Quality standard

Quality statement 1: Advice on avoiding alcohol in pregnancy

Quality statement 1: Advice on avoiding alcohol in pregnancy

Quality statement

Pregnant women are given advice throughout pregnancy not to drink alcohol.

Rationale

Drinking alcohol during pregnancy increases the risk of harm to the baby. There is no known safe level of alcohol consumption during pregnancy and the UK Chief Medical Officers' low-risk drinking guidelines state that the safest approach is to avoid alcohol altogether to minimise risks to the baby. Midwives and other healthcare professionals should give women clear and consistent advice on avoiding alcohol throughout pregnancy, and explain the benefits of this, including preventing fetal alcohol spectrum disorder (FASD) and reducing the risks of low birth weight, preterm birth and the baby being small for gestational age.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that midwives and other healthcare professionals carrying out antenatal appointments are aware of the risks of drinking alcohol in pregnancy, including FASD, and the advice in the UK Chief Medical Officers' low-risk drinking guidelines on alcohol consumption in pregnancy.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from staff training records.

b) Evidence of local arrangements to ensure that antenatal appointments include discussion of the risks of drinking alcohol in pregnancy and the advice in the UK Chief Medical Officers' low-risk drinking guidelines.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from appointment schedules and information given to pregnant women about what is covered in their antenatal appointments.

Process

Proportion of antenatal appointments in which pregnant women are advised not to drink alcohol during pregnancy.

Numerator – the number in the denominator in which pregnant women are advised not to drink alcohol.

Denominator – the total number of antenatal appointments attended.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, maternity records. Achievement levels should be agreed locally based on population needs.

Outcome

Rate of alcohol-exposed pregnancies.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local audits of maternity records. The NHS Digital Maternity Services Data Set includes information on alcohol consumption recorded at the antenatal booking appointment. The Perinatal Institute's Pregnancy notes record information on alcohol consumption in pregnancy.

What the quality statement means for different audiences

Service providers (maternity services) ensure that midwives and other healthcare professionals providing antenatal care are aware of the risks to the fetus of drinking alcohol in pregnancy, and have training on FASD awareness and alcohol brief interventions. They ensure that antenatal appointments include verbal and written advice not to consume alcohol in pregnancy, based on the UK Chief Medical Officers' low-risk drinking guidelines.

Healthcare professionals (midwives, nurses, doctors and health visitors) discuss with pregnant women the risks to the fetus of drinking alcohol in pregnancy and provide support at antenatal appointments. They provide verbal and written advice, based on the UK Chief Medical Officers' low-risk drinking guidelines, that the safest approach is to avoid drinking any alcohol during pregnancy. This includes information that the risk of harm to the baby is likely to be low if only small amounts of alcohol have been consumed but that further drinking should be avoided. They use a non-judgemental approach, discuss any concerns and provide support according to the woman's needs, which may include a structured conversation, help to stop drinking through a brief intervention and signposting, or referral to specialist services.

Commissioners (such as clinical commissioning groups, integrated care systems and NHS England) commission maternity services that give advice at antenatal appointments about not drinking alcohol during pregnancy. They commission services for pregnant women who continue to drink but are not alcohol dependent and for those who are alcohol dependent.

Pregnant women discuss the risks of drinking in pregnancy with their midwife or healthcare professional at antenatal appointments throughout their pregnancy. Their healthcare professional explains the benefits to the baby of avoiding alcohol, including preventing fetal alcohol spectrum disorder (FASD), and advises that the safest approach is to not drink alcohol at all. If they are worried about already having drunk alcohol during pregnancy or want support to stop drinking, they are reassured and offered further help.