The disjunction is even more apparent when the strength of association between attitudes and alcohol consumption is compared to the relative weakness of the association between knowledge and alcohol consumption. The disjunction between knowledge and alcohol consumption may be related to the lack of evidence regarding harm to the fetus following exposure to low and moderate alcohol consumption in pregnancy [29]. It may be that women who have knowledge about alcohol in pregnancy and FASD, are more likely to be aware of the lack of evidence regarding the effects of low to moderate alcohol consumption in pregnancy and thus perceive that their risk is low if they consume alcohol at this level. Future studies would need to include more specific questions regarding the quantity of alcohol consumed in pregnancy and the women's knowledge regarding the effects of different levels of alcohol consumption in order to explore this further.
There appears to be a paradoxical relationship between women's level of education, their knowledge, and past and intended alcohol consumption in pregnancy. Women with higher levels of education have higher levels of knowledge [23] but despite this, are more likely to drink alcohol in pregnancy. Education level is an independent predictor of alcohol use in pregnancy but is not explained solely by women's current alcohol consumption. Excessive alcohol use by tertiary education students is well documented [30] and it may be that this engenders a more entrenched alcohol culture and more tolerant lifelong attitudes towards alcohol consumption in those who attend tertiary education institutions.
When discussing prevention of Fetal Alcohol Spectrum Disorders it is important to realise that women do not have sole responsibility for ensuring healthy offspring. Women's partners can have an important and positive influence. In a Danish study, paternal smoking was a strong predictor of maternal smoking during pregnancy [31]. However, in a US study, partners' alcohol use was not predictive of maternal alcohol consumption in pregnancy [32]. In our survey, whilst most women stated that it would make no difference to their behaviour, approximately one third of women stated that if their partner did not drink alcohol during pregnancy, they would be less likely to drink themselves.