Should Women Drink Alcohol While Pregnant?
Striking numbers of expectant mothers are deciding that there’s nothing wrong with the occasional drink of alcohol. New studies suggest that they may be right, but the medical establishment is hardly convinced.
From the end of Prohibition, in the 1930s, until the early 1970s, moderate drinking while pregnant was both common and unquestioned. In 1973, however, a University of Washington study attributed physical, mental, and developmental birth defects—things like heart murmurs, small heads, and narrow eyes at birth, as well as delayed speech and poor hand-eye coordination later on—to fetal alcohol syndrome, or FAS. It wasn’t long before follow-up studies showed that FAS was actually a very rare outcome related to severe alcoholism, with an estimate of 0.5 to 2 cases per 1,000. But FAS as a notion was transformative, mostly because birth defects as a result of alcohol were viewed as completely preventable, which made continuing to drink not just thoughtless but also reckless and cruel. According to a 1999 report published in the journal Alcohol and Alcoholism, FAS was instrumental in turning excessive drinking in the public’s mind from a moral (and largely private) concern to a public-health concern on par with child neglect and abuse. In our collective consciousness, drinking while pregnant became widely associated with poverty, crime, and mental illness.
Around the time of the surgeon general’s 1981 call to abstinence, state and local governments began implementing point-of-purchase warnings about drinking during pregnancy, and in 1988, the United States became the first country to adopt legislation requiring similar warnings on the labels of beer and alcohol containers. A string of overwrought articles and movies—such as The Broken Cord, based on Michael Dorris’s bestselling 1989 book about the challenges and heartbreak of raising an adopted son who’d been born with FAS—helped fuel the idea that drinking while pregnant wasn’t just potentially dangerous but also immoral. In 1990 Wyoming became the first state to charge a drunk pregnant woman with felony child abuse.
So it’s not surprising that, according to the CDC, alcohol consumption among pregnant women declined throughout the ’80s. After that, though, the numbers began to rise. Some of the shift is doubtless attributable to the fact that researchers to this day cannot definitively say just how much alcohol, at what stage of pregnancy, causes FAS. And some of it probably owes to the fact that studies keep coming out indicating that a drink from time to time while pregnant is safe. Like the one published in June in the International Journal of Obstetrics and Gynaecology that found that up to eight drinks in a week—and as many as five at one time, which seems like an awful lot—did not have significant negative cognitive effect on kids five years later. This study followed an earlier one published in the International Journal of Epidemiology that indicated that not only could pregnant women safely drink a glass of wine or two per week, but that their children would actually perform better three years after birth than those of women who chose not to drink at all. And in Europe (of course), where the perception, at least, is that pregnant women regularly drink and smoke—though, in fact, the official position on drinking in France is abstinence throughout pregnancy—birth-defect rates are lower than those in the U.S.
The truth is, there’s no real proof that low levels of drinking are harmful to a fetus. “The quality of information is not so definitive that it is absolutely clear that drinking in small quantities is going to significantly affect pregnancy outcome,” says Robert Barbieri, the chairman of Obstetrics and Gynecology and Reproductive Biology at Brigham and Women’s Hospital. And, as we know, people like definites. It’s this very absence of actual scientific evidence that drinking is absolutely and without question bad for a baby that has led a lot of very smart, very informed pregnant women to decide that there’s nothing wrong with the occasional drink. Not that the rest of society necessarily agrees.
You don’t have to be a parent yourself to know that modern parenting can seem like a series of unending judgments, from how we conceive to what we eat and do while pregnant, with stops along the way including, but not limited to, birthing, breastfeeding, vaccinating, what our kids eat, where they sleep, how they learn, how much TV they watch, if we marry, or stay married to, the people who helped us conceive them, and if we have them at all.
At 36, and many years after declaring my mother unfit to drive me around in her exaggeratedly smoky car, I’m undecided about having children of my own. My uncertainty has nothing to do with other people’s decisions, and yet I sense that strangers and sometimes friends can feel a bit slighted when I can’t explain what it is about parenthood that doesn’t interest me. I do know my ambivalence is less about my opinion of children and more about knowing myself. I’m not sure I’m particularly well suited to sacrifice. Or to the pressures of parenting-by-comparison, which these days seems impossible to avoid. Having married a man with a child of his own, I believe I have a responsibility to be a thoughtful, caring parental figure and friend to my stepson, and supporter to my husband in his parenting choices. But I also know what it’s like to feel judged, and I’m not sure I want to sign up for more.
“As soon as you’re pregnant, or have a baby, it’s like all bets are off,” says Kara Baskin, a 33-year-old mother of a two-year-old boy. “People can say whatever they want, touch whatever they want, make whatever comments they want.” A few years back, she was at a Starbucks when the barista asked her, “Are you supposed to be having any caffeine when you’re pregnant?” She wasn’t pregnant—it was just the shirt—but of course that didn’t matter. She ran out crying.
Baskin, an Arlington-based writer, eventually did become pregnant. She recalls the time she was eight months in and “enormous,” and was meeting a friend for dinner at Lucky’s Lounge, in Fort Point. While she waited, she ordered a bottle of O’Doul’s, the nonalcoholic beer. Barely two sips in, she noticed the table full of twentysomething women whispering and sending dirty looks her way. Finally, the women signaled for a waitress, who then marched over “as if she were going to arrest me or something,” Baskin says. At the table, however, the waitress got close enough to see that it was a nonalcoholic beverage. “Oh, never mind,” she said to Baskin. “It’s okay. It’s O’Doul’s!” But what if it hadn’t been?