fetal alcohol syndrome

You’re not evil for craving a beer

My mother isn’t always admiration-worthy but I do have to hand it to her for abstaining from alcohol during her pregnancies. True, it wasn’t the sacrifice for her that it would have been for me; she didn’t suffer delirium tremens or need to be straitjacketed until the 21-day mark—but she did fend off tremendous beer cravings (although she had one or two occasional sneaky sips). After all, going cold turkey on booze is part of the pregnancy deal.

Except that it’s a relatively new deal.

Prior to a 1973 paper in the Lancet, fetal alcohol syndrome was not recognized. If women were counseled to abstain—which historically they often weren’t—the advice was based on common sense rather than scientific data. In other words, it’s simple common sense not to binge-drink, pregnant or not, but pregnancy is such a taxing condition and so replete with nausea that it just makes sense to advise women not to drink excessively.

But is there any historical wisdom we can cite that relates not to the condition of pregnancy but to the fetus? Strangely enough, literature is lacking in connections between alcohol and deleterious effects on the unborn.

You’d think there’d be an abundance. The bible, for instance, is full of dietary/hygienic exhortations and proscriptions, and it certainly doesn’t stint when it comes to limiting women’s behavior, but those cautions that it expresses against drinking pertain mostly to preconception—i.e., the husband’s ability to get it up and keep it up. As far as the resulting pregnancy? Eerily silent on the matter.

Okay, so the bible is a pretty old document. What about more recent literature? Canadian scholar Ernest Abel, author of numerous articles on FAS, has pored through Greek, Roman, and European history, from ancient to recent, and almost no references to a causal connection between liquor and fetal harm.

FAS is present in an estimated 0.02-0.15% of live births, affecting growth, facial and cranial features, structural, neurological, and intellectual development. FAS children exhibit learning difficulties, low impulse control, and an array of cognitive and motor-skill challenges—rendered all the more tragic given the preventability of the condition.

But you’d think, from popular magazine articles, product warning labels, and public service announcements about alcohol, that ONE drink could cause FAS. The accepted mantra is that “we don’t know how many drinks cause FAS”; therefore, pregnant women shouldn’t drink at all. But this seems a little facile. Surely we have some idea?

The problem with information is that simplicity always reigns supreme. It’s far catchier and easier for a magazine to demonize alcohol during pregnancy than it is to wade into a scientific journal for actual data. Data is boring. And if you bother to dig, and find that 18 units of alcohol per week are deleterious to a fetus, then well! How can you write a headline like: “Is your baby at risk? The scary truth about those 18 drinks!”

According to the Royal College of Obstetricians and Gynaecologists (RCOG):

  • No adverse effects on pregnancy outcome have been proven with a consumption of less than 120 gms of alcohol (around 15 units) per week.
  • Consumption of 120 gms (15 units) or more per week has been associated with a reduction in birth weight.
  • Consumption of more than 160 gms (20 units) per week is associated with intellectual impairment in children.

A unit is one 8-gram drink:

  • ½ pint of ordinary strength beer, lager, cider
  • ¼ pint of strong beer or lager
  • 1 small glass of wine
  • 1 single measure of spirits
  • 1 small glass of sherry

Is society incapable of parsing this? Does society consider women so childishly incompetent that it needs to dumb this down from moderate limits to no drinks at all? There are miles of difference between 15 drinks a week and none.

Understandably, many pregnant women might be uncomfortable approaching the 15-drink maximum, and I doubt many pregnant women would even want to. But how did we get to the ad absurdum conclusion that one drink is evil? Where’s the moderation here?

