{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T19:32:00Z","timestamp":1775849520623,"version":"3.50.1"},"reference-count":36,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2022,7,7]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed \u2018prenatal alcohol exposure\u2019 (PAE), by enabling more extensive diagnosis of the disability labelled fetal alcohol spectrum disorder (FASD). Here we focus on proposals to include biomarkers as a PAE \u2018screening tool\u2019, specifically those found in meconium (the first newborn excrement), which are discussed as an \u2018objective\u2019 measure of PAE.<\/jats:p>\n               <jats:p>We ask the overarching question, \u2018Can routine screening of meconium to establish PAE be ethically or legally justified\u2019, and we answer, \u2018No\u2019. To reach this conclusion, we discuss three areas. First, we consider the reasons why meconium screening should not be deemed \u2018typical\u2019 within the scope of accepted screening tools. We argue that given the aim and necessary timing of the screen, it cannot achieve what it promises. Second, we outline why patient autonomy and consent are not properly accounted for and cannot be reconciled with the \u2018routinisation\u2019 of the proposed \u2018screening\u2019. Last, we outline why the benefit of such a screen is not clear, focusing on the significance of trust in healthcare professionals (HCP) for the best interests of the future child and pregnant woman.<\/jats:p>\n               <jats:p>While recognising the adverse effects of heavy alcohol consumption during pregnancy, we emphasise the case for robust ethical, legal and social considerations and the central need for trust between HCP and patients in maternity care. We conclude the permissibility of meconium screening has not been proven, and it is not justified.<\/jats:p>","DOI":"10.1136\/jme-2022-108170","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T13:22:04Z","timestamp":1658496124000},"page":"531-535","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5796-1070","authenticated-orcid":false,"given":"Rachel","family":"Arkell","sequence":"first","affiliation":[{"name":"Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, Stratford-upon-Avon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellie","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,7,22]]},"reference":[{"key":"2025092414551529000_49.8.531.1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32833ed177"},{"key":"2025092414551529000_49.8.531.2","unstructured":"Esterson B . Foetal Alcohol Spectrum Disorder [Hansard]. (Vol. 652: debated on Thursday 17 January 2019). Available: https:\/\/hansard.parliament.uk\/commons\/2019-01-17\/debates\/19011751000002\/FoetalAlcoholSpectrumDisorder [Accessed 17 Jan 2022]."},{"key":"2025092414551529000_49.8.531.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2018.10.013"},{"issue":"1-2","key":"2025092414551529000_49.8.531.4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1080\/13698575.2021.1998389","article-title":"Beyond \u2018the choice to drink\u2019 in a UK guideline on FASD: the precautionary principle, pregnancy surveillance, and the managed woman","volume":"24","author":"Lee","year":"2022","journal-title":"Health Risk Soc"},{"key":"2025092414551529000_49.8.531.5","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2016-311686"},{"key":"2025092414551529000_49.8.531.6","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2005.078642"},{"issue":"3","key":"2025092414551529000_49.8.531.7","first-page":"e471","article-title":"Legal and ethical considerations in meconium testing for fetal exposure to alcohol","volume":"18","author":"Dickens","year":"2011","journal-title":"J Popul Ther Clin Pharmacol"},{"key":"2025092414551529000_49.8.531.8","article-title":"Behind the screen: legal and ethical considerations in neonatal screening for prenatal exposure to alcohol","volume":"14","author":"Zadunayski","year":"2006","journal-title":"Health Law J"},{"key":"2025092414551529000_49.8.531.9","doi-asserted-by":"publisher","DOI":"10.1111\/acer.12115"},{"key":"2025092414551529000_49.8.531.10","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2021-107996"},{"key":"2025092414551529000_49.8.531.11","unstructured":"National Institute for Health and Care Excellence . \u2018Smoking: stopping in pregnancy and after childbirth\u2019 Public Health guideline [PH26], 2010."},{"key":"2025092414551529000_49.8.531.12","unstructured":"National Institute for Health Care Excellence . Quitting Smoking in Pregnancy and Following Childbirth: Consultation on the Evidence (24thSeptember \u2013 22nd October 2009)\u2019 [Stakeholder Response Table, 2. PH26] This guideline has been updated and replaced by the NICE guideline on tobacco: preventing uptake, promoting quitting and treating dependence (NG209)."},{"issue":"2","key":"2025092414551529000_49.8.531.13","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s10728-018-0364-z","article-title":"Are we justified in introducing carbon monoxide testing to encourage smoking cessation in pregnant women?","volume":"27","author":"Bowden","year":"2019","journal-title":"Health Care Anal"},{"key":"2025092414551529000_49.8.531.14","unstructured":"Department of Health and Social Care . Fetal alcohol spectrum disorder: health needs assessment, Importance of early diagnosis [Guidance], 2021. Available: https:\/\/www.gov.uk\/government\/publications\/fetal-alcohol-spectrum-disorder-health-needs-assessment\/fetal-alcohol-spectrum-disorder-health-needs-assessment#diagnosis-and-epidemiology [Accessed 23 Apr 2022]."