Glass a day "safe" for pregnant women?

[Robin Garr]

From Australia, a breath of sanity ...

Glass of wine 'safe' for pregnant women

October 11, 2007 - 7:09PM
The Age

Drinking a small glass of wine every day is safe for pregnant women, a British health watchdog has suggested.

The National Institute of Clinical Excellence's (NICE) controversial new draft guidance contradicts the British government's official advice which is for pregnant women and those trying to conceive to avoid alcohol altogether.

The institute says pregnant women can safely consume up to 1.5 units of alcohol - the equivalent of a 125ml glass of wine or a 25ml measure of spirits - a day after the first three months of pregnancy.

Full story in The Age

[David M. Bueker]

Oh this will raise some hackles in the good 'ol USA (if anyone notices).

The institute says pregnant women can safely consume up to 1.5 units of alcohol - the equivalent of a 125ml glass of wine or a 25ml measure of spirits - a day after the first three months of pregnancy.

Full story in The Age

Robin,
The problem with this sort of advice is that it treats all women as equally susceptible to alcohol, which they most certainly are not. It's true that most women can consume a small amount of alcohol without undue effect, but there are always those disturbing exceptions. Doctors have observed cases of Fetal Alcohol Syndrome in women who consumed only minor amounts of alcohol. Presumably, factors such as genetic levels of alcohol dehydrogenase (such as are found in East Asian populations) and body weight will also factor into the amount of alcohol per unit time that can be safely consumed. One other problem I have with that article is that the third trimester of pregnancy is the worst time for FAS because that's when the fetus's nervous system is undergoing rapid development.
If I were a doctor (which I'm not) and offering advice, I'd say to have no more than one glass of wine, drink it slowly and with food and other liquids. In fact, this whole discussion just makes me glad that I'm not a doctor (too many variables).

Mark Lipton

Doctors have observed cases of Fetal Alcohol Syndrome in women who consumed only minor amounts of alcohol.

Mark Lipton

Mark, can you direct me to a study or documentation regarding the above?

Robin, purely as a journalistic matter, is the headline accurate?

The full quote seems to be (NICE doesn't have anything on its website at the moment):

"The experts have concluded that there is no consistent evidence of adverse effects from low-to-moderate alcohol during pregnancy (less than one drink or 1.5 units per day) but the evidence is probably not strong enough to rule out any risk," said a spokeswoman from the National Institute for Health and Clinical Excellence.

That language is quoted in the Australian source and in several other articles on this report.

Does "no consistent evidence" and "probably not strong enough to rule out any risk" equal "Safe"? NICE doesn't use the word "safe" in the text I've seen.

Regards, Bob

[David M. Bueker]

Warning politically incorrect comment ahead...warning...

With all the lunatic little kids (zero control) I see these days coming from mothers who strictly followed the zero alcohol rules I really wonder if they should have had a few drinks while they were pregnant.

[Robin Garr]

Robin, purely as a journalistic matter, is the headline accurate?

Bob, given that journalism is not science, I would say that the use of quotes around "safe" and the question mark at the end of the headline make it a fair summation.

Of course, I have my own bias here, based on a profound belief that - while true FAS is of course a tragic thing - it is rare in all cases and probably unknown among the offspring of mothers who behave moderately during pregnancy. It became a trend <i>du jour</i> upon the publication in the 1980s of a sentimental, non-scientific treatise about FAS among the children of chronic, severely alcoholic women on Indian reservations. Before that time, most women, including my mother and the mothers of everyone I know, continued drinking moderately during pregnancy without obvious mishap; same's true of women in my cohort who had children during the '70s and '80s.

It's hard for me to see why FAS suddenly became such a threat that it has become virtually a sin for a woman to so much as sniff a glass of wine during pregnancy, and I can't help but wonder if the combined forces of neo-prohibitionism and perhaps the more extreme Right To Life movement with its emotional declarations about "pre-born" life aren't important actors in promoting this social change.

But that goes well beyond what you asked.

Thanks.

I thought of the quote marks and the question mark, but wondered if that did the trick since the editor added the word "safe" which wasn't in the NICE release.

It's interesting to see how the press and the various health groups are handling this -- there's certainly plenty of interest in the Commonwealth, and I see the US media has picked it up -- over 450 Goggle hits a few minutes ago.

