To drink or not to drink?
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On the night of my 32nd birthday, my husband and I enjoyed a delicious dinner while on vacation in Orvieto, Italy. To complement my pasta, I enjoyed a single glass of red wine, my first since learning I was pregnant four months earlier. Even now my indulgence inspires periodic pangs of guilt: Did I stunt my son’s potential by sipping that Sangiovese?
Nobody questions the notion that heavy drinking during pregnancy is harmful. It can cause facial abnormalities, central nervous system problems and stunted growth. But evidence regarding the effects of light or occasional drinking is mixed. In five epidemiological studies published in 2012, medical psychologist Erik Mortensen of the University of Copenhagen and his colleagues found that five-year-old children born to women who had one to four drinks a week during pregnancy displayed no deficits in general intelligence, attention or other types of higher-order thinking. On the other hand, in 2011 psychiatrist Nancy Day of the University of Pittsburgh and her colleagues reported that teens born to women who averaged more than one drink a week during pregnancy were twice as likely as those born to nondrinkers to have conduct disorder, a condition characterized by theft, deceit or violence.
The truth is hard to discern because research on the issue is fraught with problems. The ideal type of experiment is not ethical: scientists cannot randomly assign one group of women to drink during pregnancy and compare the outcome with those instructed to abstain. As a result, they must compare what happens to women who choose to drink during pregnancy with those who do not, and these women often differ in important ways. All things considered, having an occasional drink during those nine months—say, one or two a week—probably poses little, if any, harm. Still, some experts warn, light or sporadic drinking may have effects we do not know how to measure.
Messy Methodologies
The thorniest problems with this research involve the ways in which women who drink during pregnancy differ from those who do not. A woman who drinks moderately or heavily is more likely to smoke, use drugs and physically abuse her child than a nondrinker, all of which could worsen her son’s or daughter’s prognosis independent of alcohol. This woman might also have a genetic background predisposing her—and her children—to behavioral problems.
Meanwhile women who drink lightly while pregnant may have protective characteristics. Compared with abstainers, they “are often the more affluent moms, the more educated moms, and the smarter moms as well,” perhaps because they belong to a higher socioeconomic class than teetotalers, says epidemiologist Ron Gray of the National Perinatal Epidemiology Unit at the University of Oxford. This effect could explain why, in a 2010 study, clinical psychologist Monique Robinson and her colleagues at the Telethon Institute for Child Health Research in Perth, Australia, discovered that children of mothers who drank two to six drinks a week while pregnant were less likely to have behavioral problems at age 14 than mothers who abstained. As with most such studies, the researchers tried to account for systematic differences in the groups, but as Robinson acknowledges, “these unmeasured factors may have influenced our results.”
Another complexity: most studies assess maternal drinking through interviews, and pregnant women might lie about or underestimate their consumption out of embarrassment or shame. Lower estimates can mask harmful effects if they cause light drinkers to be incorrectly categorized as abstainers and put in the comparison group. They might, however, inflate the perceived risk if heavy-drinking mothers of children with deficits get incorrectly categorized as light drinkers.
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13 Comments
Add CommentI see a lot of articles and studies about this subject. All discuss the amounts of alcohol that may or may not be harmful to a fetus.
Reply | Report Abuse | Link to thisI've never seen an article asking why, since we know alochol is a teratogen (that it mutates cells), and that in the process of metabolizing alcohol, all of us produce the chemical acetaldehyde (a toxin)--- why can't we just skip the drinking?
Why--- for 9 months-- can't we just be safe, rather than sorry? How precarious are our emotional lives? Why don't we, instead of this flurry of activity focused on determining the safety of alcohol, work to make this world a place from which we don't need to escape?
Your body also produces formaldehyde, as a byproduct of cell division. The acetaldehyde produced during drinking is then converted reasonably quickly into acetic acid, mostly harmless.
Reply | Report Abuse | Link to thisTeratogens cause birth defects, not necessarily cellular mutations. Your parenthetical describes mutagens, not teratogens.
