What Happens If You Drink Alcohol While Pregnant

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This week, the Centers for Disease Control and Prevention announced a new campaign advising all sexually active women of reproductive age who are not using contraception to avoid alcohol. The logic here, of course, is that these women can become pregnant and any amount of alcohol can harm the fetus.

What Happens If You Drink Alcohol While Pregnant

What Happens If You Drink Alcohol While Pregnant

“The risk is real,” said Anne Schuchat, the CDC’s principal deputy director. “Why risk it?”

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The blow was quick. Critics called the advice puritanical, paternalistic and overly cautious. “It’s the kind of bubblegum thinking that’s turned modern pregnancy into nine months of hilarious paranoia,” Ruth Graham wrote in Slate . And really, really bad was the CDC’s blunt messaging. (Aaron Carroll sums them up nicely.)

One question that hasn’t received nearly as much attention, however, is how solid the science behind the CDC’s advice is. Everyone agrees that heavy drinking during pregnancy can be harmful. But does light or moderate drinking in the early stages of pregnancy have any negative effects? The medical community has not agreed on a safe level of alcohol during pregnancy, so many public health agencies have adopted a zero-risk approach for women to abstain.

Many people are skeptical. Emily Oster’s widely read book, Expecting Better, concludes that there is little evidence that light drinking is harmful. In particular, he wrote, there is little good science to suggest that one to two drinks a week in the first trimester and one drink a day in the second and third trimesters harm babies. Oster’s book, published in 2013, was widely praised by CDC critics.

But this is not really the end of the story. Since Oster’s book was published, new evidence has emerged that has complicated the story — and suggests that even light drinking during pregnancy can have unexpected negative consequences. This is still an area of ​​scientific uncertainty, so let’s move on to the evidence.

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One thing that makes this question difficult is that it can be incredibly difficult to study. For obvious reasons, no research body will give ethical approval for a randomized controlled trial where some pregnant women are told to drink alcohol to see what happens to their babies.

That means a lot of the research we’re left with is observational: scientists look at women who already drink a little or a lot during pregnancy and women who don’t — and then compare their children’s health by measuring IQ at age 8. or behavioral problems or employment levels later in life.

This observation showed that children whose mothers drank little (eg, one glass or less per week) during pregnancy often did better than those who abstained.

What Happens If You Drink Alcohol While Pregnant

But here is the problem. In many countries (including the US), women who drink moderately during pregnancy are more educated and wealthier than those who don’t – factors that affect the intelligence and health of their offspring. Even the best studies cannot fully control for this difference. It is therefore possible that these socioeconomic factors account for any variation in children’s outcomes rather than alcohol itself.

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To overcome the shortcomings of earlier studies, a team of researchers from the University of Bristol in the UK wanted to try a different approach. They conducted an interesting study of pregnant women recruited for a large research program in the Bristol area involving 14,000 families.

Instead of grouping women based on how much they drank during pregnancy, researchers in the 2013 study used a technique known as Mendelian randomization. This involved grouping pregnant women based on their genetic predisposition to drink – that is, whether they carry a gene variant linked to reduced alcohol consumption as a result of faster alcohol metabolism. In layman’s terms, they wanted to find women who react badly to alcohol and therefore avoid it.

Researchers have found that women who have a low tolerance for alcohol are more likely to abstain or drink less. And, interestingly, their children performed better on IQ tests and measures of school performance than children of women who tolerated alcohol better.

One of the study’s authors, Luisa Zuccolo, explained: “Because of their genotype, these women drink little or nothing at all – and we found that their babies did better on IQ tests and school performance.”

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In another 2012 study, researchers came to a similar conclusion. They studied genetic variants associated with alcohol metabolism in more than 4,000 children. Children with the genetic mutations—and who came from mothers who drank 1 to six units of alcohol per week—actually had lower IQs (about 2 IQ points per genetic variant) than those who didn’t. Researchers say this suggests that even moderate amounts of alcohol during pregnancy can affect a child’s future intelligence.

“So far, people have not been able to conclusively prove that very low levels of alcohol are harmful,” said Bristol-based genetic epidemiologist Sarah Lewis, lead author of the study. “But using new techniques, more and more research suggests that even lower levels can have an effect.”

The researchers behind these studies noted that more research is needed on this issue to know if their results are real. Still, this study points to potential genetic components that may make some children vulnerable to even small amounts of alcohol.

What Happens If You Drink Alcohol While Pregnant

The new research is part of Britain’s chief medical officer’s release of new drinking guidelines in early January, which suggest pregnant women should abstain completely. (Previous UK guidelines suggested that light alcohol during pregnancy was fine.)

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These studies are relatively new. They need to be replicated in different settings and populations to see if the findings hold true. “This seems like a space where replication is key,” Emily Oster wrote in an email. “I hope these authors plan to do more with these genetic links to try to get to the details of this relationship.”

The UK decision was based on the precautionary principle. It can’t be said with certainty that a little drink is harmful, but there is some evidence that it can. Out of an abundance of caution, the United Kingdom has suggested that women simply avoid drinking during pregnancy.

It is also important to note that the effects found by the researchers in these new studies were not large. No one is suggesting that one drink during pregnancy will cause fetal alcohol syndrome or severely lower IQ. At best, the research suggests that examining drinking in pregnancy in new ways — based on genetic predisposition — could reveal subtle differences that no one had noticed before.

Much is still unknown about the effects of alcohol on the fetus – for example, why some women can drink heavily during pregnancy with little effect on their children, while others can’t. But so far, most evidence suggests that light drinking during pregnancy is probably not harmful. However, as evidence develops, this conclusion may change.

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A major supplier of America’s only abortion pill has said it will not distribute the drug in 31 states, for some the thought of drinking while pregnant is too much to bear. However, many women believe that it may not be as dangerous as we are told. Moreover, many women struggle with alcohol use disorders during pregnancy, which adds another layer of complexity to the problem. After all, it is not about the occasional drink of these women. They may engage in episodes of heavy drinking, which can be significantly dangerous for them and the baby.

For decades, pregnant women have been given a long list of medical recommendations that can sometimes seem like patriarchal prohibitions. Avoid raw fish, don’t eat meat delicacies, don’t do this, don’t do that, – don’t drink.

What Happens If You Drink Alcohol While Pregnant

There is scientific evidence that these activities can have a negative effect on the fetus, but what is always disputed is alcohol. After all, most of our mothers were doing this in the 1960s or earlier, right?

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It was not until 1973 that fetal alcohol syndrome (FAS) was officially recognized after an important article was published in a medical journal. The article’s findings included changes in growth, distinctive facial features, and negative effects on the developing brain, implying that alcohol causes these birth defects.

Later, in 1988, Congress passed the Alcoholic Beverage Labeling Act, which finally added the famous disclaimer.

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