While some studies have hinted that a little alcohol might be harmless during pregnancy, a leading U.S. pediatricians’ group has issued a new warning that no amount of drinking is safe while pregnant. “The only guarantee of having no effects from alcohol is no prenatal alcohol exposure,” said Dr. Janet Williams, a professor of pediatrics at the University of Texas Health Science Center and coauthor of the new statement and report from the American Academy of Pediatrics (AAP).
It’s likely, she added, that future research will continue to show that “alcohol has subtle yet important lasting effects on academic performance, attention, behavior, cognition, memory, language skills, and visual and motor development.
“Physicians and researchers have been warning about the hazards of alcohol use during pregnancy for decades. Yet almost half of all women of childbearing age in the United States reported consuming alcohol within the past month, the researchers said, and nearly 8 percent of women continue to consume alcohol during pregnancy.
The AAP published its new statement in part to update health workers and the public, Williams said.
According to the new report, published online Oct. 19 in the journal Pediatrics, alcohol use during pregnancy can cause thinking and behavioral problems that last a lifetime. “No amount of alcohol intake should be considered safe,” the report stated, and “there is no safe trimester to drink alcohol.” The report said that all forms of alcohol beer, wine and liquor pose similar risks. Getting quickly drunk, known as binge drinking, poses a higher risk in line with the extra amount of alcohol consumed, the report noted. According to Williams, binge drinking in women is defined as four or more standard drinks, typically within two hours.
Some studies published over the last few years have hinted that a small number of drinks during pregnancy could be safe. For example, research published in 2010 in the Journal of Epidemiology and Community Health found no extra behavioral or thinking risks from having one or two drinks a week. However, “studies do not conclude that alcohol use is safe,” Williams said. Instead, they only show “that in certain study populations under certain conditions, there is or is not sufficient evidence of effect that can be attributable to alcohol exposure.”
Indeed, according to Janni Niclasen, an assistant professor of psychology at the University of Copenhagen who has studied alcohol and pregnancy, “With our current research methods, we will never be able to conclude from human studies whether there is a safe lower level below which drinking is not associated with any harm to the developing fetus.” Of course, many women inadvertently drink alcohol without realizing that they’re pregnant. And alcohol often plays a role in sexual encounters aimed at producing a baby, including those that may occur when a woman doesn’t know she’s pregnant. So, should women of childbearing age always avoid alcohol?
Williams isn’t willing to go that far and would only say that alcohol and pregnancy don’t go together. She added that some women, despite the findings of research, “continue to rationalize that their own alcohol use during pregnancy is sufficiently low or infrequent to be safe.”
Niclasen, the Denmark researcher, said women who are pregnant or trying to become pregnant should avoid all alcohol. “I am often called a moralist for having this perspective, but I think we need to focus on the development and future life of the unborn children,” she said.
Christina Chambers, a professor of pediatrics at the Center for Better Beginnings at the University of California, San Diego, offers this advice: “Women of childbearing age who drink alcohol should consider their pattern of drinking. For example, avoid binge drinking and avoid pregnancy as long as they are drinking.
If pregnancy is planned, then alcohol can be discontinued.” There may be no risk “if a woman has consumed small amounts of alcohol prior to knowing she is pregnant,” she said, but “the best advice is to avoid pregnancy if drinking and to avoid drinking if pregnant.”
According to both Williams and Chambers, alcohol use poses risks in all stages of pregnancy, and neither would say the risk is higher in certain stages. Overall, Chambers said, the AAP’s statement “is an important stand to take, and hopefully it will lead to less stigma associated with (fetal alcohol spectrum disorders) and to more access to and uptake of prevention and treatment services.”
no amount of alcohol should be considered safe to drink during any trimester of pregnancy,” wrote the the American Academy of Pediatrics in a report which identified ingesting alcohol during pregnancy as the leading cause of preventable birth defects. “There is no safe amount, no safe time, and no safe type of alcohol to drink during pregnancy. It’s just not worth the risk,” said Dr. Cheryl Tan, an epidemiologist at the CDC.
The literature linking the dangers of alcohol during pregnancy is vast and extensive. It’s also very confusing. Drinking alcohol while pregnant can cause all sorts of complications like fetal alcohol spectrum disorder, a group of conditions causing different abnormalities.