You would not see such an article on this site, since it would be an opinion piece, or it would be sufficiently removed from the question "Why can't we just skip the drinking" to be no longer an article about that subject.
Not all drinking is done to escape, since alcoholic beverages are also often delicious in their own right, or used in food to provide flavors that aren't easily obtained otherwise. The associated feelings with a glass of wine at dinner are not of washing away emotions, but of relaxation, since unless you consume nearly no alcohol, a single glass of wine, with food, only every once in a while, will not shut down your brain or impair you very much at all.
The sort of blackout drinking you seem to be referring to is certainly teratogenic, but, if changing behaviors is not going to have a positive effect, why should an occasional drinker stop due to drinking to excess being harmful? It's something that quite a few people never do.
An example: Drinking to excess after a child is born leads to developmental problems due to neglect. Are you suggesting, since drinking has been established to create neglectful situations, that no parent should ever consume alcohol while their children are in their care?
The most obvious data that reveals our excessive fear of this issue comes from history. Prior to the 1980's most if not all of us were born of moderate drinking parents, (moderate probably is an understatement by todays standards). Yet we were not flooded with children with behavioral deficits. Consequently the effect of very modest drinking during pregnancy must be minimal.
Reply | Report Abuse | Link to thisAlso note that the onslaught of children with behavioral deficits begins after the much more frequent drug abusing "boomers" began having their children. Granted diagnostic criteria for such diagnoses have change over the years and that does account for some of the epidemic. However one has to wonder about the effects of street drugs and their impact on behavior problems in children. Particularly since we seem hell bent to legalize some.
I'm going to go out on a limb here and guess that Ms. Petunia is not the sort of person who enjoys a random beer or glass of wine, and has also never been pregnant. I am currently both of those things, and while 99% of the time, I am fine with eschewing alcohol, I missed it dreadfully over the holidays. New Year's Eve is just another night without champagne, and no, sparkling cider is *not* an appropriate substitution. It is sickly sweet and disgusting.
Reply | Report Abuse | Link to thisPregnant women are put under *SO* many dietary restrictions these days (my mother made me look it up on the Internet to prove to her that feta cheese and cold cuts are off limits), that it begins to feel like you're doing some kind of religious penance. Every move you make during pregnancy is tied with some kind of existential guilt. I must exercise, but not too much. I must eat protein, but not too much. I must eat seafood, but not too much. I must worry, but not too much. I must take my vitamins, but not too many. It's insane the level of stress the medical community puts on us for these nine blessed months. My mother--who downhill skied every weekend through her eighth month of carrying me--is gobsmacked every time I tell her of some new restriction placed upon me by my doctors (and yes, I am perfectly healthy, these are not unusual).
Sharing a cheeky, small glass of wine with my husband and family on Christmas was a bright spot amid all the poking, prodding, back pain, and bland lunches. And I for one have decided that the two small glasses of wine I have consumed over the course of nearly five months were worth the gamble.
These articles that say things like "the chance of x is doubled", without providing any numbers, is just not helpfull. Doubling the probability of something that has a .001 percent chance of occuring is still a very small risk.
Reply | Report Abuse | Link to thisSymptoms of Fetal Alcohol Syndrome
Reply | Report Abuse | Link to thisBy Mayo Clinic staff
Fetal alcohol syndrome isn't a single birth defect. It's a cluster of related problems and the most severe of a group of consequences of prenatal alcohol exposure. Collectively, the range of disorders is known as fetal alcohol spectrum disorders (FASDs).
Fetal alcohol syndrome is a common — yet preventable — cause of mental retardation. The severity of mental problems varies, with some children experiencing them to a far greater degree than others.
Signs of fetal alcohol syndrome may include:
Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
Deformities of joints, limbs and fingers
Slow physical growth before and after birth
Vision difficulties or hearing problems
Small head circumference and brain size (microcephaly)
Poor coordination
Mental retardation and delayed development
Learning disorders
Abnormal behavior, such as a short attention span, hyperactivity, poor impulse control, extreme nervousness and anxiety
Heart defects
The facial features seen with fetal alcohol syndrome may also occur in normal, healthy children. Distinguishing normal facial features from those of fetal alcohol syndrome requires expertise.
