# 09 - Pregnancy and alcohol use

# Pregnancy and alcohol use

492
The Maudsley® Prescribing Guidelines in Psychiatry
CHAPTER 4
Baclofen
Baclofen is a GABA-­B agonist that does not have a licence for use in alcohol 
­dependence but is nevertheless used by some clinicians as second-­line treatment for 
those who have not responded to either naltrexone or acamprosate, or where there 
are contraindications for first-­line treatment. A 2023 Cochrane review suggested that 
baclofen may help people with AUD in maintaining abstinence, particularly in people 
who are already detoxified.33 A 2022  meta-­analysis32 also suggested baclofen is 
­effective but is associated with higher rates of adverse effects including depression, 
vertigo, somnolence, numbness and muscle rigidity.
Antiseizure medications
There is currently insufficient evidence to support the use of antiseizure medications in 
the treatment of alcohol dependence, although they may reduce the number of drinks 
per drinking day compared with placebo.34 The majority of the research has been 
­carried out on topiramate. Topiramate acts as a GABA/glutamate modulator that has 
demonstrated safety and efficacy in reducing heavy drinking in patients without AUD.35 
It may as effective as naltrexone in AUD.36
There have been fewer studies on gabapentin,37 valproate and levetiracetam.30 
Although these drugs have been used elsewhere in the world, they are not routinely 
used in the UK owing to lack of evidence and concerns regarding safety profiles for 
both gabapentin and valproate.
Pregnancy and alcohol use
Evidence indicates that alcohol consumption during pregnancy may cause harm to the 
fetus. The Department of Health advises that women should not drink any alcohol at 
all during pregnancy.1 Drinking even 1–2 units/day during pregnancy can increase the 
risk of having a preterm, low birthweight or small for gestational age baby.
For alcohol-­dependent pregnant women who have withdrawal symptoms, pharmacological cover for detoxification should be offered, ideally in an in-­patient setting in 
collaboration with an antenatal team. The timing of detoxification in relation to the 
trimester of pregnancy should be risk-­assessed against continued alcohol consumption 
and risks to the fetus.9 Chlordiazepoxide has been suggested as being unlikely to pose 
a substantial risk, however dose-­dependent malformations have been observed.11 
The  UK Teratology Information Service (UKTIS)38 provides national advice for 
Box 4.3  Disulfiram: NICE Clinical guideline 115 (2011)2
Disulfiram should be considered in combination with a psychological intervention for patients who 
wish to achieve abstinence, but for whom acamprosate or naltrexone are not suitable. Treatment 
should be started at least 24 hours after the last drink and should be overseen by a family member 
or carer. Monitoring is recommended every 2 weeks for the first 2 months, then monthly for the 
following 4 months. Medical monitoring should be continued at 6-­monthly intervals after the first 
6 months. Patients must not consume any alcohol while taking disulfiram.