There’s no de­bate — it’s never OK to drink dur­ing preg­nancy

Houston Chronicle - - STAR - By Jen Gunter

Preg­nant women are given a long list of med­i­cal rec­om­men­da­tions that can come across as pa­tri­ar­chal don’ts: Don’t eat raw fish. Don’t con­sume deli meats. Don’t do hot yoga! Don’t drink.

There’s sci­en­tific ev­i­dence that these ac­tiv­i­ties can have neg­a­tive im­pacts on the health of the fe­tus, but the one that seems to be the source of most de­bate is al­co­hol.

Af­ter all, the French do it, don’t they?

And many peo­ple born in the 1960s or ear­lier had moth­ers who drank. And we’re fine, right?

My mother had a fairly reg­u­lar glass of rye and ginger ale when she was preg­nant with me. And she smoked. And I grad­u­ated from med­i­cal school at the age of 23.

So my opin­ion, es­pe­cially as some­one who be­lieves strongly in a woman’s right to make de­ci­sions about her own body, may come as a sur­prise: It’s med­i­cally best not to drink al­co­hol while preg­nant. Not even a lit­tle. The source of that view­point? My train­ing and prac­tice as an OB/ GYN.

Some at­tribute this ab­sti­nence ap­proach to the pa­tri­archy: Clearly, we doc­tors know that moder­ate al­co­hol is safe (we don’t!), and we just don’t trust women with that knowl­edge. Ac­cord­ing to this the­ory, we think a woman who hears that an oc­ca­sional drink is OK will blithely go on a ben­der. (We don’t think that.)

Some also say that, in an ef­fort to avoid friv­o­lous law­suits, doc­tors ad­vise against al­co­hol while us­ing a nudge-nudge, wink-wink

Driv­ing is also not the only fac­tor at play, in the same way that dif­fer­ences in body chem­istry can play a role in who de­vel­ops FAS. There is also the abil­ity of your new­born to with­stand an im­pact, the weather, the num­ber of cars and the state of mind of other driv­ers on the road.

While the chances of get­ting in a car ac­ci­dent while driv­ing home from the hos­pi­tal with your new­born are very small, most par­ents will re­call how much they stressed over in­stalling the car seat cor­rectly. (I re­leased a lot of pent-up rage in the hour it took me to get the car seats buck­led the first time.)

And yet, even with such lim­ited risk, I doubt a sin­gle pe­di­a­tri­cian would say: “Sure, drive un­buck­led just this once. It’s a cel­e­bra­tion.”

Guid­ance to not drink while preg­nant is not sex­ist. I’m all for smash­ing the pa­tri­archy at each and ev­ery op­por­tu­nity. And it’s true that medicine has been hope­lessly pa­tri­ar­chal since, well, medicine started. But pro­vid­ing peo­ple with ac­cu­rate in­for­ma­tion so they can make in­formed choices about their bod­ies is the an­tithe­sis of the pa­tri­archy. It is power. that only 11.5 per­cent of women re­ported con­sum­ing al­co­hol once they knew they were preg­nant. Of these women, most (72 per­cent) had a sin­gle 5-ounce glass of wine or less the en­tire preg­nancy.

We now have new data in the United States telling us that rates of FAS are higher than we knew. In 2018, a pa­per on FAS was pub­lished in the med­i­cal jour­nal JAMA. Re­searchers trained in iden­ti­fy­ing the dis­tinc­tive phys­i­cal char­ac­ter­is­tics of FAS eval­u­ated more than 3,000 chil­dren in four com­mu­ni­ties across the United States.

The find­ings were stag­ger­ing. The way we are con­sum­ing al­co­hol in preg­nancy is re­sult­ing in a con­ser­va­tive es­ti­mate of 1.1 to 5 per­cent of chil­dren — up to 1 in 20 — with FAS. Ac­cord­ing to the Amer­i­can Col­lege of Ob­ste­tri­cians and Gyne­col­o­gists, fe­tal al­co­hol spec­trum dis­or­ders are more preva­lent than autism.

And yet at least 10 per­cent of women still drink dur­ing preg­nancy.

The best anal­ogy for the risk as­so­ci­ated with al­co­hol con­sump­tion in preg­nancy is driv­ing with your new­born un­buck­led in the back seat. Maybe you’ll get into a car ac­ci­dent and maybe you won’t. And if you do, maybe it will be a fender ben­der or maybe it will be cat­a­strophic. — and rightly so — about pa­tri­ar­chal mes­sag­ing in medicine. Was no-drink­ing-while-preg­nant just one more way to speak down to us and con­trol our bod­ies?

No. But I can un­der­stand the con­fu­sion.

Part of the is­sue is that the sci­ence on al­co­hol and preg­nancy is tricky: Giv­ing preg­nant women al­co­hol for med­i­cal test­ing is not likely to be ac­cepted by ethics com­mit­tees.

And what about all those preg­nant French­women who drink (while also ap­par­ently shed­ding their baby weight with ease and bring­ing up per­fect bébés)? It turns out they aren’t, re­ally. One study in Europe that sur­veyed preg­nant women and new moth­ers dur­ing two months showed im­pact on the de­vel­op­ing brain. We now know that al­co­hol is a ter­ato­gen, mean­ing it can cause birth de­fects.

With that knowl­edge, the pen­du­lum swung hard. In 1988, Congress passed the Al­co­holic Bev­er­age La­bel­ing Act, which would add the well-known “women should not drink al­co­holic bev­er­ages dur­ing preg­nancy be­cause of the risk of birth de­fects” la­bel to al­co­holic bev­er­ages for sale or dis­tri­bu­tion in the United States. (A warn­ing about drink­ing and driv­ing was also added.) Many peo­ple un­for­tu­nately took this as an op­por­tu­nity to po­lice preg­nant women in pub­lic.

Then, over the past 10 years, women have be­come more vo­cal to in­sin­u­ate that a glass or two is fine.

But this isn’t about sex­ism (not this time) or dodg­ing lit­i­ga­tion. This is about facts. How women use those facts is, of course, their choice.

The truth is that fe­tal al­co­hol syn­drome is far more com­mon than peo­ple think, and we have no abil­ity to say ac­cu­rately what level of al­co­hol con­sump­tion is risk free.

There have been many twists and turns in how we, med­i­cally and so­ci­etally, view drink­ing while preg­nant.

There was a time when doc­tors rec­om­mended al­co­hol to preg­nant women for re­lax­ation and pain re­lief, or even pre­scribed it in­tra­venously as a to­colytic — mean­ing it stopped pre­ma­ture la­bor. One doc­tor who trained me spoke of a 1960s pre­na­tal ward full of in­tox­i­cated women “swear­ing like sailors.”

Things be­gan to change in 1973, when fe­tal al­co­hol syn­drome, or FAS, was for­mally rec­og­nized af­ter a sem­i­nal ar­ti­cle was pub­lished in The Lancet, a med­i­cal jour­nal. FAS is a con­stel­la­tion of find­ings that in­cludes changes in growth, dis­tinc­tive fa­cial fea­tures and a neg­a­tive

Claire Mil­brath / New York Times

Drink­ing dur­ing preg­nancy can re­sult in fe­tal al­co­hol syn­drome, which is far more com­mon than peo­ple think.

Jamie Grill / Getty Im­ages

Re­search shows that at least 10 per­cent of preg­nant women still drink dur­ing preg­nancy.

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