Regards, Bob

I have no idea what the stats are on FAS,

Randy, it's clear to me that both the medical and scientific communities have the same level of confidence in the information that your comment implies.

To carry the smoking analogy, I believe the campaign against smoking gained its creds through consistent medical and scientific results that showed a correlation between cancer and smoking.

As far as I know thus far, nothing even close to consistency has been presented regarding FAS, except that it might be a problem for children of pregnant alcoholics, and the "might" is the operative in that sentence. Clear correlation doesn't seem to have shown up in anything that I've read.

I'm not so sure that is enough to create a public policy over, but it seems enough to create public confusion, if not outcry!

I can relate to this with a very recent personal experience... my wife gave birth to the Doode you see in my avatar this past September 20th. Once we got pregnant, my wife and I visited with various doctors to discuss this one glass a day issue. We found tons of information that supported both positions... in the end, my wife is just too detail oriented and probably had less that 2 glasses of wine during the entire pregnancy.... even now, she refuses to drink more than 1 glass a week because she is breastfeeding...

I miss being able to drink with her as she does share my passion for wines... but I guess in another 18 months or so she will be back in the cellar with me...

From what I gathered during my wife's recent pregnancy, the stage of pregnancy is quite important as to the possible effects of alcohol on a fetus. Later in the pregnancy there is less potential impact than early on. Unfortunately, the very early stages when some women may not yet be aware that they are pregnant is one of the most sensitive times.

As for breast feeding, I have read that alcohol reaches breast milk very fast after consumption. Many women hold off on drinking till after the baby has been fed so there will be a period of time before the next feeding.

My personal experience of 35 and 40 years ago may be relevant, Alejandro. Janet felt strongly that she shouldn't have alcohol while she was pregnant. We both abstained during those periods.

It wasn't really much of a sacrifice in the general course of our lives.

Regards, Bob

The only estimate that I've come across is that 1 in every 750 infants is born with symptoms and attributes consistent with FAS (the study did not state whether it was limited to the US or it calculated this statistic based on worldwide information).

I'm not sure where I fall in this debate. Since I am not having children for a long time and the studies seem solid, I agree with the people who say that a couple of glasses a week is safe. However, if I am ever pregnant, I will probably abstain just because I wouldn't want to take the risk.

I'm not so sure that is enough to create a public policy over, but it seems enough to create public confusion, if not outcry!

Thomas / Robin, you're quite right. It is indeed causing confusion. In fact the Grauniad (aka The Guardian - probably still pretty much our most balanced left wing/socialist newspaper) led on the news article with the headline "Confusion over advice on alcohol for pregnant women".

The NICE guidelines are currently only in draft format, and have been released for consultation. Their actual preliminary recommendation says that pregnant women should limit their intake to "less than one standard drink (1.5 units or 12g of alcohol) per day, and if possible avoid alcohol in the first three months of pregnancy". It goes on to say that women should be told that binge drinking can be harmful to the foetus.

The Grauniad article goes on to say that a spokesperson for Nice said their experts had carried out a systematic review of the evidence, concluding "that there is no consistent evidence of adverse effects from low to moderate alcohol use during pregnancy but the evidence is probably not strong enough to rule out any risk". The recommendations are subject to consultation and final guidance is due to be published in March 2008.

In response, the National Childbirth Trust has backed the Department of Health advice (that it was best for women to avoid alcohol completely during pregnancy). But it has also warned that women should not be made to feel guilty."Pregnant women who have a few drinks often worry a great deal about whether they have harmed their baby," said chief executive Belinda Phipps. "On balance, it is believed that if a light, infrequent drinker, in general good health, drinks to the point of drunkenness on one occasion, the risk to her baby is small."

Pregnancy etc isn't something I've got detailed personal knowledge about, or am particularly worried about for the future either (to give you an idea, I've already passed into the supposed 'risk' age bracket for having children ). But I have to say if I were ever in that situation I'd probably go for abstinance, just in case. However as Matt said, it's the very early stages that apparently are the most sensitive times, when some women may not yet be aware that they are pregnant. So the advice not to get stressed about having had a few drinks before knowing you're pregnant is probably very good, as the stress would probably do more harm than the alcohol!

Sharon,

To me, the whole thing is suspect. With all the to-do, even this latest round admits that the evidence isn't there to say anything about how much alcohol and how often its use is dangerous during pregnancy. I fear the issue has been hi-jacked by anti-alcohol interests and made into a scientific concept.

