One drink during pregnancy won’t hurt, will it?

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It’s unlikely most of us consider it safe or socially acceptable for a pregnant woman to smoke cigarettes, yet our attitude to alcohol is vastly different.

Virtually every woman I know had a fairly relaxed approach to alcohol during their pregnancies. An occasional drink was considered no big deal and they are all lucky to have healthy children.

It’s this sort of anecdotal evidence and accepting culture that has made the odd glass of wine at dinner during my own pregnancy feel like a non-issue.

It is of course at odds with the public health message that zero alcohol is the only safe limit. 

Between 60 per cent and 80 per cent of all pregnant women in Australia drink at some point during their pregnancy and doctors vary in their attitudes, with some advising against a sip and others saying that one glass once a week or on a special occasion won’t hurt.

Having a drink during pregnancy doesn’t automatically mean your child develops a disability; Fetal Alcohol Spectrum Disorders (FASD) affects between 1 per cent and 5 per cent of the population. 

“Globally, on meta studies, it looks like about one in 13 babies that are exposed to alcohol during pregnancy develop FASD,” says Louise Gray, executive officer for the National Organisation for Fetal Alcohol Syndrome. “Factors that have a huge impact are a lack of stress, really good nutrition and lifestyle.”

One of the muddying factors around alcohol during pregnancy is our cultural attitude to drinking in general.

“We have a very tolerant attitude to alcohol use in Australia, including at risky levels, and that includes in pregnant women,” says Elizabeth Elliott, a professor in paediatrics and child health at the University of Sydney.

Elliott adds that one of her Phd students did a survey of Australian women’s attitudes to alcohol use in pregnancy. “About 30 per cent of them were quite tolerant of a very pregnant woman getting quite drunk in the pub and said ‘it’s up to them’,” she says.

Another issue is that FASD is hard to diagnose and not always immediately obvious.  

“With folate which was brought in [because it] reduces spina bifida, the outcome is immediate and observable,” Gray says. “With FASD the outcome can take between one and 10 years to be really obvious. It’s an untold havoc that is being wreaked.”

Symptoms of FASD include speech and language delays, learning difficulties, and uncontrollable behaviour (including emotional outbursts and rage) because the myelin sheath on the brain hasn’t formed properly.

One new Australian study also found that even low-level drinking can subtly change the shape of a baby’s face. In the study, “low-level” was defined as two standard drinks in one sitting, or seven standard drinks per week. There has been virtually no research on women who drink less than that; for instance, comparing women who have an occasional single drink or a maximum of one or two drinks a week with women who abstain completely.

It is the lack of evidence along with the ethical issue of conducting alcohol studies in pregnant women that also contributes to the lack of clarity about whether or not the odd drink is OK, says Elliott.

“I think what’s underpinning this is a lack of consistency in the message,” she says. 

“Now, the complexity is we will never establish what a safe level will be. I can reassure people if they’ve had one or two drinks there is likely to be no damage to their baby, but the public health message has to be that the best advice is not to drink because some women who have one or two drinks will have 10 drinks and your genetics and my genetics for metabolising alcohol will be entirely different.”

Age, liver function, body composition and genetics as well as dose and duration also impact the effect of alcohol on our bodies (and our babies).  

“The clear message is we’ve known for centuries that alcohol harms the unborn baby and we know from animal models that sometimes that harm is subtle – visible under the microscope but may not be evident clinically,” Elliott explains.

“The message to the public is we will never do experiments on women to try and establish what is a safe level, and therefore the best advice is to avoid alcohol during a pregnancy or if you’re planning a pregnancy. But it’s highly unlikely one or two drinks has done any harm.” 

Saturday is International FASD Awareness Day.

  • On International FASD Awareness Day, the National Organisation for Fetal Alcohol Spectrum Disorder (NOFASD) challenges all Austraalian men (and anyone supporting a mum-to-be) to go belly-up on alcohol to get #pregnanttogether with the expectant mothers in their lives.
  • Fetal Alcohol Spectrum Disorder,the result of exposure to alcohol in utero, is the leading known cause of developmental disability believed to affect 1 per cent of the population.
  • There are a number of ways to get behind this #PregnantTogether campaign and raise awareness of NOFASD.Join the Thunderclap by pledging a social media post to join in the conversation and help spread the FASD message on September 9. 
  • There will be a number of local events to raise awareness. Find out more here.

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