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11.29.2006

More about Wine and Pregnancy

Drinking while pregnant is a touchy subject no matter how you approach it. Most Americans, understandably, seem to be unable to approach any discussion of it without the strong moralistic bias that underlies so much of our culture. While the majority's point of view on the subject is morally driven, the righteousness of the "common sense" on the issue comes not from some religious conviction, but from an unconsidered, yet zealous acceptance of supposed scientific evidence. In short, everyone knows that "it's dangerous to drink while pregnant because it leads to Fetal Alcohol Syndrome (FAS) and birth defects."

Yet, like so many things that are "common sense" in our culture, this accepted wisdom, is only barely true, as today's article in the New York Times discusses.

Now I've addressed the subject of wine and pregnancy here before on Vinography. And the discussion which ensued was a perfect example of how strongly people feel about this subject.

One of the great things about the Times article is how well it sets out the conflicting points of view. On the one hand, we have folks who point to the experiential evidence of, essentially, the whole nation of France, where women regularly drink and smoke through their pregnancies with statistically no higher rate of FAS than in the US. On the other hand we have the warning labels on bottles of wine, and the strident insistence of many that there are scientific studies which prove that drinking during pregnancy is dangerous to the fetus.

In my opinion the supposed "scientific facts" which are behind everyone's default point of view on the subject don't support the notion that drinking while pregnant is dangerous. Oh sure, there is scientific evidence relating to alcohol and pregnancy, but scientifically it only proves two things:

1. heavy drinking while pregnant is dangerous for every normal person
2. for those with a history of alcoholism, any drinking may be dangerous during pregnancy

As the Times article, as well as the article cited in my previous post on the subject relate, there are no studies which show any increased likelihood of FAS or birth defects in healthy women who occasionally consume alcohol in small quantities during pregnancy. Of course, this doesn't stop anyone from sermonizing about the dangers. Which really has led to a culture of fear in the US.

Thankfully, reports from several of the friends I have who recently had children show that doctors are increasingly not buying the hysteria and are giving sensible advice. For most of my friends, that has amounted to "an occasional single glass of wine with a meal is perfectly fine."

Which is why any pregnant woman who eats at my house gets a wine glass at her table setting. But of course, I live in America, so I'm now forced to say that everything you've just read is my opinion only, and doesn't constitute medical advice, and you should talk to your doctor before eating or drinking anything during pregnancy which might affect your health or the health of your baby.

Read the full article.

Comments (25)

catherine wrote:
11.29.06 at 10:43 PM

Thanks, Alder, for your reasonable, rational post on this topic. I am sick to death of the idiotic frenzy over a pregnant lady and her once a week glass of wine.

Zunki wrote:
11.30.06 at 3:30 AM

Yes, and then there's the folks that gasp when they see a pregnant woman driving. Is there any scientific evidence that shows the dangers of driving for pregnant women (other than the usual ones), or are pregnant women worse drivers? I would think they would be more careful, and hence better drivers.

BrooklynGuy wrote:
11.30.06 at 9:42 AM

My wife is 6.5 months pregnant and she drinks a very small (1-2 ounce) amount of wine with dinner whenever she feels like it. She drank nothing at all during the first trimester though, but that was because she found herself not wanting to drink. She and I both believe that moderation and listening to what her body tells her will lead us in the right direction. Our doctor, by the way, right before we went on a trip to Burgundy 2 weeks ago, told her "For god's sake, drink some wine while you're there."

Ben Bicais wrote:
11.30.06 at 10:53 AM

It's good to here a well reasoned point of view on this topic for a change. The 1980s were horrible for propagating the view that if a lot of something is bad for you, than a small amount must be bad too. As you say, it whips up hysteria, and all rational judgment flies out the window.

kellie wrote:
11.30.06 at 3:53 PM

When I was pregnant with my son 10 years ago, my doctor recommended a glass of wine a day to help stop my contractions. I embraced this advice and found that it did help. I was in the last month of pregnancy. My son was and still is a very healthy boy!

