Alcohol Use During Pregnancy and Motherhood: Attitudes and Experiences of Pregnant Women, Mothers, and Healthcare Professionals, 2018-2019

Alcohol is the most used substance by women of childbearing age. Alcohol exposed pregnancies can have serious consequences to the fetus, and the UK has one of the highest rates of drinking during pregnancy. Alcohol use during motherhood is also a public health concern, linked with potential harms to the woman and child. This qualitative study investigated the attitudes and experiences of pregnant/parenting women and healthcare professionals regarding maternal drinking. A semi-structured focus group and interviews were conducted in the North West of England with pregnant women, mothers, and healthcare professionals. Quantitative measures captured demographics, alcohol use, and screened for mental ill-health for pregnant women and mothers. Reflexive thematic analysis was used to analyse narratives. Findings revealed that most participants believed avoiding alcohol during pregnancy is the safest option. However, some pregnant women and mothers stated that there was insufficient evidence to demonstrate the harms of low-level drinking and that abstinence guidelines were patronising. All participants reported that low-level drinking during motherhood was acceptable. Heavy drinking was believed to pose serious harm during pregnancy and motherhood to the baby and mother, in addition to damaging relationships. Strong motives were revealed for choosing and avoiding to drink, such as coping with the difficulties of motherhood and parental responsibilities, respectively. Contradictions were found across quantitative and qualitative self-reports of consumption, reflecting potential underreporting of alcohol use. Additionally, drinking levels were discussed in extremes only (low/heavy) without considering ‘grey area’ drinking. Clear, consistent advice and guidelines are needed to support women in reducing their alcohol use during pregnancy and motherhood. These should include the unique potential risks regarding maternal drinking, and the harm attributable to non-clinically dependent alcohol use. The maternal participants in this study were middle-class, therefore, research is needed to capture the views and experiences of women of all socioeconomic backgrounds.

Despite recommendations of abstinence, the UK has one of the highest reported prevalence rates of alcohol exposed pregnancy and foetal alcohol spectrum disorder in the world. Additionally, maternal drinking when not pregnant can be associated with increased risk of alcohol harm both for the mother and child. This study sought to identify attitudes around the motives and impact of alcohol use during pregnancy and motherhood, and whether these attitudes differed depending on the population (pregnant women, non-pregnant mothers, and healthcare professionals). By identifying the drivers and impact of maternal drinking, evidence-based interventions can be developed, tailored to supporting maternal populations drinking within relevant recommendation alcohol guidelines. Focus groups and semi-structured interviews were conducted to explore attitudes around maternal alcohol use from 6 pregnant women, 8 mothers, and 7 healthcare professionals. Audio recordings were transcribed verbatim. Transcriptions were coded and categorised using content analysis and reflexive thematic analysis.

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