Alcohol and Pregnancy: A “Safe” Mix?

by Danielle Taubman on February 19, 2013

People tend to freak out about the pregnant lady drinking the small glass of wine at the dinner party.  A flood of whispers inevitably fills the room and the next day this “indiscretion” is the talk of the town.   But is this a blameworthy issue? Are concerns about a sporadic drink during pregnancy valid?

Image courtesy of photopin.com

I have noticed differences in opinion on this issue whenever discussions about healthy pregnancy occur.  The New Year’s party I attended this past year was a case in point.  Two of the guests were pregnant: one was still in her first trimester, and, at 37 weeks, the other woman was close to delivery. At one point, I found myself sitting at a table with both of them.  Also at the table sat a tray full of deliciously-pink cupcakes.  And, as it turned out, these were no ordinary cupcakes—they were baked with real champagne.

What transpired next piqued my interest perhaps even more than the tempting cupcakes themselves.

After hearing that the cupcakes contained some unspecified amount of alcohol (the likelihood of champagne cupcakes actually containing a high amount of alcohol is very low) the newly pregnant woman looked down at the cupcake on her plate with a dismayed look, abruptly removed it, and explained that she was pregnant so she could not eat it.  The woman who was closer to term simply shrugged her shoulders, said she was starving, and inhaled the cupcake.

I first wondered if the newly pregnant woman was being more cautious than the other woman because she was in her first trimester (a time when all of the baby’s major body organs and systems begin to develop).

But I also wondered if the source of the discrepancy in the women’s behaviors was something else.  I wondered if perhaps these women had received different messages about alcohol consumption during pregnancy.

The negative effects of heavy, regular drinking (>9 drinks per week) during pregnancy are well known and widely cited. And major health sources such as the Centers for Disease Control and Prevention (CDC) and the Surgeon General recommend abstaining completely throughout pregnancy.

But what about an occasional drink? Is drinking even a small amount of alcohol during pregnancy not okay?

A Danish study from last summer, which resulted in five scientific articles, examined the effect of different drinking patterns in early to mid-pregnancy on neurodevelopment (intelligence, attention, and executive function) in five-year-old children.  My Risk Communications professor Brian Zikmund-Fisher discussed the study and its implications in class last semester and blogged about it in the Risk Sense blog through the University of Michigan Risk Science Center here.

Since it was published, the study has received a lot of attention…and not all of it has been positive.

Image courtesy of photopin.com

Published by The Lifestyle During Pregnancy Study Group from Denmark, the study suggests that alcohol consumed on occasion may not be a serious concern—a naturally controversial statement.  The study recruited women at their first prenatal visit and focused on women with low average alcohol consumption (defined here as 1 to 4 drinks per week). However, women with moderate (5 to 8 drinks per week) and high (greater than 9 drinks per week) levels of alcohol consumption were also included in the sample.

The researchers followed the recruited women throughout their pregnancy and contacted them again when their children were five.  At that time, the five-year-olds were examined for their IQ, ability to pay attention, self-control, and the ability to organize and plan. The examination took 3 hours. Perhaps Danish children are more well-behaved than American children because I don’t know many five-year-olds who can stay focused for that long to begin with.

Image courtesy of photopin.com

The authors found no effect of light or moderate drinking or infrequent episodes of binge drinking on any of these factors. Yet it may not be wise to take these results at face value.  For one thing, drinks are smaller in Denmark (12 grams of alcohol in the study versus 14 grams in a typical American drink), In other words, Danish women consuming 1 to 8 drinks (light to moderate drinking) are actually consuming less alcohol than an American woman drinking 1 to 8 drinks. Also, individuals differ greatly on their ability to metabolize alcohol and the mother’s and child’s genes both affect the child’s susceptibility to the negative effects of alcohol in the womb.  Finally, and perhaps most importantly, no evidence of associations does not necessarily mean even small amounts of alcohol are “safe”.  More on this from Professor Zikmund Fisher here.

