What to Expect When You’re Drinking While Pregnant

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The following article was retrieved from: https://broadly.vice.com/en_us/article/what-to-expect-when-youre-drinking-while-pregnant The opinions expressed within it are those of the author and not of the Prevention Conversation Project. The piece is of interest because it highlights why Fetal Alcohol Spectrum Disorder prevention is not as simple as telling women not to drink alcohol when pregnant.

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What to Expect When You’re Drinking While Pregnant

AUG 10, 2015

You shouldn’t knock back shots of Jameson, but is enjoying a glass of wine while pregnant really as dangerous as doctors, Internet commenters, and the media make it out to be?

I am person who considers, evaluates, questions. I think about what’s expected of me before acting. So when my husband and I decided to start trying for a baby, we had long discussions about whether we were ready to give up aimless Sunday afternoons in the city. We ran through scenarios of how we’d juggle work, childcare, health insurance, and our various child-free whimsies without losing our sanity or ourselves. We were acutely aware of the permanent sacrifices we’d be making to our lives–and, possibly, to our ambitions–and yet we wanted, really wanted, to make a tiny, time-consuming combination of our DNA who would turn us into puddles of goo with his ripply thighs and wide-eyed excitement for things we had long forgotten were exciting.

To our surprise, I got pregnant within our first month of trying. I found out in a bathroom stall at work, on a day I was to spend 18 hours at the office before immediately hopping on a plane to Wine Country for a three-day wedding extravaganza. As soon as I was allowed to, I collapsed in my hotel bed, threw the covers over my head, and cried. I had anticipated having to mourn my old life; I knew that doing so was healthy. But I also understood that coming to terms with these changes was something I would have to do privately.

We are a society that believes women should only be over the moon when they are pregnant, leaving little discussion about how to make room for the logical, complicated feelings that come with suddenly having adjust to new identities, routines, and biological shifts. It’s easy to theorize about what a monumental change having a kid will be–but, just like ceremoniously committing to one person forever or knowing you will one day lose your parents, actually living through that transition is a much more complex prospect. It requires varying levels of adjustment and acceptance, and for me, what was most jarring about being pregnant was the immediate feeling of losing autonomy over my own body.

As soon as the affirmative sign appeared on my pregnancy test, I felt thrust into a strict, evangelical religion that I was expected to simply connect to, with What To Expect When You’re Expecting as my Bible. I struggled to sort through the myths and guiding principles of my new dogma, most notably the idea that my body was to serve, first and foremost, as a pure vessel, purged of things I had long enjoyed, some of which I even needed without question. Pregnant, I could no longer partake in pinot, ahi, long runs, or my prescription migraine meds. And I couldn’t explain to my boss or to my colleagues or to the editor I was hoping to work with that I was being held hostage by nausea and debilitating energy drains several times a day, because, as the Prevailing American Pregnancy Doctrine states, I was to keep quiet about my condition until I was past 13 weeks. I felt especially beholden to this belief because I’m a woman trying to build professional relationships and appear dependable, and because I was over 35 at the time–a nice, round cutoff age that made me a prime candidate to be to spoken to in doomed, hushed tones about early miscarriage and Down syndrome.

What was most jarring about being pregnant was the immediate feeling of losing autonomy over my own body.

During those first roller coaster weeks, I felt I had to hide unto myself, suffer silently, and simply obey. I did not find examples in the Prevailing Pregnancy Doctrine of how to navigate the practical, professional, social, and emotional changes that come with being pregnant; I was only given dietary absolutes enforced through fear. And even with those restrictions, I wasn’t provided explanations, nor did I feel encouraged to ask them of my brisk Manhattan doctor who had another 15 appointments to get to as soon as I walked out of her office. After nearly 20 years of being my own adult, I was no longer treated like an individual with some measure of common sense, self-awareness and self-control–simply because I had gotten pregnant.

In this country, once sperm meets egg, a woman is treated, at best, like a precious imbecile, her body public domain to be scrutinized and policed. To resist this treatment–to suggest, let alone exert, freedom over your person–is to risk being labeled “selfish.” But instead of name-calling and further isolating each other during pregnancy, why not discuss how we come to make informed decisions over our own bodies? And why not start with one of the greatest taboos of all: drinking?

Read any article by a mom who confesses to having had a glass of wine while she was pregnant, and you’ll be blessed with a comments section filled with reprimands and damning judgments: “Why do you value getting trashed above your child’s well-being?” “If you want to drink, maybe you should be talking to your doctor about your mental health.” To be fair, many of these “Why I Drink” headlines are trolling for dissention; still, however, commenters rarely read the accompanying articles or parse the facts before headed straight to the comment box to post their hardline opposing opinions, dismissing the many shades of gray between enjoying a single drink and alcoholism. They aren’t there to consider or debate, but rather to reduce everything to what’s supposed to be the lowest blow: “You’re a bad mother.”

