This pilot study aimed to measure alcohol use during pregnancy and motherhood, attitudes around maternal drinking, identify key motives for drinking and for not drinking, and to determine perceived barriers to reducing alcohol use.

Given these aims, we specifically asked pregnant respondents about their drinking behaviour since knowing they were pregnant. Estimated UK prevalence rates of any alcohol use (41.3%) and binge drinking (18.6%) during pregnancy (Lange et al. 2017; Popova et al. 2017) are high, but some data show that this drops to around 12% once the pregnancy is confirmed (Schölin et al. 2019). In our sample, around 9% of pregnant respondents reported alcohol use since knowing they were pregnant (with median consumption of 2.3 units a week). Although these rates are similar, it should be noted that retrospective reporting of pre-pregnancy drinking was 8.8 units for pregnant women (compared to 13.7 units for mothers). This may be an accurate reflection of our self-selecting population (discussed below) or it may suggest a reporting bias, with pregnant women more likely to underreport their alcohol use even when reporting pre-pregnancy drinking. This fits with previous studies reporting that women are likely to underreport their drinking behaviour during pregnancy, perhaps for fear of consequences and stigma (Phillips et al. 2007; Schuler et al. 2015). An alternative reason may be that retrospective recall of behaviour is influenced by current behaviour, with pregnant women using their current low levels of alcohol use to estimate historical drinking behaviour. There is evidence that mood can influence autobiographical memories through congruency effects, but it is unclear whether this applies to recall of historical health behaviour (Drace 2013).

Most of the non-pregnant mothers reported drinking alcohol (median 6.9 units/week), with approximately 25.7% drinking above recommended weekly guidelines (14+ units/week) and 1 in 20 mothers scoring 16 or more on the AUDIT, suggesting high risk or probable dependence. Even with potential underreporting of alcohol use, this rate is higher than that reported in the general population of women aged 25–44 years (15% drink above 14 units/week) (NHS Digital 2020). This suggests that mothers may be a specific population where targeted information around reducing alcohol use could be beneficial. Crucially, most maternal drinking research focuses on alcohol use in pregnancy due to the risk of FASD. However, maternal drinking by mothers who are not pregnant can also increase the risk of harm, to both the woman’s and child’s health and well-being (Blair et al. 2009; McGovern et al. 2018; Rossow et al. 2016; IAS 2017). This finding highlights a need for more work that focuses on maternal alcohol research beyond pregnancy.

In terms of drinking motives, given that very few of the pregnant respondents reported any alcohol use, we cannot derive much from reported motives in this population. However, among pregnant responders, 71% reported drinking to enjoy social occasions. This fits with existing research which demonstrates the role alcohol continues to have in some women’s social lives during pregnancy (Meurk et al. 2014). Additionally, studies have found that specific questions on special-occasion drinking were more effective in identifying alcohol use during pregnancy than the use of more traditional measures (e.g., the AUDIT-C) (Muggli et al. 2016; Tsang et al. 2022). Although tentative due to the numbers, motives that may be a risk for greater alcohol use during pregnancy were to have fun (which is likely related to enjoying special/social occasions), to reduce stress and to relax, and drinking out of habit.

Interestingly, some pregnant respondents chose not to answer the question about whether they drank since knowing they were pregnant, perhaps indicating that they did not wish to admit this behaviour. However, because they did not answer the screening question, subsequent questions concerning alcohol use were shown to them (in addition to the 76 pregnant women who said they had consumed alcohol since knowing they were pregnant). This led to approximately 40 more pregnant women providing data on their motives for drinking since knowing they were pregnant. This would result in a prevalence rate of around 13–14% of drinking after pregnancy recognition, slightly higher than the previously reported rate (Schölin et al. 2019). Therefore, including questions around alcohol use which do not directly ask about quantity of consumption may be a way to gain more accurate information on prevalence rates of drinking during pregnancy.

Motives for drinking in mothers were wide-ranging, with approximately half of the sample stating that their motives for drinking had changed since becoming a mother. Reflecting existing evidence (Johnson et al. 2022), qualitative responses highlighted alcohol as a coping strategy for stress and symptoms of mental health issues, and as a reward and a way for mothers to cheer themselves up. In line with our prediction, higher drinking levels were associated with women who reported drinking when in a negative mood and who used alcohol to feel better. This is important, as evidence shows that drinking for negative reinforcement (e.g., coping-based) motives may be associated with increased risk of experiencing alcohol-related harm and developing an alcohol use disorder (Cooper et al. 2015; Thomas et al. 2014) and greater harm to children (Bryant et al. 2019). However, it is important to note that with the exception of ‘feeling pressured to drink’, all motives were associated with higher alcohol use in mothers.

For motives not to drink, many of the pregnant women reported that they had not reduced their alcohol use since knowing they were pregnant. This may suggest that most respondents were planning their pregnancy and so had reduced their drinking as part of this preparation, which is in line with UK Chief Medical Officer (CMO) guidance for women trying to conceive (Dept. of Health 2016). This may also help explain the lower reported levels of pre-pregnancy alcohol use in our pregnant sample.

