Alcohol

The Pregnant Woman at the Bar

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It's not often that The New York Times deserves praise for being politically incorrect, but today's Dining Out story about drinking during pregnancy certainly qualifies. The writer, Julia Moskin, not only locates physicians who are willing to question the public health establishment's insistence (as reflected in the surgeon general's warning on every bottle of beer, wine, and liquor sold in America) that complete abstinence from alcohol is the only acceptable option for pregnant women. She admits that she herself is pregnant and nevertheless continues to enjoy an occasional glass of wine. Readers who can suppress their urge to call the cops long enough will learn there's no evidence that light to moderate drinking during pregnancy harms the fetus. Fetal alcohol syndrome, which features facial deformities and mental retardation, is found only in the children of heavy drinkers. Does Jane Brody read The New York Times?

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  1. So at what point does light to moderate drinking become heavy drinking?

  2. This notice to pregnant women to quit all alcohol consumption was probably the first “public health crusade” in this new generation of zero tolerance. Almost all of these policies have no data to support it but lead to sweeping public policy laws that simply criminalize a larger portion of Americans.
    It also started the softening up process of the American public that now willing accept, or even insist on, bans affecting every aspect of our lives.
    Interesting to see the 60’s generation that didn’t want government in their bedrooms has decided the best way to govern is to put government everywhere else.

  3. Yuri, my pediatrician and ob/gyns all three set that line at the equivalent of three drinks/ day. (drink = one bottle of beer, standard glass of wine, or cocktail containing 1 oz of distilled liquor.) In other words, unless you’re a real sot, you’re okay. They did warn me that I shouldn’t ever have more than three drinks at a time anyway, but since the smell of alcohol, along with coffee, baking bread (I still don’t get that one) and my secretary’s foul cologne sent me dashing to the nearest concealed place to vomit, it wasn’t really a problem.

  4. “Fetal alcohol syndrome, which features facial deformities and mental retardation, is found only in the children of heavy drinkers.”

    There has been over 30 years of study on the effects of prenatal alcohol and the reason total abstinence is the recommendation is that there has not been any way to establish a safe level of exposure. Genetic susceptibility, timing, nutrition and alcohol exposure all play a role in whether damage occurs due to prenatal alcohol exposure. FAS and other fetal alcohol spectrum disorders can accompany very low levels of alcohol exposure. The annual costs of FAS in the united states has been estimated at 5 billion dollars a year (due to healthcare costs and lost productivity). Fetal alcohol spectrum disorders (of which FAS is only one) are more prevalent than FAS and share similar cognitive and behavioral deficits. Any recommendation other than abstinence is irresponsible.

    “Children do not need to have full FAS to have significant difficulties due to prenatal exposure to alcohol. According to research done by Drs. Joanne L. Gusella and P.A. Fried, even light drinking (average one-quarter ounce of absolute alcohol daily) can have adverse affects on the child’s verbal language and comprehension skills. [Neurobehavioral Toxicology and Teratology, Vol. 6:13-17, 1984] Drs. Mattson and Riley in San Diego have conducted research on the neurology of prenatal exposure to alcohol. Their studies show that children of mothers who drank but who do not have a diagnosis of FAS have many of the same neurological abnormalities as children who have been diagnosed with full FAS. [Neurotoxicology and Teratology, Vol. 16(3):283-289, 1994]”

    http://www.come-over.to/FAS/FASbrain.htm

    More here
    fasdpn.org
    http://fascenter.samhsa.gov/index.cfm

  5. So at what point does light to moderate drinking become heavy drinking?

    My guess is around .1 (point 1) BAC.

  6. The last (and only) baby shower I attended was a gathering of 20 or so physicians and their spouses. The very pregnant woman (also a doctor) had a couple of beers while opening her gifts. She made some offhand remark about the baby being fully baked. Everyone laughed. So, 20 out of 20 doctors agree; a pregnant lady and two beers is funny, not exactly scandalous.

  7. An occasional glass of wine my not hurt anything but the occasional cigarette will kill you!

    So sayeth the Danes.

  8. Mainstream Man:
    You haven’t just bought the bullshit, you bought the bull.

  9. THREADJACK ALERT

    Did anyone see this story? Eight people have been charged with manslaughter in the death of the kid at the Panama City, FL “juvenile boot camp” earlier this year.

    http://www.washingtonpost.com/wp-dyn/content/article/2006/11/28/AR2006112801429.html

    There was a very disturbing Hit and Run thread several years ago in response to a long article about private “boot camps” that parents send their deliquent children to, often outside the US, and the physical abuse that occurred at these camps.

    Please make a thread with a link to the old thread, editors! Thank you very kindly!

