Drinking During Pregnancy

This article is a commentary on the current guidelines for drinking during pregnancy.

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Clik here to view.It was Friday evening and Elaine, nine months pregnant with baby number two, was looking forward to a relaxing dinner with her husband at their favourite Italian restaurant. It was a special occasion, and Elaine decided she would treat herself to a glass of wine. It would be the first alcoholic beverage of her entire pregnancy.

Yet, when she got to the restaurant, she chickened out.

“It’s one thing to have a drink while pregnant. It’s quite another to do it in public. It wasn’t that I had changed my mind about the health implications, I was pretty sure having a drink was fine at this stage of my pregnancy. It was the stigma. I didn’t want people to get the wrong idea, to think I wasn’t taking care of myself or the baby.”

As Elaine’s experience attests, drinking during pregnancy is a decided no-no, not only according to Health Canada guidelines, but also according to our current social mores. Indeed, any woman who has been pregnant in the last decade or so can relate to Elaine’s experience — that acute awareness that having a drink while pregnant is not something that would go unnoticed or “un-judged” by others.

We know that heavy and binge drinking during pregnancy is associated with an increased risk for fetal alcohol spectrum disorder (FASD). But what about light drinking? Are children born to women who engage in light drinking during pregnancy (e.g., one to two drinks a week or per occasion) at an increased risk for social/emotional problems or cognitive deficiencies?

According to the growing body of evidence on this question, the answer is no. A recent study published in the Journal of Epidemiology and Community Health, for example, shows that children born to mothers who drink lightly during pregnancy (up to two drinks per week or per occasion) are not at any increased risk of behavioural or cognitive deficits. In fact, this large-scale study showed that, at 5 years of age, the children born to mothers in the “light drinking” group actually scored higher on a number of cognitive and behavioural measures than the children of mothers who did not drink at all during pregnancy.

This is not the first study to show that light drinking during pregnancy is safe. At the time of this writing, I am aware of three other studies from the UK as well as two from Australia all showing no increased risk of social/emotional problems or lower cognitive test scores among children born to women who drank lightly during pregnancy.

Despite this growing body of evidence, the medical community doesn’t seem to be in any big hurry to re-examine its current guidelines on drinking and pregnancy, which, at least in Canada, recommend that all pregnant and possibly pregnant abstain from alcohol altogether.

In large part, the total avoidance rule reflects a “best to err on the side of caution” strategy. It’s a strategy that operates on the logic that: a) it shouldn’t be that much of a sacrifice to stop drinking while pregnant or while trying to get pregnant (how hard it is, after all, to forgo to glass of wine at dinner or a cold beer on a hot summer day?); and b) because we don’t really know how much alcohol during pregnancy is “too much”, it is better to be as safe as humanly possible. In other words, demanding abstinence can’t be that big of a deal; after all, it’s the health of our babies we’re talking about.

My response to this is two-fold. First of all, there’s “erring on the side of caution” and then there’s unnecessary overkill. Erring too much on the side of caution isn’t sound preventive health advice, it’s medical paternalism.

It’s taking knowledge about a particular risk (that binge and heavy drinking during pregnancy presents an increased health risk for FASD and related problems) and amplifying it (that any alcohol during or pre pregnancy may present an increased health risk) far beyond what’s reasonably required in order to efficaciously manage that risk.

Basically, it’s the medical community not trusting pregnant and pre-pregnant women to be able to make sound preventive health decisions themselves. It’s a tacit and institutionalized way of saying we need extra-wide safety margins — size XL prevention bumper pads — for our own good and for the protection of our offspring.

The second issue I have with the excessive caution strategy is that it colludes with, and helps to legitimize, the moral subtext of the no alcohol rule.

In today’s cultural climate, following medically-established rules for a “healthy pregnancy” is one of the key markers (and requirements) for showing that we have the proper moral fortitude for, and are worthy of, the motherhood role.

The current guideline, with size XL prevention bumper pads, has helped to culturally code the act of drinking any alcohol whatsoever, either during or pre pregnancy, as dangerous, irresponsible, and as selfishly indulgent.

The no drinking rule has become much more than just an overly safe guideline for healthy pregnancy. It’s become a cultural signpost for maternal worthiness. (This is a strikingly ironic contrast to the cultural coding of light to moderate drinking for the non-pregnant population, where certain kinds of alcohol – like red wine, for example – are actually promoted as part of a responsible and healthy lifestyle.)

To me, it’s not okay. It’s not okay for the health community to participate (wittingly or not) in moral gate-keeping or medical paternalism. It’s not okay to create health guidelines that inappropriately amplify our perception of risk, especially when we know that these kinds of guidelines (“healthy lifestyle” guidelines in particular) play such a central role in the cultural creation of broader moral codes and social mores.

Especially now, with an increasingly solid and growing body of research showing that light drinking during pregnancy is safe — and with no body of evidence to the contrary — it is time to revise our thinking about the acceptable margins of safety for alcohol consumption during and pre pregnancy.

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