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Experts Respond to New Report Telling Pregnant Women To Totally Avoid Alcohol

A report from the American Academy of Pediatrics advises women to cut out all booze while pregnant—but advice from the rest of the world varies.
Photo by Peter Bernik via Stocksy

How bad is a glass of wine when you're knocked up? Very, according to a new clinical report from the American Academy of Pediatrics (AAP).

The leading US pediatricians' group issued updated advice on Monday that warns that no amount of alcohol should be considered safe for consumption while pregnant—no matter what trimester you're in or how teeny-tiny the wineglass you imbibe from.

Read More: What to Expect When You're Drinking While Pregnant

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"The research suggests that the smartest choice for women who are pregnant is to just abstain from alcohol completely," said Dr. Janet F. Williams, one of the report's lead authors, in a statement published on the AAP's website. She believes that diagnosis of fetal alcohol spectrum disorders remain "significantly under-recognized" due to a lack of uniformly accepted diagnostic criteria.

Dr. Williams' clinical report, titled "Fetal Alcohol Spectrum Disorders," concludes that "despite research evidence clearly documenting the spectrum of detrimental consequences of PAE (pre-natal alcohol exposure), too many women continue to drink alcohol during pregnancy." The AAP stressed that "no amount of alcohol intake should be considered safe."

Fetal alcohol spectrum disorders (or FASDs) is an umbrella term for the range of abnormalities that can occur in a person whose mother drank during her pregnancy. The most severe of these disorders is known as fetal alcohol syndrome. FASD symptoms can include learning difficulties, hyperactive behavior, and physical signs such as shorter-than-average height and abnormal facial features.

The problem is we don't know exactly how much alcohol somebody has to drink and when in order for children to appear on that [FASD] spectrum.

A Centers for Disease Control and Prevention (CDC) report that surveyed 8,383 pregnant women found that one in ten reported consuming alcohol in the past 30 days, and one in 33 reported binge drinking (defined as consuming four or more drinks in one go).

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Lee Wright, a senior lecturer in midwifery and women's health at Birmingham City University in England, said that he believes that abstinence is the best practice for women—especially because of the lack of scientific knowledge on how booze affects pregnancy.

"The problem is we don't know exactly how much alcohol somebody has to drink and when in order for children to appear on that [FASD] spectrum," Wright told Broadly. "Some people could technically drink a little bit and have [a child] who's quite severely affected. Other people could drink more and actually their baby could seem not so much affected. That's why the current advice is none at all."

Why is this? "If I could answer that, I would win myself the Nobel Prize for medicine," Wright replied. "It's one of those bizarre situations. If you drink a lot in your pregnancy, then obviously you increase your chances of having many more problems, not just FASD. However, some women can drink a relatively small amount, thinking they're only having the occasional glass, and yet their baby can still be affected."

Read More: When Being a New Mom Means 30 Days of Staying Home Without a Shower

While the received wisdom in America is that abstinence—and only abstinence—is the way to go for pregnant women, Europeans lean towards a slightly different approach. A 2012 study from Denmark even found that low and moderate drinking in early pregnancy had no adverse effects in children aged five, with low average consumption defined as one to four drinks a week and moderate drinking defined as five to eight drinks a week.

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In the UK, the Department of Health recommends that pregnant women should avoid drinking altogether, but does provide guidelines for women who do want to imbibe during pregnancy: Basically, don't do it during the first three months, and limit what you drink thereafter.

"If they do choose to drink, to minimize risk to the baby, the government's advice is to not have more than one to two units of alcohol once or twice a week, and not to get drunk," explained Sarah Jarvis, the medical advisor to the alcohol education charity Drinkaware. In the UK, one alcoholic unit is equivalent to one shot of spirits; a 125 ml glass of wine equals one-and-a-half units. "Our advice is that if you are concerned about the impact of drinking in pregnancy, the safest option is to avoid alcohol."

For one, women are not stupid, and they are capable of both understanding the evidence and differentiating between a glass and the best part of the bottle.

Some women have argued that the all-out rejection of alcohol limits their ability to make an informed decision about alcohol consumption. (Or, as Jessica Machado writes in a feature on drinking while pregnant: "My body, my informed choices.") One reproductive choice charity, the British Pregnancy Advisory Service (BPAS), has warned that abstinence advice may even create serious, unexpected problems.

"BPAS now regularly sees women so distraught that they have caused their baby harm by what they drank before they knew they were pregnant, they consider abortion," said Clare Murphy, the director of external affairs for the organization.

"Some campaigners now argue that pregnant women should be told to abstain from alcohol in pregnancy completely because they cannot tell the difference between a little and a lot, and an abstinence-only message is much easier for them to understand. For one, women are not stupid, and [they] are capable of both understanding the evidence and differentiating between a glass and the best part of the bottle. Messages to abstain may be well-intentioned, but they may have serious and unintended consequences."