I came across an article yesterday while I was surfing online for some other tidbits of information. It was not just any article. It was an article that gave me a strange visceral reaction. The article to which I am referring is titled “I’m Drinking for Two!” (McClear, 2010), and it shares the opinion of several pregnant women who have elected to partake in alcoholic beverages on an occasional basis. This article goes on to make a comparison between typical practices in the United States, where drinking during pregnancy is not accepted widely, and those in European countries, where occasional drinking during pregnancy is portrayed as being much more commonplace (McClear, 2010).
Ultimately, having read this article, you would assume that pregnant women in the United States are “uptight”, either in their own right or as a result of advice that they have taken from their doctors (McClear, 2010). As I said, this article took me aback and really got me thinking about the effects of alcohol during pregnancy. In the end, I kept coming back to the same question — Why would a pregnant mother take the risk?
Certainly, in thinking about this issue, I personally cannot get past the difficulties that children who are diagnosed with Fetal Alcohol Syndrome (FAS) experience. Although it is clear that not every exposure to alcohol during pregnancy will result in a case of FAS (Streissguth, 1997), the difficulties that occur when FAS is present can be devastating. The problem is that alcohol is so terribly neurodegenerative. As a result, prenatal alcohol exposure has been labeled as the most common cause of mental retardation as well as the leading preventable cause of birth defects in the United States (Papalia, Olds, & Feldman, 2009).
In particular, prenatal exposure to alcohol can cause brain damage that ultimately results in dysfunction in the central nervous system (Streissguth, 1997). Such dysfunction may be evidenced by short attention span, distractibility, hyperactivity, learning difficulties, mental retardation, and a variety of psychiatric symptoms (e.g., mood dysregulation, aggression; Sokol, Delaney-Black, & Nordstrom, 2003). Further, there are also common physical features that tend to occur with FAS, including small eyes and other eye anomalies (e.g., nearsightedness, underdevelopment of the optic nerve), a smooth philtrum, and a thin upper lip as well as a variety of skeletal anomalies (e.g., limitations in certain joint movements; Streissguth, 1997). Given such symptoms, it is no wonder that the American Congress of Obstetricians and Gynecologists (ACOG) takes the stance that no amount of alcohol should be considered safe during pregnancy (ACOG Office of Communications, 2008).
Even with such a strong stance by ACOG, some individuals may argue that there are a number of studies that have examined the outcomes of infants whose mothers drank in moderation during their pregnancies and that find no differences between the infants of mothers who drank and those of mothers who did not. For example, Bakker and colleagues (2010) examined the outcomes of infants born to 7333 women. Based on the report of Bakker and colleagues (2010), 37% of these women continued to consume alcohol during their pregnancies, with most consuming fewer than three drinks per week.
Their findings suggested there were no differences in the growth rates of fetal head circumference, abdominal circumference, or femur length when comparing the infants of mothers who drank and those of mothers who did not. There findings also indicated that there were no consistent associations between mothers’ alcohol consumption and fetal growth characteristics during mid- and late pregnancy. As a result, the overall conclusion of this study was that light to moderate drinking during pregnancy did not adversely affect fetal development (Bakker et al., 2010).
So, there you go — Drinking during pregnancy is not a problem, right? Wrong. The truth is that we really do not know for sure. From a methodological standpoint, the problem with studies similar to the one noted above is that they are correlational in nature. That means that the researchers did not randomly assign the pregnant women to consume different numbers of alcoholic beverages during the course of their pregnancy. In other words, one woman would be randomly put in a group that is assigned to have one alcoholic drink per week, whereas another woman would be randomly put in a group that is assigned to have three alcoholic drinks per week. This random assignment insures that each of the different groups of women are as much alike as possible, except for in the amount of alcohol that they drink. This fact allows for a telling comparison of how different levels of alcohol consumption might really affect infants. Instead, correlational studies collect information on how much pregnant women are drinking (or, at least, what they are willing to report that they are drinking) and make comparisons among these women.
As a result, there may be all kinds of reasons for the outcomes that are depicted in correlational studies. Most importantly, there is no way for us to determine what kind of causal relationship may exist between alcohol consumption during pregnancy and outcomes for infants unless experimental research is completed. Unfortunately, correlational research is not nearly powerful enough to answer these causal questions. From a more practical standpoint, we also do not know when is the wrong time or how much alcohol is the wrong amount to drink during pregnancy (Streissguth, 1997). Certainly, research suggests that the more a pregnant mother drinks, the greater the potential effect (Papalia et al., 2009). However, there is no way to know when someone crosses the line.
So, again, I come back to — Why would a pregnant mother take the risk? I guess that, in the end, each woman will have to make a choice with which she is comfortable. For me, personally, I cannot think of a reason that could persuade me currently to drink during a pregnancy. I will wait for some strong experimental studies to tell me what those reasons might be.
ACOG Office of Communications. (2008, Feb. 6). Alcohol and pregnancy: Know the facts. Retrieved from http://www.acog.org/from_home/publications/press_releases/nr02-06-08-1.cfm.
Bakker, R., Pluimgraaff, L. E., Steegers, E. A. P., Raat, H., Tiemeier, H., Hofman, A., & Jaddoe, V. W. V. (2010). Associations of light and moderate maternal alcohol consumption with fetal growth characteristics in different periods of pregnancy: The Generation R Study. International Journal of Epidemiology, 39, 777-789.
McClear, S. (2010). “I’m drinking for two!”. Retrieved from http://www.nypost.com/f/print/entertainment/drinking_for_two_4t9eZth5K9UykQO0T0Xy7H.
Papalia, D. E., Olds, S. W., & Feldman, R. D. (2009). Human development (Eleventh edition). Boston: McGraw Hill.
Sokol, R. J., Delaney-Black, V., & Nordstrom, B. (2003). Fetal alcohol spectrum disorder. Journal of the American Medical Association, 209, 2996-2999.
Streissguth, A. (1997). Fetal alcohol syndrome: A guide for families and communities. Baltimore: Paul H. Brookes Publishing Co