Doctors may use other terms to describe some of the signs of fetal alcohol syndrome. An alcohol-related neurodevelopmental disorder is a mental or behavioral impairment that occurs as a result of fetal exposure to alcohol. Alcohol-related birth defects are physical defects that occur from fetal alcohol exposure.
When to see a doctor
If you're pregnant and can't stop drinking, ask your obstetrician or other health care provider for help.
Because early diagnosis may help reduce the risk of long-term problems for children with FAS, let your child's doctor know if you drank alcohol while you were pregnant. Don't wait for problems to arise before seeking help.
If you've adopted a child or are providing foster care, you may not know if your child's biological mother drank alcohol while pregnant — and it may not initially occur to you that your child may have fetal alcohol syndrome. However, if your child has learning and behavioral problems, talk with your child's doctor so that the underlying cause might be identified.
http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184/DSECTION=symptoms
Speaking as a retired addictions counselor who has studied this stuff, and experienced it for nearly four decades, I just don't know. I don't think anyone does. Granted, the vast majority of pregnant women who drink very moderately, or who eat feta cheese, or even who smoke, do not bear children with serious or even noticeable effects resulting from these behaviors.
Reply | Report Abuse | Link to thisWhat we don't know about are the possible effects that are not at all obvious but that may have a negative impact on the child's life.
One does not either have FAS or not. There are all manner of manifestations that range from totally disabled to "not readily noticeable" but which still may have a negative impact. And we imagine that some parents and children will be much more sensitive than others.
Bottom line: we just don't know so the best choice is probably not to take the chance in the first place. Anyone who can't make it through nine months without the use of a psychoactive drug might want to see an addictions counselor before risking pregnancy.
True, that might be uncomfortable, but so is living with the guilt of realizing that your choices during pregnancy may have effected your child for life. I've seen a bit of that. It's not pretty.
I understand people's concerns about alcohol abuse but I think you have it exactly right. It seems so simple to understand that before the '70s we didn't create entire generations of mutant simpletons despite the fact that the majority of mothers drank moderately.
Reply | Report Abuse | Link to thisWhy, then, is it so hard to understand that moderate drinking is not the bugaboo it has been made out to be? Oh, wait, I forgot that we are living in the era where "if it only saves 1" and "we must make life Completely Safe" are the standards by which we must live.
For all of us in the Boomer Generation who steered our society toward these norms, I heartily apologize. I know we meant well, but: What were we thinking?
I have social anxiety disorder. When going to a wedding, my doctor actually told me having a glass of wine would be better form me then abstaining because I was not comfortable taking any psychiatric medication which would definitely harm the fetus. Extreme stress can cause hormones which are harmful to a child. Some women may have a reason for light drinking when pregnant. Everyone is different.
Reply | Report Abuse | Link to thisAlso, a woman may not always know that she is pregnant during the first trimester. There are a lot or reasons for not abstaining, but none for judging the decisions that a woman makes along with her doctor.
In developed countries, the teratogen that cuases the most widespread damage to prenatal development is alcohol. Although it used to be believed that moderate alcohol use would cuase no harm during pregnancy, recent research has shown that the only safe amount of alcohol for a pregnant woman is none at all.
Reply | Report Abuse | Link to thisYes, what is the big deal about abstaining for nine months? If you cannot give all to having healthy children, might consider supporting zero population dutifully.
Reply | Report Abuse | Link to thisSince everyone creates alcohol in their body, the amount created shouldn't be harmful for a fetus. But can we say that the amount added by a drinking mother is safe? I'm only asking the question. I have no definitive answers.
Reply | Report Abuse | Link to thisSeems like booze is a little too important to some people here. Yes, it can be tasty. It helps to relax. A few drinks a week does not make you an alcoholic. But if the thought of abstaining for nine months (not that long, really) is that terrifying to you that you'd rather risk harming your child, I don't think you have a healthy relationship with alcohol.
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