},{"key":"2025092414551529000_49.8.531.15","unstructured":"National Institute of Health and Care Excellence . \u2018Fetal alcohol spectrum disorder\u2019 Quality Standard [QS204] \u2018Consultation Summary Report\u2019."},{"key":"2025092414551529000_49.8.531.16","unstructured":"National Institute of Health and Care Excellence . \u2018Fetal alcohol spectrum disorder\u2019 Quality Standard [QS204] \u2018Quality Standards Advisory Committee, Post-consultation Meeting Minutes\u2019."},{"key":"2025092414551529000_49.8.531.17","unstructured":"Scottish Intercollegiate Guidelines Network (SIGN) . Children and young people exposed prenatally to alcohol. Edinburgh: SIGN, 2019. http:\/\/www.sign.ac.uk"},{"key":"2025092414551529000_49.8.531.18","unstructured":"NHS . Nhs screening. Available: https:\/\/www.nhs.uk\/conditions\/nhs-screening\/ [Accessed 17 Jan 2022]."},{"issue":"6","key":"2025092414551529000_49.8.531.19","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1111\/cch.12017","article-title":"Diagnostic Nomenclature for foetal alcohol spectrum disorders: the continuing challenge of causality","volume":"39","author":"Miller","year":"2013","journal-title":"Child Care Health Dev"},{"key":"2025092414551529000_49.8.531.20","unstructured":"General Medical Council . Decision making and consent (guidance came into effect on 9 November 2020). Available: https:\/\/www.gmc-uk.org\/ethical-guidance\/ethical-guidance-for-doctors\/decision-making-and-consent [Accessed 17 Jan 2022]."},{"key":"2025092414551529000_49.8.531.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2004.09.009"},{"key":"2025092414551529000_49.8.531.22","unstructured":"Montgomery v Lanarkshire Health Board [2015] UKSC 11."},{"key":"2025092414551529000_49.8.531.23","unstructured":"Gill E . Hospital is the first in country to screen pregnant women for birth defects brought on by drinking alcohol. Manchester Evening News [Online]. Available: https:\/\/www.manchestereveningnews.co.uk\/news\/greater-manchester-news\/hospital-first-country-screen-pregnant-11324058 [Accessed 17 Jan 2022]."},{"key":"2025092414551529000_49.8.531.24","doi-asserted-by":"publisher","DOI":"10.1136\/jme.2006.018861"},{"key":"2025092414551529000_49.8.531.25","unstructured":"Department of Health and Social Care . Fetal alcohol spectrum disorder: health needs assessment, Law and Ethics [Guidance]. Available: https:\/\/www.gov.uk\/government\/publications\/fetal-alcohol-spectrum-disorder-health-needs-assessment\/fetal-alcohol-spectrum-disorder-health-needs-assessment#law-and-ethics [Accessed 17 Jan 2022]."},{"key":"2025092414551529000_49.8.531.26","unstructured":"Royal College of Obstetricians & Gynaecologists . Providing quality care for women: a framework for maternity service standards, 2016. Available: https:\/\/www.rcog.org.uk\/globalassets\/documents\/guidelines\/working-party-reports\/maternitystandards.pdf [Accessed 17 Jan 2022]."},{"issue":"98","key":"2025092414551529000_49.8.531.27","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2021.102987","article-title":"The importance of nurturing trusting relationships to embed shared decision-making during pregnancy and childbirth","volume":"98","author":"O'Brien","year":"2021","journal-title":"Midwifery"},{"key":"2025092414551529000_49.8.531.28","doi-asserted-by":"publisher","DOI":"10.1136\/jme.28.2.77"},{"key":"2025092414551529000_49.8.531.29","doi-asserted-by":"crossref","DOI":"10.1016\/j.srhc.2021.100628","article-title":"Midwives' views on alcohol guidelines: a qualitative study of barriers and facilitators to implementation in UK antenatal care","volume":"29","author":"Sch\u00f6lin","year":"2021","journal-title":"Sex Reprod Healthc"},{"key":"2025092414551529000_49.8.531.30","doi-asserted-by":"publisher","DOI":"10.1215\/03616878-1966333"},{"issue":"1","key":"2025092414551529000_49.8.531.31","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3138\/ijfab.1.1.67","article-title":"Measuring motherhood","volume":"1","author":"Kukla","year":"2008","journal-title":"International Journal of Feminist Approaches to Bioethics"},{"key":"2025092414551529000_49.8.531.32","unstructured":"Murphy G . Midwives fear women could feel stigmatised if mandatory alcohol screening introduced at every antenatal appointment. Royal College of Midwives [Media Release, Online]. Available: https:\/\/www.rcm.org.uk\/media-releases\/2020\/september\/midwives-fear-women-could-feel-stigmatised-if-mandatory-alcohol-screening-introduced-at-every-antenatal-appointment\/ [Accessed 17 Jan 2022]."},{"key":"2025092414551529000_49.8.531.33","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2022.103433","article-title":"WRISK voices: A mixed-methods study of women\u2019s experiences of pregnancy-related public health advice and risk messages in the UK","volume":"113","author":"Blaylock","year":"2022","journal-title":"Midwifery"},{"key":"2025092414551529000_49.8.531.34","unstructured":"Armstrong EM . Conceiving Risk, Bearing Responsibility: Fetal alcohol syndrome & the diagnosis of moral disorder. 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