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02.05.2016

Ridiculous Recommendations about Wine and Pregnancy

preggo_wine.pngIn news that will be welcomed by women everywhere in America, the only time you should drink a glass of wine is when you're actively taking birth control pills.

Insert sound of needle being pulled off a record here.

Say what?!?! What crackpot organization would suggest something so ridiculous, you ask? Merely the American Center for Disease Control, also known as the CDC.

In a move that is shocking the wine drinking world, not to mention a large portion of the female gender, the CDC is indeed putting its foot down and suggesting contrary to recent scientific studies that any amount of alcohol, regardless of the personal history of the woman, is dangerous to a fetus.

This recommendation is shocking for several reasons. Firstly, it reverses a trend that I have personally been tracking for some time, which is a gradual relaxation of strictures against drinking during pregnancy from a medical research standpoint. Most of the earliest studies about alcohol's effects in pregnancy, and the particular dangers of Fetal Alcohol Spectrum Disorder (formerly known as Fetal Alcohol Syndrome), were conducted on people who were essentially alcoholics. These studies established that moderate to heavy drinking by those with a history of alcohol abuse increased the likelihood of FASD and the various birth defects that accompany this syndrome.

Subsequent studies, as well as analysis of much existing research seemed to rationally suggest that the zero tolerance position historically taken by the American medical establishment, might be extreme and unwarranted.

My own personal experience, and conversations with many peers who have all recently become parents, indicated that OBGYN practitioners in the San Francisco Bay Area all gave similar advice to pregnant moms wondering if a glass of wine with dinner was OK. The answer, overwhelmingly, was yes.

But the recent CDC guidelines suggest that the only time it's safe for a sexually active woman to have a drink is if she's taking the pill.

I'm not a doctor. I'm not a scientist. I'm definitely not qualified to give medical advice, and this article does not constitute and should not be interpreted as advice concerning behaviors that should be the decision of a woman in consultation with her doctor.

But, please. Give me a break. If having a drink was really unsafe for sexually active women, that danger would be manifest in an incredibly high number of births with FASD not only in this country, but around the world. And when I say high, I mean... well, just how many women do you imagine might have had a drink on the evening they conceived, and again sometime between that event and when they found out they were pregnant (a time period that can sometimes be weeks long). That number is unbelievably high.

According to government agencies that track this sort of thing, more than half of adult Americans admit to having consumed alcohol within the past few weeks of being asked the question. And we're a bunch of tee-totalers compared to the rest of the world. 91% of French citizens consume alcohol with some regularity, and that country most certainly does not recommend that its sexually active female population abstain from alcohol. Where is the epidemic of FASD in France?

While I expect the American Medical Association, in a country as litigation-prone as the United States, to drastically err on the side of zero liability, it comes as a surprise to me that the CDC has entered that camp. Maddeningly, the CDC seems to be relying on studies that suffer from the same problems as many previous studies, namely that they can only reliably associate FASD diagnoses with heavy or binge-level consumption of alcohol by the mothers. To wit:

"Approaching significance in the data were that the FASD maternal group reported more first trimester alcohol consumption, were more likely to binge with 5 or more drinks, and reported more drinking days in the past 30 days than controls. Mothers of children who had FASD reported that their husbands/partners consumed significantly more drinks per drinking day during pregnancy, and more paternal binge drinking, although the latter variable only approached significance." (May PA, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics 2014;134:855-66).

To my reading, this study does not, nor do any of the others cited by the CDC, prove the claim that ANY AMOUNT of (responsibly consumed) alcohol during pregnancy significantly increases the likelihood of FASD. It only proves that the more alcohol you drink, the more likely you are to have a kid with FASD. That makes sense, of course, but a correlation between negative outcomes and increased levels of risky behavior is very different than saying a small amount of that behavior constitutes a significant risk.

I'm not a woman. I will never be faced with the choice of whether to drink while pregnant. But I was supportive of my wife in whatever choice she wanted to make when she got pregnant. We found out she was pregnant about 6 weeks after conception, a period of time in which she consumed alcohol at her normal level (1-3 glasses per week). Throughout her pregnancy she chose to have a small glass of wine occasionally with dinner.

Our daughter is fine. And so are the children of dozens of other couples we know who engaged in the same behavior. That doesn't prove anything of course, but it makes me wonder whether the CDC is going just a little bit too far.

Read the full set of guidelines from the CDC. And then tell me what you think.

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