Perhaps the fear is that some pregnant women—you know how they can’t be trusted, with hormones and whatnot—might decide to have 15 drinks all at once. Imagine! I mean, raise your hands—does anyone not realize that would be bad? And if we’re concerned about the few pregnant idiots who might decide to stack their drinks (or take it to the next level and stack two weeks’ worth!), shouldn’t we be worried about them in a more general sense? For instance, they’re probably not eating well either, and then there’s the heroin they’re injecting…

And then there’s the built-in assumption that regardless of what’s proven harmless, complete abstinence is still best. That’s not necessarily true. A British study of over 18,000 households revealed that if a pregnant mother had one or two drinks per week:

  • sons had fewer problems with behavior and hyperactivity
  • daughters had fewer peer-related and/or emotional problems
  • boys had better cognitive abilities than those born to abstainers

The scientific establishment leapt to discredit this study, citing socioeconomic factors (e.g., casual-drinking mothers tended to have higher income/education). These and other variables tend to confound the issue rather than clarify it.

iStockphoto

But what’s troubling is the guilt heaped upon women who have a few drinks here and there before discovering they’re pregnant. Those pregnancies are fraught with worry about the damage potentially done to their developing babies—and that worry is never alleviated by the media. If anything, it’s compounded by a society that is ever-vigilant to ensure that pregnant women abstain 100% from the demon alcohol. It’s patronizing, it’s over-simplified, and it’s unfair.

I’m just a dumb bear without a medical degree, so I’d never tell anyone to drink while pregnant—it’s not my right to do so—but for anyone who’s worried about the one or two drinks consumed before knowing, or feeling guilty for indulging in a Guinness, here are some interesting links:

Mixing medical advice, alcohol and pregnancy

Oxford Journals: Alcohol and Alcoholism—Commentary on the Recommendations of the Royal College of Obstetricians and Gynaecologists Concerning Alcohol Consumption in Pregnancy

Fetal Alcohol Syndrome: “The American Paradox”

Fetal Alcohol Syndrome: The Origins of a Moral Panic

Was the Fetal Alcohol Syndrome Recognized by the Greeks and Romans?

Back off, villagers

My Fellow Inebriates,

If you’ve been following me you know that at one time I had a price tag on me for $10, which covered the cost of two bears—one to go home with the customer, its twin to go to charity. Having acquired an irreversible taste for alcohol in the few weeks I lived at the liquor store, I was determined to fall into the first of these categories—that way I would be certain to go home with people purchasing alcohol. Logical, right?

Yet I failed to be fully logical when I chose my purchasers. (Yes, I chose them—I practically jumped at them.) Sure, they were loading their cart up with hooch, but the woman I’d come to know as my mother looked about 11 months pregnant.

She was 10 days past her due date, in fact, and accompanying my soon-to-be dad on a pre-Christmas booze-shopping trip so the house would be stocked for all the guests they expected that holiday. Little did I know, she’d done everything in her power to persuade Miss P to vacate her uterus before the onslaught of Christmas visitors, but Miss P was determined to remain inside. So there my mum was waddling around the liquor store, hoping some exercise might trigger labor.

My mum was painfully resigned to watching houseguests drink constantly for two weeks while she learned to nurse her new baby or—more dire—continued to jump up and down trying to dislodge Miss P sometime before 2006. Shopping for alcohol was the closest she could hope to come to enjoying alcohol.

So it wasn’t very logical of me to wink at them. If I’d known anything about pregnancy/nursing/parenting, I would not have been lured by the nine bottles of wine, the giant Bailey’s bottle, the magnum of champagne or the 25-year-old whiskey in their shopping cart. I would have waited—logically—for an alcoholic to buy me: someone with obvious jitters, for instance. Not a gravid woman and her clean-cut husband.

But I did wink at them, and next thing you know, they adopted me.

I was reminded of this by a comment from Emily (The Waiting—highly recommended), who, with eight weeks to go until her baby arrives, has already endured months of abstinence from alcohol and is having a very typical pregnant craving (which I have apparently been exacerbating) for BEER. Beer, people! As my mother can corroborate, pregnancy often brings on BAD-ASS cravings for beer, even among women who don’t ordinarily like it. My mother’s been through two full summers pregnant, and in each case she would have sold her soul for a beer.

And there’s almost nothing that makes society more hopping mad than the idea of a pregnant woman drinking.

Even if she’d collected a dozen authoritative medical papers asserting that one drink could not harm a third-trimester fetus, my mother would not have indulged.

Did she have the occasional sip from my dad’s glass? Sure. But only occasionally, and not in public. Because society vilifies women who drink while pregnant. That is, after it patronizes them with zero-tolerance doctrines about fetal alcohol syndrome (FAS).

