Women received a familiar directive from the American Academy of Pediatrics on Monday: Don’t drink while pregnant. Not even a little bit. Ever. At all. That’s the message of a new survey to be published in the journal Pediatrics. The message from the paper’s lead author, University of Texas Health Science Center professor of pediatrics Janet Williams, as paraphrased by the Guardian: “[T]here is no known ‘safe’ level of alcohol consumption.”
Those words seem definitive, but they also suggest a more complex truth. The interdiction on light drinking while pregnant is about known unknowns: whether there’s a totally safe level of consumption and what that level might be. It’s not a statement about something that we do know: that alcohol, even the occasional glass of wine, is definitively harmful to a developing fetus.
Roughly 1 in 10 American women drink while pregnant, with college-educated, professional women more likely to do so than other groups. Binge drinking—usually defined as having more than four drinks in a sitting—has long been known to carry a risk of fetal alcohol spectrum disorders, including learning and emotional disabilities as well as physical abnormalities. But many new studies suggest that light drinking is just fine. A series of five papers published by Danish researchers in 2012 found no differences between the 5-year-old children of mothers who had up to eight drinks a week (never bingeing on any single occasion) and those who abstained. Writing for Slate in 2013, economist Emily Oster, author of Expecting Better, highlighted a few other studies, including one that found no behavioral differences in 14-year-olds whose mothers had had up to a drink a day, and one that found the same for test performance and intellectual ability.
These new studies don’t constitute enough information to tell us where, exactly, to draw the line, which could explain why doctors set it at zero. In her much-shared Cosmopolitan piece “Why I Drank While I Was Pregnant,” writer Michelle Ruiz hypothesized that, in our litigious society, OB-GYNs don’t want to be responsible for telling women that the occasional glass of Pinot is fine, even if that’s what they privately believe. It’s also true, as Williams argued in the Guardian, that “we don’t have sensitive enough methods” to detect every minor abnormality that could stem from alcohol use. Since researchers don’t know for sure what they could be missing, she said, “I think it’s a leap in faith to say it’s safe, it’s completely safe.”
The same logic has sometimes been applied to women who take psychiatric drugs. Expecting mothers with histories of bipolar disorder and depression are often advised to stop taking their medications, sometimes with disastrous consequences for their mental health, even though the studies disagree on the risk the drugs pose.
In the case of alcohol, it’s worth pondering why the U.S. medical establishment’s response to uncertainty has been a blanket assertion that no one should drink while pregnant. Other countries seem more comfortable leaving the decision in women’s hands. The most oft-cited example is the United Kingdom, where the Royal College of Obstetricians and Gynecologists has called abstinence the safest option but openly acknowledged that “[s]mall amounts of alcohol during pregnancy have not been shown to be harmful.”
The group National Advocates for Pregnant Women has documented hundreds of cases where women were unconstitutionally arrested for “endangering” their unborn cargo. Some of these women had used illegal drugs, but others were detained for contemplating ending a pregnancy, contemplating self-harm while pregnant, or even, in one case, for accidentally falling down the stairs. Across the country, attacks on pregnant women are increasingly prosecuted according to the rights of the fetus. Drinking while pregnant is a subtler issue—but it seems to give rise to the same set of biases. In her Slate piece, Oster noted that—of all the conventional wisdoms around pregnancy that she addressed in her book—her writing on drinking “garnered the loudest reaction, much of it outrage.”
Some of the arguments levied at Oster, she wrote, were “philosophical”:
People ask, “Why take the risk?” since there is no benefit to the baby. But this ignores the fact that we are always making choices that could carry some risk and have no benefit to the baby. Driving in a car carries some risk to your baby, and your fetus does not benefit from that vacation you took. Or they ask, “Is it so hard to give up drinking for nine months?” The answer is, of course, no, but because you might enjoy the occasional beer, it seems worth at least asking the question about the risks.
It’s not fair to ask women to forego driving, working, and eating junk food because they’re pregnant. Likewise, it’s not necessarily constructive for the American Academy of Pediatrics to simply deliver its two-dimensional decree. Better to give women the complex, contradictory information and trust them to make their own decisions.