But expectant mothers who drink lightly aren’t exactly rare outliers. The lack of wine-sipping confessions is more likely a reflection of moms-to-be feeling pressure to keep their drinking, however light, in the closet. According to a Centers for Disease Control and Prevention survey conducted between 2006 and 2010, 7.6 percent of pregnant women in the US admitted to drinking alcohol in the past 30 days; for those ages 35 to 44, that percentage doubled to almost 15 percent. Because it’s hard to get women on the record about such matters, these estimates are conservative at best–drawn from a sample who answered landline phones and were asked first if they were pregnant, then if they drank, by people essentially researching fetal alcohol syndrome.

I wasn’t interested in pushing any boundaries–I only wanted to understand what the boundaries were.

I polled my childbearing friends (educated and otherwise healthy women from varying ethnicities and parts of the country) if they drank during pregnancy. Most had at some level, from a flute of champagne at New Years to the vague “yeah, maybe I’d have half a glass of wine after work.” I was surprised that my pals–many who’ve I’ve know for a dozen-plus years and are usually about as shy as Kanye at the mic–felt they couldn’t really be frank on this subject. And yet I, too, didn’t entirely feel comfortable being open about what little I drank. Everyone else’s silence had made the act feel shameful. I was more at ease anonymously ordering a glass of red at a restaurant (strangers in New York are too engrossed in their own matters to pay attention to what you’re doing, and liberal waiters don’t mind upping your dinner tab) than I did openly having a beer at a friend’s party because it would invite questions I didn’t want to sound defensive about answering, or worse, questions they wouldn’t ask and I’d never get a chance to defend.

So let’s get the defensiveness and the extreme points of contention out of the way: I am not here to dispute that heavy drinking can cause birth defects (this is a fact); nor am I here to advocate for drinking during pregnancy (if you weren’t unwinding with a beer before you were knocked up, now is not the time to start). I am advocating for knowing all the data and biases, and then applying some critical thinking and basic sense before jumping to judgment of others who do have an occasional drink.

In my own pregnancy, I wasn’t interested in pushing any boundaries–I only wanted to understand what the boundaries were. And I found that pregnancy do’s and don’ts change every handful of years, based on advanced medical research and our country’s shifting values. Many in my mom’s generation puffed on cigarettes but were told exercising was bad for their unborn children, two ideas that have long been flipped. A dozen or so years ago, you weren’t supposed drink caffeine, but now doctors say you can have up to 200 milligrams a day, which is essentially a grande latte from Starbucks and a can of Coke.

And despite what we’ve been told for eons, nearly all contemporary research supports the idea that light drinking during pregnancy (i.e., a glass of wine over dinner) won’t harm the fetus, nor will it hinder the child’s mental and behavioral well-being in later years. A 2010 study out of the U.K. found that kids whose moms who had one or two drinks a week during pregnancy were not at an increased risk for behavioral or cognitive problems by age 5; a 2012 study in Denmark essentially concluded the same thing, accounting for children’s IQ and attentions spans as well. A study in Australia took it a step further, following children until age 14, noting that light to moderate drinkers (two to six drinks a week) had kids with fewer behavioral problems than those who didn’t drink at all. And in regards to preterm births, pregnant women who have a drink or two a week aren’t at a higher risk for those, either.

Nearly all contemporary research supports the idea that light drinking during pregnancy won’t harm the fetus.

Then why is it ingrained in us not to take a sip of alcohol when we are with child? Well, the simple answer is we live in America–a country that has a very complicated, all-or-nothing history with booze, from its Puritan roots to Prohibition–and thus very black-and-white views about drinking. The studies mentioned above were done in Europe and Australia, and that’s because research on this matter is easier to control there. Since it’s unethical to allot pregnant women various amounts of alcohol and sit back and watch what happens to their fetuses, women have to volunteer for these studies, and in those parts of the world, where there is a lesser stigma about drinking (and, with the possible exception of Italy, fewer instances of fetal alcohol syndrome than in the US), women are more likely to participate and be honest. When it comes to US-published research, the difference is not in the data, but in how it’s interpreted and presented: Buried in a 2011 Alcohol Research & Health article about the correlation between consuming anywhere between three and 14 drinks a week during pregnancy and the risk of miscarriage, stillbirth, or preterm delivery are the findings that having just one or two drinks a week has almost no correlation to those conditions.