Winesmith wrote:
11.30.06 at 6:41 PM

I have to disagree with the sentiment in this post and from the other comments.

Taking chances with your unborn's life just because the "proof" about the dangers of drinking while pregnant can be put in quotation marks is not smart move.

Sure...we'll hear tales of doctors who sipped wine and Guiness during their pregnancies, but that doesn't mean it's a smart thing to do.

And I think it's absurd and inaccurate to characterize people who don't drink during pregnancy as "zealots" who "buy the hysteria."

Pregancies are already full of unknowns. So why fault expectant parents for taking precautions to give their newborn the best chance at a healthy life?

Alder wrote:
11.30.06 at 8:43 PM

Alan,

Actually, I don't fault anyone for making whatever choice they want about their drinking habits during pregnancy, nor would I ever considering labeling them as anything.

I do think, however, that we live in a culture of fear, and a lot of people's decisions to not drink at all during their pregnancy comes from that fear. I'm criticizing the culture that gives rise to that fear, not the folks who are swept up in it.

The zealots out there are the ones walking up to pregnant women in bars telling them that they're irresponsible mothers who are engangering their babies by drinking some wine. The ones who buy the hysteria are the ones sending me e-mails telling me that I'm killing babies by suggesting that women might be able to drink wine during their pregnancies. That is totally disgusting.

Dr. Vino wrote:
12.01.06 at 9:30 AM

Perhaps the most important question to all the dads out there, new and old, is did YOU stop drinking during the preganancy to show your solidarity if your wife didn't drink?

Alder wrote:
12.01.06 at 9:34 AM

I know many who do. But I hope Ruth would never ask me to do that. :-)

It certainly would put a cramp in my blogging.

Alder

12.03.06 at 1:47 AM

Love the idea that we "Can't be too carefull" when it cones to the unborn. So what are you so protective for? So you can send them off to die in some "concocted for the super rich" war of the future? Or so they can die at 35 from a heart attack brought on by obesity, again brought on by the Non-Smoking freaks who have replaced tobacco with junk food to solve the feelings of insecurity that they have largely contributed to. Thank you Puritans!

Anonymous wrote:
12.03.06 at 7:20 PM

Alder,
It is incongruous to think that any amount of ethanol in pregnancy is safe.Ethanol is a weakly charged molecule that moves easily thru cell membranes,equilibrating between blood and tissues.The effects of drinking depend in part on the amount consumed per unit of body weight;the level is expressed in milligrams or grams of ethanol per deciliter (e.g.,100mg/dL or 0.1000 g/dL). In general ,340 mL (12oz) of beer,115 mL (4oz) of nonfortified wine,and 43 mL (1.5oz)(a shot) of 80 proof beverage each contain approx.,10g of ethanol. Congeners found in alcoholic beverages may include low molecular weight alcohols (e.g., methanol and butanol),aldehydes,esters,histamine,iron,lead,cobalt,phenols,tannins etc.. At least two metabolic routes , each with different optimal concentrations of ethanol result in the metabolism of approx. one drink per hour. The most important is via ADH. The rxn produces acetaldehyde,which is destroyed by ALDH.Each requires NAD as a cofactor and it is the increased ratio of NADH:NAD responsible for the metabolic derangements. The misosomes of the smooth endoplasmic reticulum account for approx. 10 % of ethanol oxidation at high levels. "Legal intoxication is approx. 80-100 mg/dL. Death may occur at 300-400 mg/dL. Heavy drinking during pregnancy results in rapid placental transfer of both ethanol and acetaldehyde, which may have serious consequences for fetal developement. Organogenesis takes place in early first trimester. Fetal alcohol syndrome may result in microcephaly with mental retardation ,atrial and ventricular septal defects,genitourinary abnormalities etc. The specific amount of alcohol and/or exact time of vulnerability have not been defined,thereby making it inadvisable for pregnant women to imbibe.There is no dose relation curve that one may point to in defining the aount resulting in fetal alcohol syndrome although it probably is linear.

