Impact of alcohol strength on attitudes and decisions concerning special occasion drinking during pregnancy

Background Special occasions are a risk factor for drinking during pregnancy. This study determined the impact of alcohol strength on attitudes around, and perceived harm of, drinking in pregnancy. If perceived harm decreases with lower strength alcohol, this may promote drinking when abstinence is recommended. Methods Two online ‘special occasion’ vignette studies randomised female participants to one of three drink strength conditions (11%, 7.5%, 0% alcohol beverage volume [ABV]). In the study (N = 1030), participants were asked to imagine themselves or someone else choosing to consume the beverage when pregnant. Outcome measures assessed how harmful participants thought drink choice was, and the extent to which they agreed with the drink choice. Results The standard and lower strength alcohol beverages were viewed as more harmful than the alcohol-free drink ( p <  .001), and participants agreed with the alcohol-free drink choice more than the standard and lower strength beverages ( p  < .001). Perceived harm was greater in when rating own hypothetical alcohol use in comparison to rating observed hypothetical alcohol use ( p <  .01). Participants who reported drinking in their own pregnancy rated the alcohol choices as less harmful and more agreeable than participants who had not consumed alcohol in their own pregnancies ( ps <  .001). Conclusions Perceived harm, and the ability to apply the potential harms of drinking during pregnancy to one’s own circumstances, may be crucial in reducing the risk special occasions pose to alcohol exposed pregnancies. Public health campaigns should focus on facilitating this, compassionately explaining the risk of harms across a range of drinking behaviours, while explicitly tackling the stigma and shame women may experience around this public health issue.