White moms-to-be ahead in dangerous habit

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The latest study by the Substance Abuse and Mental Health Services Administration (SAMHSA) reports on the prevalence of tobacco, alcohol, and illicit drug use among pregnant women ages 15 to 44 years. Overall, Hispanic women had the lowest rates of substance abuse in all categories, while white and black pregnant women were slightly more likely to engage in drinking and illicit drug use. The real discrepancy, however, appeared in the rates of smoking among pregnant white women: At 21.8 percent, the proportion was considerably higher than among blacks (14.2 percent) or Hispanics (6.5 percent).

What are we to make of this significantly higher rate of smoking among pregnant white women? ACSH's Dr. Gilbert Ross recommends that we take these numbers with a grain of salt. As he points out, a recent study on the link between prenatal smoking and asthmatic children reported that nearly 19 percent of African-American mothers smoked at some point during pregnancy a far different number than the 14.2 percent reported by SAMHSA. "These numbers are dynamic and depend on a given study's methods and conditions," he notes. This is not to say that we shouldn't be concerned about lowering the rate of smoking among pregnant women, whatever that rate may be given the risks of smoking in relation to the developing fetus. And to this end, SAMHSA sponsors three different programs that help identify and treat women with substance abuse problems.

However, we re somewhat concerned about the strong emphasis that SAMHSA's preventive programs place on combating the use of alcohol during pregnancy. As ACSH's Dr. Elizabeth Whelan observes, the current attitude of zero tolerance toward any use of alcohol whatsoever during pregnancy simply does not reflect the data. "Taking their cue from the hyper-precautionary public health statements, people don't consider the significance of dosage," she says. "They either shun or accept a substance entirely." However, there is good evidence that moderate use of alcohol during pregnancy is not a cause for concern. For instance, a large 1997 study observed no harmful effects on children when the mother's consumption of alcohol was less than 8.5 drinks per week, while a 1998 meta-analysis found that consumption ranging from two drinks per week to two a day during the first trimester of pregnancy was not associated with any increased risk of fetal malformation.

Thus, Dr. Whelan points out, while it's clearly in the best interest of all involved that pregnant women avoid smoking and illicit drugs, hysterical attitudes leading to total alcohol abstinence during pregnancy serve little purpose.