Alcohol and pregnancy: A volatile mix

A British scientist is criticizing doctors over the advice they give to pregnant women about drinking, saying that pregnant women are big girls who can make up their own minds about the risks.

In the United States, most medical advice on drinking during pregnancy centers on one word: "Don't." But the British have wrangled over the issue with considerable angst in recent years. In 2007, United Kingdom government officials recommended that women abstain from drinking any alcoholic beverages during pregnancy. The advice was controversial because, while excessive drinking in pregnancy is clearly harmful to a developing fetus and can result in fetal alcohol syndrome, there is debate over the harm of light or moderate drinking during pregnancy. In 2008, the U.K.'s National Institute for Health and Clinical Excellence reported that there was no evidence of harm if women drank no more than one or two drinks a week.

Studying the issue seems to be a favorite pastime in the U.K. One recent study suggested that even drinking small amounts of alcohol during pregnancy can affect maternal-child bonding and delay the mother's recovery from childbirth. Another study found that children born to mothers who drank one or two drinks per week during pregnancy were not at increased risk for behavioral or cognitive problems at age 3 compared with kids whose mothers did not drink.

In the United States, both the National Institute on Alcohol Abuse and Alcoholism and the American College of Obstetricians and Gynecologists advise women to avoid alcohol during pregnancy.

In an article published today in the Journal of Medical Ethics, Colin Gavaghan warns doctors against telling women to abstain instead of a more truthful message. Women, he says, should be presented with the medical facts as they stand at the moment and trusted to make good decisions.

"The days where doctors routinely withheld information ... on the groups that patients would become confused and make bad decisions are, supposedly, consigned to history," he writes. "It is far from clear why a paternalistic exception is permitted in the case of pregnant women."

Gavaghan suggests that if a woman enjoys a drink or two and it helps her relax, that may be might be just as important to consider as the "interest of the future child."

Moreover, if doctors exaggerate the risk, he says, "their advice on genuine risks will carry less authority."

Paternalism has no place in medicine, but many doctors advise women to abstain from alcohol while pregnant or while trying to become pregnant because it's not really clear if there is any safe level of alcohol use. Women who drink at mild to moderate levels and then find out they are pregnant shouldn't panic, experts say, but they should stop drinking. The emerging field of epigenetics suggests that a fetus may be vulnerable to small and subtle changes in the mother's diet or environment that may alter its later risk for disease. It's not appropriate to frighten women unnecessarily. But it's wise to be prudent.

-- Shari Roan

Photo: Martin Berinetti / AFP/Getty Images

Comments

[NancyB]

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[Kathryn Kelly]

According to the British Medical Association, in their June 2007 publication Fetal Alcohol Spectrum Disorders, A Guide for Health Care Professionals, "There is considerable debate as to the adverse effects of prenatal alcohol exposure at low-to-moderate levels as the existing evidence is inconclusive. Research evidence is continuing to emerge as to the potential effects of prenatal alcohol exposure at low-to-moderate levels, however, it is currently not possible to predict who is and who is not at risk. Given the ambiguity regarding the level of individual risk to the developing fetus and the fact that health promotion advice and sensible drinking guidelines lack clarity, the only sure way to prevent these disorders is to stop alcohol consumption during pregnancy."

Mr. Gavaghan proposes an unnecessary risk to the fetus. Why run the risk of burdening the unborn child with a lifelong disability?