One study cited by the pediatricians suggests the risk of having a baby with growth retardation increases even if a woman has just one alcoholic drink a day. Mothers who drunk during pregnancy were more likely to have kids with neurodevelopment issues such as troubles with abstract reasoning, information processing, and attention-deficit/hyperactivity disorder.
“The research suggests that the smartest choice for women who are pregnant is to just abstain from alcohol completely,” said Dr. Janet F. Williams, one of the leading authors of the report from the American Academy of Pediatrics. Now, you might that’s not news. After all we see the government-mandated warnings on alcoholic beverage labels everywhere nowadays. The science, however, isn’t quite clear. While there are a lot of studies that suggest the risk of child abnormalities goes up with alcohol intake, others didn’t reach the same conclusions.
One study published in 2008 found “children born to mothers who drank up to 1–2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of abstinent mothers.” What’s more in a fit of irony, the same researchers found boys born to mothers who had up to 1–2 drinks per week or per occasion were less likely to have conduct problems or hyperactivity.
Girls were less likely to have emotional symptoms and peer problems compared with those born to abstainers. And strikingly, boys born to light drinkers had higher cognitive ability test scores. Another study found total abstinence from alcohol during pregnancy was correlated with an increased risk of stillbirth (alcohol inhibits uterine contractions). There are other studies which don’t support the hypothesis that mild drinking is linked to child abnormalities.
Is it that the standards for confounding factors and statistical significance may have been too low? Might be. It’s likelier, however, that these differences in findings can be attributed to the dose. The literature on the subject isn’t very clear on what constitutes “light”, “mild” or “binge” drinking, and most accounts rely on self-reporting which can be inaccurate.
What the American Academy of Pediatrics is doing is staying on the safe side, considering that this is the most ethical position available. According to the report, 10% of women regularly ingest alcoholic beverages and 3% say they consume more varied drinks on marked occasions. In an effort to once and for all put a rest to any debate about drinking during pregnancy, the American Academy of Pediatrics has put out a clear message: Don’t do it. Ever. At all. Not even a tiny bit.
“No amount of alcohol should be considered safe to drink during any trimester of pregnancy,” the group wrote. The group released a report Monday identifying prenatal exposure to alcohol as the leading preventable cause of birth defects, as well as cognitive problems later in life.
Health authorities in nearly every other country also advise pregnant women unequivocally not to drink, according to the International Alliance for Responsible Drinking. Italy and the United Kingdom are two exceptions.
While authorities there instruct pregnant women not to drink, they say if women do choose to imbibe, they should limit it to about one drink, once or twice a week. In the United States, the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention also advise pregnant women to abstain from alcohol.
“There is no safe amount, no safe time, and no safe type of alcohol to drink during pregnancy. It’s just not worth the risk,” said Dr. Cheryl Tan, an epidemiologist at the CDC.
Drinking alcohol during pregnancy increases the risk the baby could have myriad problems, including trouble with hearing and vision, and with the heart, bones and kidneys. Children of mothers who drank while pregnant were also more likely to have neurodevelopment issues such as troubles with abstract reasoning, information processing, and attention-deficit/hyperactivity disorder.
Women who drank in their first trimester were 12 times more likely to have a child with these issues, compared to women who didn’t drink at all. First- and second-trimester drinking increased the risk 61 times, and women who drank during all trimesters increased the risk by a factor of 65.
Previous studies in animals and humans have shown that alcohol exposure is related to a decrease in the size of the cerebellum, a part of the brain, according to Rajesh Miranda, associate professor of neuroscience and therapeutics at Texas A&M Health Science Center.
Over the years, some studies have found that a moderate amount of drinking during pregnancy is not linked to cognitive or behavioral issues. A 2010 study found that children of mothers who drank one or two glasses of alcohol a week while pregnant had no problems with behavioral or intellectual development by the time they turned 5.
A study three years later found that the children of mothers who drank three to seven glasses of alcohol a week did not have trouble with balance tasks at age 10, a sign of neurological development. But doctors warn that even if these studies are accurate, every baby and mother will react differently to alcohol, and so the safest thing is to not drink at all.
The research suggests that the smartest choice for women who are pregnant is to just abstain from alcohol completely,” said Dr. Janet F. Williams, one of the leading authors of the report from the American Academy of Pediatrics.
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