Making policy based on lack of evidence is junk science.

Should pregnant women avoid vinegar? A salad a day with vinaigrette over 9 mos. equals about a glass of wine! Only way to abstain is to abstain--completely.

As someone I know posted elsewhere, here is a list of the other compounds which, along with alcohol, are considered dangerous teratogens.

Acetylsalicylic acid (aspirin)
Antibiotics
Benadryl
Betel nut
Bracken fern, dried
Caffeine and caffeic acid
Camphorated oil
Candida albicans (yeast infection)
Cassava (a starch used to make tapioca)
Cholesterol
Corn oil
Cortisone
Cottonseed oil (unhydrogenated)
FD&C red No. 2
FD&C yellow NO. 5
Ferrous sulfate (iron)
Folic acid
Insulin
Lactose
Lithium
Lysine (an amino acid found in gelatin)
Magnesium sulfate (a muscle relaxer used to used to treat pre-eclampsia, eclampsia and preterm labor)
Mineral oil
Monosodium glutamate (MSG flavor enhancer)
Morphine
Neem oil
Nicotine
Nutmeg oil, east indian
Oxygen
Ozone
Palm oil
Papain (a papaya enzyme used in face creams, cleansers and tooth pastes. Taken orally for bloating and indigestion.)
Potato, green parts
Quercetin (a bioflavonoid found in grapes, wine, broccoli, cabbage, carrots, onions and peppers; used as an anti-inflammatory)
Selenium (a trace mineral found in grains, nuts, and seafood; amounts depend on the regions’ soils—Nebraska and North Dakota have the highest selenium contents in North America. Three ounces of tuna provides 95% of the recommended daily value for selenium, and 1 ounce of Brazil nuts provides 780% of the recommended daily value.)
Sodium fluoride (used in water fluoridation and fluoridated dental products—overuse is associated in medical journals with bone fragility and intellectual impairment)
Sodium lauryl sulfate (a cheap detergent used to produce foam and bubbles in shampoos and toothpaste—a recognized irritant; contact with skin, scalp and gums should be limited)
Streptomycin
Sucrose
Tinactin
Tobacco
Vitamin A
Vitamin B7
Vitamin B12 complex
Vitamin D2
Vitamin K
Xanax
Zinc oxide (sunblock)

In this country (the USA), pregnant women don't eat sushi. From what I understand, in Japan people think that is absurd. Pregnant women there eat raw fish at will, but are cautious about eating raw vegetables. Can you imagine telling pregnant women in the US not to eat salad? Clearly societal norms and pressures are very strong and very different across the world.

Of course all of this risk we are discussing pales in comparison to the risks of, say driving a car, which we would never pressure a pregnant woman to avoid doing.

I have no idea what the stats are on FAS,

Randy, it's clear to me that both the medical and scientific communities have the same level of confidence in the information that your comment implies.

To carry the smoking analogy, I believe the campaign against smoking gained its creds through consistent medical and scientific results that showed a correlation between cancer and smoking.

As far as I know thus far, nothing even close to consistency has been presented regarding FAS, except that it might be a problem for children of pregnant alcoholics, and the "might" is the operative in that sentence. Clear correlation doesn't seem to have shown up in anything that I've read.

I'm not so sure that is enough to create a public policy over, but it seems enough to create public confusion, if not outcry!

It also might be a problem for the children of moderate drinkers.
There is a lack of consistency in the birth defect itself. There are cases of identical twins where one is severely disabled and the other is "normal". Because there is no black/white amount where it suddenly becomes unsafe for all, some recommended that abstainance is best some say small amounts are safe. That does not make it ok for anyone to berate and stress a pregnant woman out for having a little wine with dinner. That would be counter productive. Stress is a dangerous thing as well.
As someone who has raised a wonderful, bright, kind, and very smart child with FAE, I'll tell you that no amount of pleasure from wine is worth putting up with countless times where a simple homework assignment becomes an all night ordeal, seeing someone you love's self esteem lowered because their buddies can understand things that are lost on them, the worry that your child might be getting into trouble because they do not understand actions/consequences very well.

For more information, I recommend Ann Streissguth's books.

[Jenise]

Alejandro: congratulations on your lovely new baby. It's a boy? FWIW, I would have done as your wife did. Much as I love my wine, for the baby's sake it's just not worth it.