Is it safe to drink during pregnancy?

4928Is it safe to drink during pregnancy?

This article, written by Amy Westervelt and published in The Guardian highlights the continued debate around alcohol consumption when pregnant and showcases why conversations about alcohol and pregnancy are so important. The FASD Prevention Conversation supports the Public Health Agency of Canada’s official recommenation that:

There is no safe amount or safe time to drink alcohol during pregnancy or when planning to be pregnant.

When I hit the sixth month of my pregnancy, a strange thing happened: everywhere I went, people offered me a drink. Checking in at a hotel, the front desk clerk offered me a glass of champagne. Ordering dinner at a restaurant, the waitress asked if I’d like a glass of wine with my meal. At a friend’s barbecue, at least six people asked if I wanted a beer, or maybe a margarita. Each time I had the same reaction: first, surprise. Then, the sense that I should automatically just point to my belly and say no. And finally, a wave of, well, maybe just one drink, or a half of one, would be okay.

It turns out I am not alone. At some point in their pregnancy, most expectant mothers find themselves facing a glass of wine or a bottle of beer and have to consider the difficult question of whether or not to drink it. To make matters worse, even after decades of debate, there still doesn’t seem to be a definitive answer.

The norms around drinking while pregnant seem to change every couple of decades. During the 1950s and 1960s, it was perfectly acceptable for pregnant women to drink – and smoke, for that matter. In fact, in the 1960s, some doctors even prescribed alcohol to avoid premature labor.

In the 1970s, the cultural attitude toward drinking during pregnancy swung to the other extreme when researchers determined that alcohol could lead to malformations in embryos. In 1973, doctors coined the term fetal alcohol syndrome to describe a combination of features common to babies born to alcoholic mothers, including low birth weight, slow growth, small eyes, cleft palates and severe cognitive disabilities. Every international medical association proclaimed it unsafe for pregnant women to have even a drop of alcohol.

Some of these warnings still stand. Recently, the American Academy of Pediatrics reaffirmed its recommendation that pregnant women don’t drink. However, it also acknowledged that, while doctors agree about the negative effects of alcohol abuse during pregnancy, there is no evidence to prove that occasional drinking is hazardous to unborn babies. That’s largely due to the fact that it’s not exactly ethical to set up a clinical trial in which one group of pregnant women abstains and the other drinks occasionally.

The US isn’t the only country that encourages teetotaling: the ministries of health in Ireland, New Zealand and Australia also recommend that pregnant – and, in Australia’s case, breastfeeding – women abstain from alcohol. On the other hand, studies are beginning to pile up that indicate the odd drink here or there is harmless. A series of five studies conducted in Denmark showed that – as of age five – the children of mothers who had drunk moderately during pregnancy suffered no ill effects, and a 2010 UK study found that children born to light drinkers fared better on cognitive development tests than the offspring of teetotalers. In fact the UK Royal College of Obstetricians and Gynecologists has consistently stated that “women should avoid drinking excessive amounts of alcohol when pregnant but there is no evidence that drinking one to two units once or twice a week is harmful”.

But while conclusions differ, the consensus is that pregnant women should avoid drinking in their first trimester. Early last year, even the Royal College of Obstetricians and Gynecologists pulled its support for occasional drinking for newly pregnant women. Of course, first trimester teetotaling can be problematic, given that the majority of women don’t know the exact moment when conception occurs. In my case, when I was newly pregnant with my first son, I was living it up at an Irish wedding, blissfully unaware of how much time I’d be spending worrying about birth defects in the coming months. Thankfully, my doctor was unconcerned and reassured me that despite all of the cautions around first trimester drinking, I should stop worrying about it.

Ultimately, the aggregate of all this advice on pregnant drinking comes down to a few simple guidelines: every medical organization agrees that expectant mothers shouldn’t binge drink, drink in their first trimester, or drink more than one or two drinks once or twice a week. Beyond that, most experts seem to agree, each woman should do what feels right to her. One friend of mine drank one glass of wine once a week during her pregnancy; another, who’s pregnant now, has a half-glass of wine whenever she feels like it; yet another decided that it’s not worth it at all. On the other hand, I’ve also had friends who have beaten themselves up for their decision after the fact, as doctors and family members have blamed their drinking during pregnancy for everything from hyperactivity to a cleft palate.

As for actual, peer-reviewed research, the findings are inconclusive – doctors simply don’t know what amount of alcohol will cause which issues in a particular fetus with a particular mother. That’s why so many of the guidelines err on the side of caution. As the latest American Association of Pediatrics guideline states: “There is no known absolutely safe quantity, frequency, type, or timing of alcohol consumption during pregnancy, but we know that having no prenatal alcohol exposure (PAE) translates into no fetal alcohol spectrum disorders (FASD).”

As for me, I’ve waffled back and forth on the issue, unsure of the safety and advisability of reaching for a glass of wine or a highball – and, beyond that, unsure of the point exactly. For that reason, more than any other, I’m mostly of the “not worth it” mindset. I’ll have the occasional half-glass of wine when a dinner particularly calls for it, or if I’m out at some sort of celebration, but – thankfully – there are other options, and I’ve spent the last few trimesters enjoying the increasingly wide world of fancy juices and sodas that are on the market.

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