NoLo Drinks and Pregnancy: Women’s harm perceptions, labelling ambiguity, and guidance needs

Background: No- and low-alcohol (NoLo) products are increasingly promoted as harm-reduction alternatives to standard alcohol, but their relevance to pregnancy is unclear. This study examined pregnant and recently pregnant women’s perceptions of harm associated with NoLo products, how these perceptions relate to alcohol use during pregnancy, and women’s information preferences.Methods: A cross-sectional mixed-methods online survey was completed by 515 UK women who were pregnant or had given birth in the past 12 months. Participants rated perceived harm of standard-strength alcohol, NoLo (0.0–1.2% ABV), and alcohol-free (≤0.05% ABV) drinks, reported alcohol use during pregnancy, and provided open-text responses on NoLo understanding.Results: Standard-strength alcohol was rated as most harmful, followed by NoLo and alcohol-free drinks (p < .001). Women who were aware of abstinence guidelines and those who did not drink during pregnancy rated all alcohol-containing drinks as more harmful. Variation in harm perception was greatest for NoLo products. Lower perceived harm of NoLo drinks predicted a greater likelihood of drinking during pregnancy (OR = 0.97, 95% CI 0.96–0.99), whereas harm perceptions of standard alcohol did not. Qualitative findings revealed widespread confusion about NoLo definitions, concerns about misleading labelling, and strong preferences for clear, clinician-led guidance.Conclusions: NoLo products occupy a psychologically ambiguous space in prenatal alcohol decision-making. Clearer regulation, transparent labelling, and pregnancy-specific guidance are needed to support informed choice without increasing fear or guilt