The Risks of Alcohol and Drug Use in Pregnancy
Alcohol’s Unique Harm to the Developing Foetus
Alcohol poses a uniquely severe threat to foetal development more so than any other substance. While many drugs (including illicit substances) can lead to withdrawal symptoms, low birth weight, or temporary neonatal complications, alcohol is the only substance proven to cause permanent structural and functional brain damage.
This lifelong impact is known as Foetal Alcohol Spectrum Disorder (FASD). Link Meaning . There is no equivalent lifelong neurodevelopmental condition resulting from prenatal exposure to heroin, cocaine, cannabis, or prescribed opioid substitution therapies.
FASD Is a Brain Injury Not a Behavioural Issue
FASD is caused solely by alcohol exposure during pregnancy. It is not a reflection of maternal behaviour, lifestyle, or dependency. Importantly:
- FASD can occur without alcohol dependence
- It can result from episodic or binge drinking
- It may arise even when alcohol use stopped early in pregnancy
- Many mothers were unaware they were pregnant at the time
How Drug and Alcohol Exposure Differ Prenatally
In contrast, harm associated with prenatal drug exposure is often:
- Dose-dependent
- Linked to ongoing use
- Amenable to improvement once exposure ceases
- Not associated with permanent, global brain injury
This distinction is critical in care proceedings, where evidence-based findings and accurate risk assessments must be made.
Misinterpretation of Alcohol Risk in Care Proceedings
In practice, prenatal alcohol exposure is often:
- Minimised or under explored
- Treated as less serious than illicit drug use
- Subsumed under generic “substance misuse” categories
Conversely, drug use in pregnancy tends to attract:
- Greater scrutiny
- Stronger professional reactions
- More immediate safeguarding responses
This imbalance persists, despite alcohol being more likely to cause lasting harm to the foetus than most illegal drugs.
Consequences of this imbalance:
- Children with FASD may go undiagnosed
- Parents with FASD may be misjudged as non-compliant or lacking insight
- Care plans may fail when neurological impairment is misunderstood as wilful behaviour
Implications for Threshold and Risk Assessment
Alcohol exposure alone can meet the threshold for significant harm where FASD is present. However, this harm is static, not escalating the brain injury has already occurred. (link brain injury to brain injury page)
This contrasts with drug misuse, where risk may be:
- Ongoing
- Variable
- Responsive to treatment and abstinence
In care proceedings, professionals must distinguish between:
- Historical harm (alcohol-related brain injury)
- Current parenting risk (which may or may not be present)
Failure to make this distinction can lead to disproportionate interventions.
Mothers, Stigma, and Misplaced Blame
Alcohol use in pregnancy is highly stigmatised and often retrospectively moralised during proceedings especially problematic when:
- Official guidance on alcohol use has changed over time
- Cultural norms previously normalised drinking
- The pregnancy was unplanned
- The mother herself has undiagnosed FASD
Blame-focused narratives do not improve outcomes for children and may actively obstruct accurate assessments and the provision of appropriate support.
Practice Implications for Professionals
Those involved in care proceedings should:
- Treat alcohol exposure as a distinct and specific risk factor
- Avoid conflating alcohol with other substances
- Actively consider FASD where prenatal alcohol exposure occurred
- Recognise that cessation of alcohol use does not reverse FASD
- Adjust assessments and expectations accordingly
Conclusion: FASD Requires Distinct Recognition
Alcohol is not “just another substance” during pregnancy. It is uniquely damaging, legally relevant, and frequently misunderstood.
In care proceedings, differentiating FASD from drug exposure is essential not as a technicality, but as a core requirement for fairness, accurate risk assessment, and ensuring the child’s long term welfare.