwives and LMCs Learn Online

HPA resources (alcohol.org.nz)

FASD prevalence

There has never been a prevalence study for FASD in New Zealand so estimates are used. The Fetal Alcohol Network NZ has estimated the prevalence of FASD as more than 1 in 100¹ (an estimated 1800–3,000 births annually)⁶. This would make FASD the most common “birth defect” in New Zealand. However, as the rates of FASD are only an estimate and considering the diagnosis is difficult to make, it may be more accurate to say that it is one of the most common causes of long-term disability.

International prevalence studies suggest FASD is conservatively estimated to occur in at least 1 out of every 100 live births and may be much higher in communities where binge and hazardous use of alcohol are prevalent. No research has confirmed the prevalence in New Zealand but it is thought the numbers could be substantially higher due to hazardous drinking patterns.¹

A systematic review published in 2016 reported that the worldwide rate of FASD was 113 per 1000, FAS 55 per 1000 and the neurodevelopmental delay was 20 per 1000.²
A Taranaki study reported a rate of 28% drinking during pregnancy with 10% of these women drinking more than 2 units a day for 7 days per week.³
Studies in Canada and US report an incidence of between 5 in 1000 to 15 per 1000 in aboriginal populations for the prevalence of FASD. This study reported that the rate of FASD is about 5 times that of FAS which is not entirely consistent with the systematic review but may be more appropriate to NZ. This is with a background of 10%–15% drinking alcohol in pregnancy.⁴

References

Foetal Alcohol Spectrum Disorder Foetal Alcohol Network, NZ
Roozen, S., Peters, G..-J.Y., Kok, G., Townend, D., Nijhuis, J., Curfs, L. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis (2016) Alcoholism: Clinical and Experimental Research, 40 (1), pp. 18-32.
Ho R, Jacquemard R. Maternal alcohol use before and during pregnancy among women in Taranaki, New Zealand New Zealand Medical Journal, 2009;122(1306):20-32.
Popova S, Lange S, Probst C, Parunashvil, N, Rehm J. Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States Eur J of Med Genet. 2017;60(1):32-48
Taking Action on Fetal Alcohol Spectrum Disorder: 2016-2019 - An action plan is New Zealand's national policy document. For more information and to download or order the action plan
Fetal alcohol spectrum disorder Ministry of Health, NZ, 2022