I for one had thought the theory of "no safe level of alcohol while pregnant" had been thoroughly dispelled. Guess not, because now the primary health agency of our nation, the Centers for Disease Control and Prevention, has issued a new advisory for women.
It's telling all women of child-bearing age who are not using contraception to "just say no" to alcohol. Go dry, in other words, to protect the fetus/embryo from the potentially toxic effects of alcohol during the early stages of development. The most feared outcome: fetal-alcohol spectrum disorder (FASD), more commonly known as "fetal-alcohol syndrome," a constellation of effects that can include mental retardation as well as facial and other abnormalities.
Alcohol can permanently harm a developing baby before a woman knows she is pregnant, said CDC Principal Deputy Director Anne Schuchat, in a statement. About half of all pregnancies in the United States are unplanned, and even if planned, most women won t know they are pregnant for the first month or so, when they might still be drinking. The risk is real. Why take the chance?
The premise of the argument in favor of promoting abstinence for women of child-bearing age is that there is no evidence for a safe threshold of consumption. While this is true, such reasoning epitomizes the precautionary principle, or better safe than sorry in the face of less-than-100 percent known risks. In essence, it forbids (not only) pregnant women, but women who might conceivably (sorry!) become pregnant, from enjoying an occasional drink. The "there is no known safe level" argument has been applied to so many other potential (or hypothetical) "toxins" that it has lost much of its potency as a realistic warning.
As we noted not too long ago, the guidances available on drinking alcohol during pregnancy are at best confusing, at worst contradictory. It is, and forever will be, impossible to examine the risk of alcohol consumption, as one would document adverse reactions in drug trials, since it can never be ethically possible to design a randomized controlled trial to test the effect of alcohol in pregnancy in a human model. However, it is equally true that there is no evidence for an unsafe threshold of consumption.
When it comes down to the nitty-gritty of such arguments, it is scientifically impossible to prove that anything is safe, since under some conditions nothing is actually always safe. Therefore, without acknowledging that little evidence exists linking low-level prenatal alcohol exposure with actual harms, such messages are likely to be met with skepticism. Threat-based messages based upon scanty evidence frame the problem of alcohol use in pregnancy in a paternalistic manner.
Moreover, most (if not all) of the FASD alarmism derives from interpolation of data from binge-drinking, fetal-alcohol provoking excesses of intake. For instance, a 2012 CDC survey found that included among the 8 percent of pregnant women who drink, 1.4 percent actually binge-drink, obviously skewing the FASD statistics, since in all likelihood the fraction of pregnant drinkers who have FASD babies mainly derive from the bingers, not the occasional cocktail consumers. And a large 2013 study from the UK showed that light consumption of alcohol by pregnant women has no deleterious effects on children up to seven years of age.
Agreeing with these data, author and Professor of Economics Emily Oster, in her excellent book, "Expecting Better," has this to say: "I summarize two studies in detail in my book: one looking at alcohol consumption by pregnant women and behavior problems for the resulting children up to age 14, and one looking at alcohol in pregnancy and test performance at age 14. Both show no difference between the children of women who abstain and those who drink up to a drink a day."
Maintaining a clear stance in advising abstinence from alcohol during pregnancy as the safest option, in order to reduce the risk of FASD, is one approach to this issue and it can be defended. While it may be true that complete abstinence is easier than perfect moderation, we should remember the manifold benefits of small amounts of alcohol, especially for heart health. And the CDC seems to have bent over backwards here to shame women into total abstinence when even contemplating pregnancy. So I d advise that, as far as infrequent gestational tippling is concerned, let s not throw out the fetus with the bathwater.