Exploration of dietary patterns and alcohol consumption in pregnant women in the UK: A mixed methods study

•Lower levels of alcohol consumption during pregnancy compared to pre-pregnancy.•Drinking low levels of alcohol during pregnancy associated with better quality diet.•Women more conscious of dietary and alcohol intake during pregnancy.•Social and cultural expectations play a key role in behaviour change.•Inconsistent advice about diet and alcohol created uncertainty.

Backgroundfetal Alcohol Spectrum Disorders is a term used to describe a range of physical, cognitive and behavioural deficits in the offspring of women who drank alcohol during pregnancy. A growing body of evidence suggests alcohol consumption in the presence of poor maternal nutrition may increase the risk of harm to the developing fetus.Objectiveto investigate relationships between maternal dietary patterns and alcohol consumption, and explore which factors influence women's decisions about what to eat and drink during pregnancy.Designa mixed methods study comprising a questionnaire (paper-based and online) and semi-structured, in-depth interviews with a sub-sample of women who completed the questionnaire.Participantswomen were eligible for inclusion if they were ≥16 years of age, pregnant and living in the UK and were recruited through antenatal clinics, specialist substance misuse antenatal clinics or via social media platforms; 350 women completed a questionnaire and a sub-sample of 6 women participated in an interview.Methodsthe questionnaire comprised the Alcohol Use Disorders Identification Test Consumption to measure alcohol consumption patterns and a Food Frequency Questionnaire to measure dietary intake. Dietary pattern analysis was conducted using Principle Components Analysis and linear regression models were used to explore relationships between dietary pattern scores and alcohol consumption. Analyses were adjusted for socio-demographic and lifestyle characteristics. Semi-structured, in-depth interviews were conducted face-to-face and analysed thematically.Findingstwo key dietary patterns were derived. Women who reported frequent alcohol consumption before and during pregnancy were more likely to adhere to the 'Prudent' dietary pattern compared to those who abstained. No relationships were observed between alcohol consumption and adherence to the 'Cafeteria' dietary pattern. Six key themes were identified through the qualitative analysis: (1) pregnancy as a time to review behaviour; (2) listen to your body - it will tell you what you need; (3) treats are still important - on special occasions; (4) social and cultural expectations constrain behaviour; (5) inconsistent or ambiguous information creates uncertainty; and 6) confidence increases following a successful pregnancy.Conclusionsthose who drink low levels of alcohol during pregnancy may have better quality diets compared to women who report no alcohol consumption. The reasons for this are complex and influenced by social context and previous pregnancy experience, which should be considered when healthcare professionals provide advice during this period.