Then there is the American media’s spin: When ABC News presented the Denmark study in which light drinking in pregnancy wasn’t found to harm the baby, it was paired with quotes by doctors and prevention advocates pooh-poohing all drinking (“We know that FASDs [fetal alcohol spectrum disorders] are 100 percent preventable if alcohol is not consumed during pregnancy, so why take the risk?” says the executive director of the National Organization on Fetal Alcohol Syndrome). Your own OB-GYN may tell you differently in the privacy of your examining room (“a glass of wine a week is okay” is not uncommon advice), but abstinence during pregnancy is the broad-sweeping stance of the American medical industry. This, according to economist-author Emily Oster, is a result of a lack of patient trust: Doctors don’t believe you will stop at one glass of wine; they fear you’ll take their light approval as license to down seven shots of Jameson as soon as you walk out of their office.

Oster goes on to summarize my feelings on this rationale in her book Expecting Better: “To put it mildly, I’m not crazy about the implication that pregnant women are incapable of deciding for themselves–that you have to manipulate our beliefs so we do the right thing. That feels, again, like pregnant women are not given any more credit than children would be in making important decisions.” Oster’s book is divisive among moms because she is an economist, not a medical doctor, so some doubt her authority to dole out medical advice. But to me–because, again, I am someone who likes to research and evaluate, not just be told to obey a list of no-no’s without question–her background in gathering data and weighing facts makes her findings and the reasoning behind her personal decisions just as interesting to me as what is barked by my doctor, who sees me for five minutes every few weeks, speaks in a totalitarian tone, and sends me on my way with a $50 copay. As in all areas of life, I want to be informed before I decide how to treat my body.

Simply parsing statistics on alcohol and fetal development–data that can never serve as a catch-all for women and their varied metabolisms–isn’t sufficient. We should have a scientific understanding of how a fetus receives or doesn’t receive alcohol before concluding any amount of drinking is detrimental to an unborn child. Alcohol makes it way from your mouth to your stomach to your small intestine down to your liver, which is given a first pass to metabolize the alcohol. (For a 150-pound person, the liver can metabolize about seven grams of alcohol an hour, or half a standard drink; add food, and you slow down the amount of alcohol that reaches the liver at any given time.) Any unmetabolized alcohol then enters your circulatory system, including the blood that goes to your baby via the placenta. Whatever your baby can’t process, which isn’t very much, is then diffused back to your liver to take another pass. Obviously, too much remaining alcohol–which would come from having multiple drinks, which the liver can’t keep up with–can get into the fetus’s tissues and impact its development. But if you drink lightly, slowly, and with food (like a European), the alcohol will likely not impact your kid.

Doctors don’t believe you will stop at one glass of wine; they fear you’ll take their light approval as license to down seven shots of Jameson as soon as you walk out of their office.

Of course, pregnancy can be its own best defense against alcohol use. In the first 15 weeks, I was nauseous, constipated, and exhausted (not to mention worried enough about what kind of parent I’d be), which quelled my taste for booze, smelly fish, and the acidity of coffee. During that time, I boned up on how I should go about developing a human. I also just tried to survive. By the time I felt better, in my second trimester, I had already been broken of my Friday-after-work drinking habits, and my interest in things I was supposed to avoid (margaritas, ham sandwiches, piles of lox) had been replaced with other hankerings (cheesy pasta, steak, chocolate milk)–a sort of biological/learned-behavior combo that worked in favor of protecting my fetus.

I made my dietary decisions with all my extensive pregnancy research in mind, erring on the side of caution and paying attention to my body. Just as I wouldn’t seek out a massive Magnolia cupcake if I didn’t crave one, I wouldn’t pour a glass of sauvignon blanc if I didn’t want one of those, either. And when I did desire a glass on vacation or over a nice dinner? I just had the one, and I didn’t feel bad about it. I also didn’t feel bad when made myself some runny eggs (salmonella can be found in many foods that aren’t on an OB-GYN’s don’t-ingest list; eggs get a bad rap), or drank a cup of coffee every morning once it smelled awesome again (a cup that didn’t even hit the 200-milligram mark), or nibbled on sushi from reputable places (I went low on mercury, safe on food prep–just like I would if I weren’t pregnant). My body, my informed choices.

But again, these were my decisions. You know you best–not the doctor you met for the first time after you got knocked up, or the lady writing a controversial book, or me, a woman who’s trying to point out a few things in a single essay. If you can’t have a glass of wine without wanting another, perhaps pass on it during pregnancy. If you think even the smallest amount of alcohol is not worth the risk, then that’s cool, too. I get why people prefer to take the doctor on her “you must abstain” word. I understand why some would rather not fall down an Internet hole of complicated data and fear-mongering posts. Pregnancy is overwhelming, and it can be easier to take the road to less resistance. But that doesn’t mean your way is the only way.

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