I was in Nevada this last week, working with obstetricians on strategies for identifying pregnant women who are drinking alcohol. All was going well until I met up with a physician who would have no part of the conversation. Like other skeptics I've met through the years, he was vehement in his protests that there is not any research to prove that no amount of alcohol is safe to drink during pregnancy. He brushed aside any attempt at a reasonable conversation, labeling the issue of alcohol use in pregnancy another government attempt to invade physicians' private practices and women's private lives.
In support of his assertion that alcohol is safe to drink during pregnancy, he cited a study in the Journal of Epidemiology and Community Health published in late 2010. The study was a longitudinal assessment of child health in a population of children born in Great Britain between September 2000 and January 2002. The issue at hand was whether there is a safe amount of alcohol a woman can consume during pregnancy.
Although the authors presented their findings in an even-handed manner, the translation of the study findings in the national and international media was anything but responsible. Headlines in newspapers and newscasts screamed the message that light drinking of alcohol during pregnancy is not only perfectly safe but actually results in higher developmental scores in children at age five -conclusions that are not supported by the research and are, in fact, reckless and misleading.
The study relied on the mothers' recalling their pattern of alcohol use during pregnancy nine months after having delivered, self-reports that the authors acknowledge are prone to "recall bias." In addition, the women who drank light amounts of alcohol were wealthier, better educated, had higher-level jobs, and smoked cigarettes far less than any of the other women in the study. So, although initial results suggested that children of light drinkers had fewer behavioral difficulties and higher IQ scores, there was no doubt that a variety of other factors were at play. In fact, the authors themselves were quick to stress that most of the differences in IQ scores were explained by the socioeconomic advantage of the "light drinking" group of mothers.
In addition, prenatal exposure to alcohol may have "sleeper" effects resulting in the emergence of developmental issues as children enter the school years. Because this study only evaluated children until age five, these potential developmental problems could not be captured: only screening instruments were used to evaluate the children; no full battery of testing was performed.
While some reporters in the public media presented thoughtful evaluations of the the article in question, far too many did not. Clearly, the researchers never claimed that alcohol is beneficial for a growing fetus, yet Emily Sohn, a journalist for Discovery News, reported that drinking while pregnant "could actually give your kids a slight developmental advantage."
Why is it so important to correct these misapprehensions? Because prenatal alcohol exposure is the leading cause of preventable intellectual disabilities and behavioral difficulties in the United States; because biologic, foster, and adoptive families raising children who have been affected by alcohol exposure can tell you countless stories about how "just a little alcohol" has caused endless heartbreak for their child and themselves; because alcohol exposure, on the basis of dose, timing, pattern of drinking, and maternal and fetal genetics, can cause brain damage in the developing fetus; and perhaps most crucially from a public health perspective, because it seems that many physicians just don't seem to want to admit that alcohol use in pregnancy poses a consistent danger to unborn children.
Which brings us to the only reasonable response to the question, "How much alcohol can a woman safely drink during pregnancy?" The answer is we don't know. But if it's your daughter, your granddaughter, or friend, or patient, the most caring answer is, "No amount of alcohol is safe to drink during pregnancy."
And it's not a government plot.