In recent years it has been learned that ACE inhibitors (Class of drugs used in high blood pressure and congestive heart failure ) may cause serious congenital abnormalities if used in pregnancy. No medical professional one would argue about discontinuing this medication.

Ethanol is a drug and should be respected.It really doesn't matter ,quote ,unquote "What the French are doing".

Warmest Regards, Robert F. Sweeney ,M.D.,FACC,FACP

Alder wrote:
12.03.06 at 8:42 PM

Bob,

No offense, but I sure as hell hope you don't talk to your patients this way. How on earth could you imagine that anyone without a medical or a biochemistry degree could make sense of that? Or maybe you don't and you're just trying to make things sound scary and complicated?

I'm not a doctor. I'm not a biochemist. Neither are most people. Your advice seems to come down to this: No one has conclusively proven how much alcohol is dangerous or when specifically in the pregnancy it is dangerous, but we do know that "heavy" drinking is dangerous.

So your professional advice is against drinking during pregnancy. But there are other doctors out there who are apparently using the same facts to suggest that a glass of wine once or twice a week is in all likelihood not a big deal.

The point is that since no one has "definitive proof" each person must make their own choice, and in that situation how can you possible discount "what the french are doing" since the only evidence that exists is correlated with "heavy drinking" which does not describe what is being discussed here?

Lenn wrote:
12.04.06 at 4:58 AM

This debate is one that certainly gets people all in a tizzy, doesn't it?

My wife is almost 8 months pregnant and she has, for the most part, abstained during her pregnancy, though she has tasted (and spit) wines with me throughout. Heck, we planned a trip to SF and Sonoma before we knew she was pregnant...she wanted to at least taste the wines!

Personally, I've volunteered to stop drinking (that is, swallowing) wine during Nena's pregnancy, but she thought that was silly. And I've encouraged her to have a 1/4 glass with dinner throughout. For the most part, she's refused, but there have been a couple times when she's enjoyed an ounce or two.

What I find annoying about this whole debate is the people who feel SO strongly on either side that they start throwing words around like "stupid" "irresponsible" "bad mother".

To drink or not during pregnancy is a decision that can only be made on an individual basis. I am of the belief that my wife -- the future mother of my child -- could have a little wine a couple times a week. She chooses not to. But if she did, I'd defend her to those who would blast her for it.

Mind your own business.

Anonymous wrote:
12.04.06 at 4:59 PM

Alder,

That is exactly the point! Ethanol is a very complicated subject.
In patient care it is very important to be specific and to communicate in lay terms easily understandable.

Pregnancy is a exciting process for potential mothers.Medical people should avoid being cavalier in dispensing advise to their patients, based on the best science available.On controversial subjects there are Class I,IIa,IIb,and III recommendations from the various professional organizations to guide us. Class I being the best scientific evidence and Class III being a contraindication to said treatment or subject matter.

Bob

Winediva wrote:
12.05.06 at 12:23 PM

Kudos for a rational approach to a highly sensitized subject. I have avoided having children for many reasons, but the primary of which is my career. I'm too afraid people will freak out when they discover their wine teacher is knocked up. Even though I generally spit during classes and private events; I see the looks pregnant women get at any of my tastings - even if ther're drinking sparkling water. Its unbelievable to me that anyone thinks they have the right to tell anyone else what they can eat or drink. Then again, I live in Chicago where we have made foie gras an illegal substance. Lordy. Makes my beloved city look like a bunch of yahoos.

Mike wrote:
12.05.06 at 4:12 PM

"What the French are doing" is a very relevant statement when discussing this issue. In September I spent a few weeks visiting a friend in Spain. His wife was 6.5 months pregnant at the time and her doctor had told her no clear alcohols and stick to no more than a glass a day with food.

Does anyone remember when U.S. doctors were telling mothers not to breast feed?

jade wrote:
12.06.06 at 10:28 PM

Common sense is the uncommon virtue here. My son is four months old now, and according to the doctor he is very healthy, and in the highest percentages for his height and weight. My wife drank a glass of wine here and there during her pregnancy, probably about two to three glasses per month total.