An Ongoing Debate

You can find sources that say any drinking can do damage as well as sources that say a bit of alcohol won’t cause any harm.

Even the study at hand reads: “To date, the scientific literature, including the present study, does not establish a safe level of alcohol consumption during pregnancy.”

Given the uncertainty about what constitutes a “safe” threshold of alcohol during pregnancy, the best available advice is abstinence.  Nevertheless, the research promotes the sense that women should not feel guilty if they have a drink or two during their pregnancy.

 

Hillary February 19, 2013 at 2:29 pm

The woman who ate it probably realized that the vast majority of alcohol cooks off when used in baking/cooking. :P

Danielle Taubman February 19, 2013 at 2:55 pm

Yes, I thought about that too. I wonder if the other woman also knew this but was still just being extremely cautious. Also, there was some champagne mixed into the frosting so she may have considered that to be risky!

Brian Zikmund-Fisher February 19, 2013 at 5:00 pm

Thanks for the nice post and for the “shout out”.

My personal thought is that there are two processes that might be operating in situations like this:

(a) It might be a slippery-slope / self-control issue. We make absolute rules because we don’t trust ourselves to stop if we aren’t absolute and we know there lies danger if we slip completely. This makes logical sense. I just don’t buy it. We do all kinds of other risky behaviors where the same logic applies and we trust our ability to partake in moderation.

(b) It might be a pure stigma issue. As you note, the sight of a pregnant woman with a drink evokes a reaction even among bystanders. We may all just be internalizing this social pressure.

(c) It might be that there is something about this risk that makes the possibility of harm intolerable in a way that is not true about other risks. If so, then the fact that the probability is low doesn’t matter. This is what I think is true, but it may take a while to prove it.

Still, good to hear your thoughts on one of the most common and controversial “risky” behaviors in day-to-day life.

Andrew Maynard February 19, 2013 at 8:18 pm

Brian – what do you think about the potential influence of social norms here? Campaigns against drinking during pregnancy have been so successful it seems that the social norm in some areas at least is not to drink. Does this lead to a default reaction against drinking, followed by a need to rationalize when challenged – and an assumption that anyone or anything that challenges the conventional wisdom is wrong? And if this is the case, how does it affect analysis of scientific studies – is there a tendency to be apologetic about results that don’t seem to support the norm, and to over-qualify them?

Danielle Taubman February 19, 2013 at 10:44 pm

Hi Brian, thanks for your insights on this. I agree that pregnancy is a special, highly sensitive area of public health and when it comes to their baby’s health, women often ere on the side of caution. As you said, perhaps even with more established research showing levels of alcohol that do not pose a statistically significant threat to the baby during pregnancy, women will still choose to abstain from drinking. And, if society continues to admonish the behavior it will surely also contribute to women’s reluctance to drink even small amounts of alcohol when pregnant.

Gale February 19, 2013 at 8:05 pm

I really enjoyed your article and it hits home for many women. I know that when I was pregnant I didn’t drink alcohol and I even stopped drinking my favorite…diet coke. Your post gave me something to think about and it seems like there is more research to be done before knowing for sure if there is a safe threshold for alcohol consumption during pregnancy. Being informed is key to making a good decision.

Danielle Taubman February 19, 2013 at 10:55 pm

Hi, I’m glad you were able to connect with the post. It’s difficult to make health behavior changes and certainly if you have to give up your favorite thing it can be a really big challenge. I’m uncertain about the current research on drinking soft drinks when pregnant (whether they are diet or regular), but I imagine it is healthiest to stop drinking these kinds of beverages when pregnant. As you said, being informed is essential. In my mind, the most important step is informing women about the dangers of frequent drinking during pregnancy. Once this is known, understood, and followed, women can come to their own conclusions about whether they will drink light amounts of alcohol during pregnancy.

Nella February 28, 2013 at 9:14 am

I liked all the pictures that you used. I did not know that you could have a drink when u are pregnant.i had always thought that you can not ever drink when you are pregnant because it is not good for your child. Has there been any other studies on this? #spx9

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