In mothers, the most frequently chosen response was being too tired to drink, followed by motives related to mother’s and child’s health and well-being. The optional free text responses echoed these findings. Both pregnant women and mothers reported a clear motive to reduce drinking as child welfare (e.g., avoid harm, breastfeeding), which fits existing literature (Martinelli et al. 2019). In addition, mothers reported other motives focused on their own health and well-being, as well as practical and social issues more unique to motherhood (e.g., too tired to drink, avoiding a hangover when looking after children, no opportunity to go out and socialise).

Attitudes around drinking suggest ambivalence to some extent, with both pregnant women and mothers saying they enjoy alcohol, while also believing that alcohol was bad for their health. Although most respondents reported trying to drink within recommended levels, higher alcohol use was associated with women who reported some level of awareness that they were drinking more ‘than they should’ and that there was potential risk of harms associated with their drinking. In addition, heavier drinking in mothers was associated with respondents who said they drank more when in a positive mood and that they enjoyed drinking (perhaps associated with socialising/celebrating), in a negative mood, and to feel better. Again, this suggests some mothers are using alcohol coping-based strategies, and so more work is needed to support mothers in adopting more adaptive coping methods.

In terms of perceived barriers to reducing alcohol use, mothers were more likely to report any barriers than pregnant women. This may reflect a public health focus of alcohol behaviour during pregnancy due to the potential harm to the foetus (e.g., FASD). During antenatal appointments, pregnant women are asked about their drinking and given basic information on the potential harm alcohol can have on the foetus. Once the baby is born, mothers may be given some information on alcohol harm, but this tends to be focused on specific behaviours that may not be relevant to all women (e.g., co-sleeping and breastfeeding). In particular, mothers reported that stress, pressure from others, and a lack of knowledge around how to reduce drinking were barriers to reducing alcohol use. These factors could therefore be a target in tailored interventions aimed at supporting mothers in keeping drinking at low risk levels.

There are several limitations to this study. Firstly, the data are not representative of the pregnant or non-pregnant population of the UK. Although respondents were fairly representative regarding maternal age, our sample was more likely to be white, have a higher level of education and household income (see supplementary material for representative data). This necessarily means that findings should be interpreted with caution. However, these findings, along with the existing literature around drinking during pregnancy, and the growing narrative around mothers needing to drink shows that this is an area that needs focused, systematic work. Although women (including mothers; Johnson 2021) are heavy social media users irrespective of socioeconomic status (Deloitte 2020; Lupton and Maslen 2019), our recruitment methods focused on a restricted number of online platforms (e.g. Twitter, Facebook) and so will have limited our population. It will be important for future research to actively engage with more diverse populations to ensure representation and enable an investigation of how demographics, including intersectional characteristics, may affect the motives and impact of maternal drinking.

Secondly, given the lack of research investigating the mechanisms underlying maternal drinking, there are no validated scales designed to measure relevant issues tailored to pregnant women and mothers. We therefore adapted existing scales, based on feedback with maternal public advisors, and created items based on existing evidence. This pilot work highlights a need for development and validation of maternal alcohol use scales. Also, given that this is a cross-sectional survey, it is impossible to make any comments on cause and effect of alcohol use behaviour in this population.

Lastly, given the stigmatising issues covered in this study (Vicario et al. 2021), concerns around maternal populations underreporting alcohol use (Morrello et al. 2022), and increased dropout rates as people move through surveys (Hoerger 2010), we conducted public engagement activities to ask women about the design of the survey. As a result, key outcome measures (e.g., alcohol use) were placed at the start of the survey, with demographic questions at the end. Additionally, where possible, display logic was used to tailor the survey more to the individual participant, and participants could choose not to answer a question they did not want to. However, this likely contributed to a large proportion of respondents not providing demographic information, and less data on some topics (e.g., alcohol use and drinking motives of pregnant respondents who initially said they had not been drinking since knowing they were pregnant). Although it is important to work with the population of interest and to keep observational research as concise as possible, there is a balance to be had in order to obtain the most useful data.

Maternal drinking is associated with a range of harms to the mothers and child. These initial findings provide a more nuanced understanding of why pregnant women and mothers drink and do not drink. Understanding the motives for drinking is important, and pregnant women and mothers who use alcohol as a coping mechanism may be at risk of drinking more, leading to a greater risk of experiencing alcohol-related harm. Additionally, there appear to be unique reasons for maternal populations to reduce their drinking. It is likely that a focus on how women can reduce stress in more adaptive ways, while emphasising the positive impact reduced drinking can have on them and their children, will result in more effective public health interventions. Prospective longitudinal studies are now needed to understand the causal risks of increased drinking and harm in maternal populations, while reducing issues around retrospective self-reported drinking behaviour, which may be particularly biased in maternal populations.