CONCLUSIONS

Pregnant women wished to be able to make fully informed decisions and to take responsibility for their own health. They felt that, at present, the available advice and guidelines lacked explanations and supporting evidence. Such findings are important, given that women reported being influenced by perceptions of risk and that many put their unborn child’s needs first. Pregnant women require clear and consistent advice about safe levels of drinking from policy makers and health professionals.

Declaration of Competing Interests
The authors declare that they have no competing interests.

Authors’ Contributions
We confirm that all authors fulfil the criteria for authorship. All authors contributed core ideas and to writing the paper. NR recruited the sample, carried out the interviews, and helped to draft the manuscript. CB participated in the design and coordination of the study, data analysis, interpretation of the findings, and writing the paper. CG participated in the conception of the study, interpretation of the findings, and writing the paper. KS had the original concept, supervised data collection and the co-ordination of the study, participated in the data analysis and interpretation of the findings, and drafted and finalised the paper. All authors read and approved the final manuscript.

Acknowledgements
We thank all the participants and both reviewers for their helpful comments on the initial submission of the manuscript.

REFERENCES

1. Sokol RJ, Delaney-Black V, Nordstrom B: Fetal alcohol spectrum disorder. JAMA 2003, 290:2996­2999.
2. Mukherjee RA, Hollins S, Abou-Saleh MT, Turk J: Low level alcohol consumption and the fetus. BMJ 2005, 330:375-376.
3. British Medical Association: Fetal alcohol spectrum disorders. London: BMA; 2007.
4. O’Brien P, Nathanson V, Jayesinghe N, Roycroft G: Head to Head: Is it all right for women to drink small amounts of alcohol in pregnancy? BMJ 2007, 335:856-857.
5. Gray R, Henderson J: Review of the fetal effects of prenatal alcohol exposure: report to the Department of Health. National Perinatal Epidemiology Unit, University of Oxford; 2006
6. Sayal K, Heron J, Golding J, Emond A: Prenatal alcohol exposure and gender differences in childhood mental health problems: a longitudinal population-based study. Pediatrics 2007, 119:e426-34.
7. Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, Janisse J, Martier S, Sokol RJ: Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics 2001, 108:e34.
8. Kelly Y, Sacker A, Gray R, Kelly J, Wolke D, Quigley MA: Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age? Int J Epidemiol 2009, 38:129-140.
9. American Academy of Pediatrics: Fetal alcohol syndrome and alcoholrelated neurodevelopmental disorders. Pediatrics 2000, 106:358­361.
10. Sayal K: Alcohol consumption in pregnancy as a risk factor for later mental health problems. Evid Based Ment Health 2007, 10:98-100.
11. Sayal K: Commentary: Light drinking in pregnancy: can a glass or two hurt? Int J Epidemiol 2009, 38:140-142.
12. Rickards L, Fox K, Roberts C, Fletcher L, Goddard E: Living in Britain: Results from the General Household Survey, no 31; London: The Stationery Office; 2004.
13. Floyd RL, Decoufle P, Hungerford DW: Alcohol use prior to pregnancy recognition. Am J Prevent Med 1999, 17:101­107.
14. Department of Health. The Pregnancy Book, 2006. [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsP olicyAndGuidance/DH_4136417]
15. Department of Health. The Pregnancy Book 2007. [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsP olicyAndGuidance/DH_074920]
16. Royal College of Obstetricians and Gynaecologists. Statement No. 5: Alcohol Consumption and the Outcomes of Pregnancy. 2006. [http://www.rcog.org.uk/files/rcog-corp/uploadedfiles/RCOGStatement5AlcoholPregnancy2006.pdf]
17. National Institute for Health and Clinical Excellence. Antenatal Care: Routine Care for the healthy pregnant woman. Draft for consultation. 2007. [http://www.nice.org.uk/nicemedia/pdf/ANCpartialupdate2008NICEVersion.pdf]
18. National Institute for Health and Clinical Excellence. Antenatal care: routine care for the healthy pregnant woman. 2008. [http://www.nice.org.uk/nicemedia/pdf/CG062NICEguideline.pdf]
19. Chang G, McNamara TK, Orav EJ, Wilkins-Haug L: Alcohol Use by Pregnant Women: Partners, Knowledge, and Other Predictors. J Stud Alcohol 2006, 67:245-251.
20. Lelong N, Kaminski M, Chwalow J, Bean K, Subtil D: Attitudes and behavior of pregnant women and health professionals towards alcohol and tobacco consumption. Patient Educ Couns 1995, 25:39-49.
21. Kesmodel U, Kesmodel PS: Drinking During Pregnancy: Attitudes and Knowledge among Pregnant Danish Women 1998. Alcohol Clin Exp Res 2002, 26:1553­1560.
22. Pope C, Mays N: Qualitative Research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995, 311:42-45.
23. Boyatzis R: Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks: CA. Sage; 1998.
24. Braun V, Clarke V: Using Thematic Analysis in Psychology. Qualitative Research in Psychology 2006, 3:77-101.
25. Joffe H, Yardley L: Content and thematic analysis. In: Research methods for clinical and health psychology. Edited by Marks M, Yardley L. London, Sage 2004, 56-68.
26. Alvik A, Heyerdahl S, Haldorsen T, Lindemann R: Alcohol use before and during pregnancy: a population-based study. Acta Obstet Gynecol Scand 2006, 85:1292-1298.
27. Testa M, Reifman A: Individual differences in perceived riskiness of drinking in pregnancy: Antecedents and consequences. J Stud Alcohol 1996, 57:360-367.
28. Verbeke W, De Bourdeaudhuij I: Dietary behaviour of pregnant versus non-pregnant women. Appetite 2007, 48:78-86.
29. Prime Minister’s Strategy Group: Alcohol harm reduction strategy for England. London: The Cabinet Office; 2004.
30. O’Connor TG, Heron J, Golding J, Beveridge M, Glover V: Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years, Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 2002, 180:502-508.
31. Payne J, Elliott E, D’Antoine H, O’Leary C, Mahony A, Haan E, Bower C: Health professionals’ knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy. Aust N Z J Public Health 2005, 29:558-564.
32. Diekman ST, Floyd RL, Decoufle P, Schulkin J, Ebrahim SH, Sokol RJ: A survey of obstetrician-gynecologists on their patients’ alcohol use during pregnancy. Obstet Gynecol 2000, 95:756­763.
33. Dunn CL, Pirie PL, Hellerstedt W: The advice-giving role of female friends and relatives during pregnancy. Health Educ Res 2003, 18:352-362.
34. Aquilino WS: Telephone versus face-to-face interviewing for household drug use survey. Int J Addiction 1992, 27:71-91.

Neil Raymond, Charlotte Beer, Cristine Glazebrook, Kapil Sayal

Division of Psychiatry, School of Community Health Sciences University of Nottingham, UK