We chose to think about it like this: the culture here in America is not provide accurate medical advice, it is to avoid getting sued. So there will never be proof that a little wine during pregnancy is okay. There aren't medical announcements that condone anything in particular, due to the "CYA" factor.

And think about how many women through the ages have consumed alcohol during pregnancy without a second thought, and their children came out fine. Before anyone else spits out their pre-conditioned response to this topic, please take a moment to consider these possibilities.

Don wrote:
12.07.06 at 2:40 PM

And let's not forget what started all of this hysteria in the first place.

As I recall, a child was born with birth defects after the mother threw back a fifth of gin a day through her entire pregnancy. She, the mother, sued the distiller because they didn't warn her that sucking down a fifth a day might harm the baby. The really insane thing was that I also recall her winning the suit. Go figure......

LT wrote:
12.30.06 at 10:09 AM

I am pregnant with my second child. I didn't drink at all after I found out I was pregnant with my first child (quite ironically, I discovered that I was pregnant the first time because I had been out with girlfriends and drank several beers and ended up with a sick hangover, something I never got with beer, was a little late and decided to test and VOILA).

However, it is almost New Year's Eve. I'm in my second trimester. I've had every test known to man because I'm over 35 and the baby is fine - just fine and dandy. But I would like to share a glass of champagne with my husband on NY's Eve because of the day and because it's the week of our anniversary.

Should I even tempt it?

I would drink a glass of something - wine, beer, a mixed drink, when I got home from work about two or three times a week - until I found out I was pregnant with this one. I have a high metabolism and rarely get "drunk" because of it.

I can forego the glass of champagne this New Year's, but I'd like to have one if I could.

Decisions, decisions.

Alder wrote:
12.31.06 at 11:20 AM

Lara,

I hope those questions are rhetorical -- and what I mean is that the LAST place you should be coming for medical advice is a blog. Sure, I've got information for you to make your own informed decision, but none of my writing here can or should be considered medical advice in any way shape or form. If you're not sure what you want to do I strongly recommend you ask your doctor / obstetrician for advice.

PJ wrote:
01.08.07 at 2:34 PM

Thank you Alder for your sensible comments on this topic. I'm so tired of the hysteria, fear and anxiety that are imposed on pregnant women. I've got 13 days until our first baby's due date and have abstained from wine until a few days ago. My doctor has advised that the occasional glass of wine would be just fine. In fact, it might just make these last uncomfortable weeks a bit more tolerable. And let me tell you -- she was right.

KT wrote:
09.24.07 at 11:05 AM

I find it crazy that we are discussing wether or not it's ok to have A occassional glass of wine during pregnancy when 98% of all births are medicated using synthetic drugs that are similiar to cocaine and heroin!

Alder wrote:
09.24.07 at 11:12 AM

Well, to be fair... If you're talking about an epidural, you're talking about a "local" anesthetic that is injected into the mother's spinal column, and if any of it gets into the bloodstream of the mother, there's not a lot of time for it to get into the baby's system. And in this case we're talking about a mature baby that is about to be born, not a fetus that is still undergoing development, which is what people are concerned about when they're talking about drinking and pregnancy.

I think it's apples and oranges.

Tiera wrote:
03.05.08 at 10:31 AM

I know this is an old post. but just wanted to say I am currently 17 weeks pregnant and just got back from my OB appt and my doctor told me it is OKAY to drink red wine. Not only 6 oz once a month, but if wanted a glass daily with dinner it was okay, as red wine relaxes the uterus and is actually good for pregnany women. Now this being my third pregnany I wish I had know all this in the past so when others were enjoying a drink I could of had one without freaking out.

rs wrote:
01.13.09 at 3:39 AM

A fact frequently overlooked is that many pregnant women take their first and perhaps 2nd, 3rd, etc. drinks BEFORE they find out they are pregnant. What do the studies show there with re: to FAS?

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