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To Toast, or Not to Toast: The Truth about Social Drinking and Pregnancy

During her pregnancy, Connie Sievers frequently enjoyed a glass of red wine. “Probably as often as every weekend, if we had an event or party to attend,” says Sievers, an Ohio mom of one. Her son is now five years old and healthy. “I was encouraged by a friend from France, who said that French women drink red wine during pregnancy to keep them relaxed. My relatives also weren’t shocked—the older adults had been told by their doctors that drinking red wine during pregnancy was OK.”

Many moderate drinkers may have similar stories. But is the advice they’ve been given about the safety of alcohol in pregnancy accurate—or are they just incredibly lucky?

Probably the latter, says Dr. Mark Mengel, MD, MPH, chair of community and family medicine at Saint Louis University School of Medicine. “As much as all of us would like for there to be, there doesn’t seem to be a safe threshold for alcohol consumption in pregnancy.”

“Generally I think most women know that a large amount of drinking is not good for the baby, but they may not think that they really drink ‘a large amount’,” adds Dr. Mavis Schorn, CNM, director of the nurse-midwifery program at Vanderbilt University. “Somehow it has become accepted that a small amount really doesn’t hurt.”

How Much is too Much?

The truth is, no one knows exactly how much alcohol a pregnant woman can consume safely. What is known is that drinking during pregnancy can cause physical and mental birth defects. Most severe is fetal alcohol syndrome (FAS). People born with FAS suffer from problems such growth deficiencies, facial deformities, and learning disabilities. According to the March of Dimes, FAS is one of the most common known causes of mental retardation.

For every child born with full-blown FAS, as many as ten more may be born with milder degrees of alcohol-related damage. These are often referred to as fetal alcohol effects or fetal alcohol spectrum disorders, says Dr. Diane Ashton, MD, associate medical director of the March of Dimes. “These are kind of partial manifestations of FAS. Sometimes these manifest themselves as learning difficulties, poor school performance, poor impulse control, or problems with organ development.”

FAS was first identified in 1973. In 1981, the US Surgeon General issued an advisory that suggested that pregnant women limit the amount of alcohol that they drink. By now, most women are aware that heavy drinking during pregnancy can harm their baby. However, recent research has found alcohol-related effects resulting from much smaller amounts than were previously thought to be harmful. “Of course, if you drink heavily or binge drink you’re at a greater risk for your baby suffering the adverse effects of alcohol use during pregnancy,” says Dr. Mengel, “but even lower-level drinking has been shown to cause adverse effects.”

In one study, children whose mothers drank as little as once per week during pregnancy were more likely to have behavior problems at six and seven years of age than children of non-drinkers. Another recent study showed that the offspring of rhesus monkeys given the equivalent of one to two drinks per day during pregnancy had permanent changes in their dopamine systems (a component of the central nervous system that helps to regulate many areas of the brain).

Complicating the issue further, different bodies metabolize alcohol in different ways depending on their genetic makeup, says Dr. Ashton. So what might be a safe amount of wine for one pregnant woman could be dangerous for another.

Awareness is Evolving

Cara Stevens is pregnant with her second child, and she’s abstaining from alcohol until after the baby is born. However, she did ask her doctor about it. “The response was, ‘If you are going to drink, a glass here and there is OK, but never more than that’,” says Stevens, of Baton Rouge, Louisiana.

There are still a substantial number of healthcare professionals who tell their pregnant patients that drinking moderately is safe, says Dr. Mengel. He notes that it can take time for practice to catch up with research. “A lot of this work has been done just in the last 10 to 15 years, and even thought it seems like that would make it into practice relatively easily, it doesn’t.”

This may change as US public health officials release new information. In fact, current US Surgeon General Richard Carmoda recently updated the office’s advisory on pregnancy and drinking to say that no amount of alcohol consumption can be considered safe.

“When all these studies show consistently that low-level drinking has some effect—you have to believe it,” says Dr. Mengel. “You just have to believe that there is some risk there. It’s not a huge risk, it is not a big risk, but it is there.”

Making the Decision

Laura Nickelson says passing on the occasional glass of wine or beer wasn’t difficult during her pregnancies. Nickelson, a mom of two in Monroe, Louisiana, is also a psychologist who works with adults with developmental disabilities. “I’ve seen firsthand what drinking during pregnancy can do to a person. I know women who had a drink or two, or more, while they were pregnant, and their children turned out fine; but I personally was never willing to take that chance.”

“The thing about using any drug during pregnancy—and alcohol is essentially a drug—is that we always have to do what’s called a risk/benefit analysis,” says Dr. Joel Evans, MD, director of the Center for Women’s Health in Darien, Connecticut, and author of The Whole Pregnancy Handbook. “What are the risks of using this drug, and do the benefits outweigh the risk? There’s absolutely no health benefit to alcohol, and there are some theoretical risks.”

What If You Drink before You Know?

So, what happens if you find out your pregnant the week after your sister’s wedding or just days after you and your partner indulge in a decadent dinner and drinks, should you be worried? “If a woman takes an occasional drink before she knows she is pregnant, it probably won’t harm her baby,” says the March of Dimes.

Tanya Murphy found herself in such a situation. She learned she was expecting shortly after the holidays. “I drank wine at a Christmas party before I knew I was pregnant,” says Murphy, of Haughton, Louisiana. “I was so concerned that could have caused [my son] some damage.” Murphy’s baby, born the next August, was unharmed by the holiday drink.

The important thing to remember is that once you do know you’re pregnant, it is time to focus on your and your baby-to-be’s health. It’s probably best to skip the champagne and have an extra dessert instead.

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