A toast to pregnancy

My nephew will be 1 year old in just about 1 week.  While my sister was pregnant, she spent A LOT of time reading about pregnancy, childbirth, early childhood development, etc.  Most of this reading was done on popular websites that published articles from multiple contributors on these topics.  Some of the information was useful. Some was interesting. Some was misleading.   I was shocked by the frequency with which popular news articles would cite a research paper to support a claim, but upon reading the research, I would discover that the research didn't support the claim at all.  Because of this, I am excited to write a number of posts about the science of childbearing, but I thought I would start with something my sister sent me recently that came from a local scientist.

The report came from the American Academy of Pediatrics, and the lead author on the paper was Dr. Janet Williams of the UT Health Science Center.  The message of the paper has been picked up by local tv news as well as CNN and others.  Referring to drinking alcohol during pregnancy, CNN wrote, "the American Academy of Pediatrics has put out a clear message, "Don't do it. Ever. At all. Not even a tiny bit."  This was a stark contradiction to the advice of my grandmother who asserted that my sister shouldn't "let those doctors tell her she can't have a glass of wine." CNN did, in fact, correctly quote the paper as saying, "no amount of alcohol should be considered safe to drink during any trimester of pregnancy."  Before I go any further, I want to say that this is a safe rule to go by and it is probably why they say this the way they do.  We do not need pediatricians recommending that pregnant women walk a tightrope, and we don't need them flirting with boundaries about what is safe for a developing child.

That being said... To me, the message was not quite so clear as CNN made it out to be.  While the paper concludes that it is safest to advise women to abstain from drinking while pregnant, it also acknowledges that there is no consensus on the safety of low levels of alcohol exposure.  In addition the logic that leads to that recommendation is based on a questionable interpretation of data from a 30 year old research paper.  Essentially, they say that we know that drinking a lot is bad for your baby.  And it has been shown that drinking even 1 drink per day is bad for your baby, so if we assume it is all part of a spectrum.... drinking anything at all must be bad.  This may be true, but it is certainly not proven.  In fact, the paper that they cite to establish that even 1 drink per day is bad for your baby doesn't really establish that for me.  First, they state that they looked at a number of factors related to the health of the pregnancy, yet the only one that they discuss is birthweight.  This tells me that they did not find any differences worth discussing in the other factors they looked at.  Next, the raw data actually shows that light drinkers (<1 drink per day) had higher birthweight babies than those born to non-drinkers.  They ignore that data in their discussion and instead discuss modified data that shows a very small reduction in birthweight 14g (average weight is 3500g).  Moreover, they fail to adequately discuss the differences in race, age distribution, and socioeconomics of each group.  And lastly, the groups were based on self-reported average daily alcohol consumption.  There was a group for none, less than 1, 1-2, 3-5, and greater than 5 drinks per day on average.  This also fails to take into account drinking patterns.  If an expectant mother drinks only every Friday and Saturday night, but still averages 2 drinks per day, they are drinking 7 drinks every Friday and Saturday.  I would imagine that this would have a vastly different impact on a baby than having even 1 drink every night.

Now, I want to be clear that I am not, nor would I ever, encourage pregnant women to consume alcohol.  But, I am also weary of bad science being used to advance any agenda.  Here is my summary of what is known about drinking during pregnancy.  Based on existing evidence, we know that heavy drinking is unhealthy for the unborn child.  Evidence even suggests that drinking 1 drink per day has negative effects.  However, we know nothing of any negative outcome for light drinking during pregnancy (less than one drink per day).  I see nothing wrong with a pregnant women having a taste of a beer or a sip of champagne at her baby shower.  Don't go crazy, but after looking at the research, my grandma might be on to something.  So I propose a toast to all the expectant moms: a toast to pregnancy.