  10. http://www.brookespublishing.com/store/books/streissguth-2835/excerpt.htm

    For anyone interested in the basics… this above link is for a nice book chapter.

    A more indepth look can be found here
    http://pubs.niaaa.nih.gov/publications/arh21-3/192.pdf

    Alcoholism: Clinical and Experimental Research
    Volume 20 Page 763 – June 1996
    doi:10.1111/j.1530-0277.1996.tb01684.x
    Volume 20 Issue 4

    Prenatal Alcohol Exposure and Academic Achievement at Age Six: A Nonlinear Fit
    Lidush Goldschmidt1, Gale A. Richardson23, David S. Stoffer4, Diklah Geva56, and Nancy L Day23

    This is a report on the effects of prenatal alcohol exposure on the academic achievement of children at 6 years of age. In this longitudinal study, women were interviewed at the end of each trimester of pregnancy, at delivery, and at 8, 18, 36, and 72 months postpartum. The women were of lower socioeconomic status, high school-educated, and moderate users of alcohol. The offspring received age-appropriate physical and developmental assessments at each follow-up. Linear regression and nonlinear curve fitting were used to investigate the nature and shape of the relationship between prenatal alcohol exposure and achievement. In addition, the role of child IQ in this relationship was explored. Alcohol exposure during the second trimester predicted deficits in each of the three subtests of the Wide Range Achievement Test-Revised (WRAT-R): reading, spelling, and arithmetic. The relationship was partially reduced by the addition of IQ to the model, but prenatal alcohol exposure still predicted significant deficits in achievement, even after controlling for IQ. Tests for the shape of the relationship demonstrated that the effect of prenatal exposure on the arithmetic subtest of the WRAT-R was a linear or dose-response relationship. By contrast, the relationships between prenatal alcohol exposure and performance on the spelling and reading subtests of the WRAT-R were better modeled as threshold effects. The thresholds for both were ?1 drink/day in the second trimester.

  11. “You haven’t just bought the bullshit, you bought the bull.”

    I’m sure Schlitz Malt Liquor is good for babies.

  12. I think we are still missing a very important aspect about the role of drunken pregnant women in society.

  13. “You haven’t just bought the bullshit, you bought the bull.”

    Art, you might consider which of us is buying the bull. I presented a study showing that half a drink a day results in cognitive deficits… another that 1 drink a day results in deficits…

    Neither of these levels are considered to be heavy drinking by anyone I know. Mothers should be informed based on the evidence…and there has never been a study which has been able to demonstrate a safe level of drinking. There have been many that establish that deficits accompany very low levels of prenatal alcohol exposure.

  14. Maternal alcohol consumption even at low levels was adversely related to child behavior; a dose-response relationship was also identified. The effect was observed at average levels of exposure of as low as 1 drink per week. Although effects on mean scores for Externalizing and Aggressive behaviors were observed at low levels of prenatal alcohol exposure, effects on Delinquent behavior and Total Problem Scores were observed at moderate/heavy levels of exposure. Children with any prenatal alcohol exposure were 3.2 times as likely to have Delinquent behavior scores in the clinical range compared with nonexposed children. The relationship between prenatal alcohol exposure and adverse childhood behavior outcome persisted after controlling for other factors associated with adverse behavioral outcomes. Clinicians are often asked by pregnant women if small amounts of alcohol intake are acceptable during pregnancy. These data suggest that no alcohol during pregnancy remains the best medical advice.”

    [Pediatrics Vol. 108 No. 2 August 2001, p. e34]

  15. It’s amazing that the same people that will laugh at creationists’ rejection of scientific evidence will turn around and reject other scientific evidence that doesn’t conform to their own dogma.

  16. For a group who pride reason and science, some folks here are awful quick tothrow someone under a bus in the name a liberty. From the Surgeon General…

    There is no known safe level of alcohol consumption for pregnant women.

    MSM is right on this one, to an extent. The data to establish levels does not exist. So the only safe path for most (as a public health issue) is none at all.

    My wife’s obstetrician, OTOH, recommended an occassional (1-3 a week) glass of wine or bear in the third trimester, but no spirits.

    At that point the baby was generally considered past the point of a problem with FAS. It would also be therapautic and relaxing for my wife in the runup to delivery. Beer also had the added benefit of aiding lactation.

    My youngest son is 3, cute and frightenlingly smart.

  17. MainstreamMan has not yet learned that any attempt to influence public health in a positive manner is really a conspiracy by nanny state liberals and authoritarian conservatives to stop people from having a good time.

  18. Back in the good ol’ days (i.e. before prohibition), German-Americans (and presumably Germans too) brewed a type of beer for pregnant women, similar to beer brewed for children, with low alcohol and lots of nutrients.