Take the geezer handing out wine samples at the liquor store the day I was purchased. This man saw my mum heaving herself along near his table and PREEMPTIVELY called out to her: “I’m sorry, ma’am, I can’t give you a sample. I have very strong feelings about pregnant women and alcohol.”

My mum almost smacked him.

First of all, she didn’t want any of his f#cking Dixie-cup plonk.

Second, she hadn’t bellied up to his table so much as filled the entire store with her behemoth tummy. There was no hiding that tummy, and the last thing she had the slightest inclination to do was let fifty other shoppers watch her damage her baby by drinking a thimbleful of cheap pinot noir.

Third, she’d abstained from alcohol for nine months already. And guess what? She’d had a glass of wine on a couple of occasions before discovering her pregnancy, and her doctor had reassured her thoroughly that it was no big deal.

Fourth, it was no one’s effing business.

I was already in the cart at that point and I started getting frightened. Not only had I foolishly chosen family-type people who probably wouldn’t restock their liquor cabinet after Christmas; I was going home with a freaking enraged woman! I clung to the bottles, quivering.

My mother has remembered that old guy’s self-righteous and unsolicited remark verbatim for six years. Rarely has anything antagonized her so much.

Pregnancy is a unique condition in that society tends to put a collective stake in it. Whether they’re grabbing the belly uninvited, advising the gravid what to eat—or denouncing women for simply craving beer—people overstep boundaries around pregnant women. Get knocked up and you become public property.

It’s well established that alcohol and pregnancy don’t mix. Alcohol crosses the placental barrier, causing central nervous system damage, and is the leading cause of intellectual disability in the westernized world. What is not well established is the amount of alcohol that can harm a fetus.

Any OBGYN, unless he/she is a crackpot, will reassure a pregnant patient that the couple of drinks she might have had between conception and implantation cannot affect the fetus, and that fetal alcohol syndrome (FAS) is caused by excessive drinking during pregnancy, not by one drink. The problem is that scientists don’t know exactly what constitutes excessive drinking. There are too many variables to ascertain a cut-off, so doctors advise pregnant patients to avoid alcohol altogether.

There's a world of difference between heavy consumption and moderate consumption. Source: Wikipedia

Society has done a good job shaming women who don’t adopt the zero-tolerance doctrine. The handful of times my mum took a sip of my dad’s beer during her pregnancies, she did so very surreptitiously, knowing judgment was everywhere. Intellectually she knew one sip was fine, but she couldn’t feel good about doing it—and not because of logical health concerns but because she didn’t feel like being condemned.

Despite my expressed awe of women who eschew alcohol, my mother didn’t find it to be a constant hardship. It’s the sort of responsible commitment parents make, and continue to make, over a lifetime. A commitment made from parent to child, within a family.

Which is to say it has nothing to do with the idiot doling out vinegary pinot sips at the liquor store.

Sure, he might argue, it takes a village to raise a child, and he was just being a good villager.

But the thing about the village model is this:

The village is IN YOUR FACE from conception to birth, and then it fucks off. Yes, it royally fucks off and leaves parents to their own devices, trying to figure out parenthood with precious little village wisdom to help. The village is in your face if you want to prevent pregnancy, it’s in your face if you don’t want to continue being pregnant, and it’s in your face if you, pregnant, decide to take a half-glass of champagne during a wedding toast. The village is like an asshole backseat driver that only gives a shit about your child until it surpasses eight pounds.

Statistically a lot of women make bad choices about alcohol during pregnancy. But they make plenty of other bad choices, too, yet the magnifying glass remains stubbornly on their bellies instead of addressing the socioeconomic concerns that lead pregnant women to engage in reckless behavior.

I’m just a bear, and a drunken one at that, and I’ve meandered again. Emily asked me to recommend something for after Bebe comes. I’m going to say Guinness: low alcohol, B vitamins, and an incredibly satisfying sipper (the beer-review wankers would say “sessionable”). I’m not going to say Emily should have a Guinness right now because I’m not a doctor and I have no business dispensing advice. But I bet her doctor would say it’s all right.

After all, doctors used to prescribe Guinness to pregnant women.