    It’s not like beer was invented 20 years ago. Obviously we don’t have scientific studies telling us the exact amount of alcohol that’s safe, and we never will, because anything properly scientific would be insanely unethical, but I would say that common sense would say it’s somewhere above “none”

  19. BMJ 2005;330:375-376 (19 February), doi:10.1136/bmj.330.7488.375

    Low level alcohol consumption and the fetus
    Abstinence from alcohol is the only safe message in pregnancy

    Recently the media in the United Kingdom highlighted the messages presented by one of us (RASM) and researchers from other industrialised countries, that the only safe communication about alcohol consumption in pregnancy is that of abstinence. Unfortunately the scientific basis for this recommendation was not clarified in the media. We provide here examples of the evidence that has led the United States, Canada, Australia, and other countries to adopt the abstinence message.

    Fetal alcohol syndrome was first reported in the international literature by Smith and Jones in 1973.1 Before that, Lemoine published a series of 127 cases in France, highlighting the phenotypic presentation of people exposed to alcohol while pregnant.2 The full syndrome is characterised by a combination of short stature, neurocognitive deficits, and a specific triad of facial dysmorphology (short palpebral fissures, flat philtrum, and thin upper lip vermilion).

    Fetal alcohol spectrum disorder is an overarching term encompassing the behavioural diagnoses occur ring when the prenatal brain has been exposed to the teratogenic effects of alcohol, but the full phenotype of fetal alcohol syndrome has not developed. Fetal alcohol spectrum disorder is difficult to diagnose, but it is possible, with a positive history of alcohol consumption in the mother and neurocognitive deficits with or without the facial features.3

    The neurocognitive deficits in fetal alcohol syndrome and fetal alcohol spectrum disorder are pervasive. They include hyperactivity, impulsivity, difficulties with planning and mental organisation, concrete thinking, visuospatial problems, lack of awareness of social cues, and difficulties understanding the consequences of their own behaviour.4 They can cause immense distress and persistent difficulties for the affected individual. Furthermore, evidence shows overlap and comorbid presentation with conditions such as attention deficit hyperactivity disorder, autism, and personality disorder, requiring skilled clinical differentiation.5

    Over the last 30 years the opinions of professionals working in this area have changed. Previously fetal alcohol syndrome was considered to be a possible consequence of chronic alcohol consumption occurring in specific high risk populations such as the native American tribal groups.1 6 Views later changed to encompass moderate consumption in all populations.6 Evidence from animals and humans now provides confirmation that behavioural changes may be seen even at low doses of alcohol consumption.

    Ikonomidou et al report that exposure of the rat brain to ethanol for a period of hours during a specific developmental stage induces an apoptotic neurodegenerative reaction that deletes large neurones from several developing sites.7 Charness et al report that cell adhesion molecules are inhibited even at exposure to low concentrations of ethanol. These have subsequent effects on neuronal migration, fasciculation, and synaptogenesis, all vital to the developing brain.8

    Sood et al report a prospective study of 501 mother-child dyads in which the child’s behaviour was adversely affected even at low levels of alcohol consumption-as low as one drink per week. They further report that a dose-response relation existed between the level of alcohol consumed and behaviours seen. Children exposed to any level of alcohol, compared with those not exposed, showed 3.2 times greater odds of delinquent behaviour. These relations continued even after other factors were controlled for.9 Knupfer et al argue that because of methodological problems, such as differing classifications of drinking practice and the imprecise definition of what low level consumption meant in early studies, more research is needed before conclusive evidence is available about the dose-response relation.10

    Evidence is currently emerging, but is as yet inconclusive, about the exact dose of alcohol that is safe in pregnancy. The likelihood is that individual differences in alcohol metabolism may protect most women when drinking small quantities. Currently we cannot predict who is and is not at risk.

    A small unpublished study carried out by one of the authors (MAS) at St George’s Hospital in London showed that just under 50% of those attending the teenage antenatal clinic drank more than four units on a single occasion and 27% occasionally got drunk. A further 25% drank at least once a week. Kaskutas and Graves studied alcohol consumption in 321 pregnant women. They found that when self selecting drinks, the size of the drinks was up to 307% greater than standard measures. The authors concluded that risk based on current assumptions might actually be much higher than previously expected.11

    Unlike the position of the department of health-that one to two units a week in pregnancy are safe-the position adopted increasingly in other countries is that no level of alcohol consumption is known to be safe in pregnancy. A health promotion message about a safe amount of alcohol, although designed to protect the pregnant mother and the developing child, can be dangerous as it can be so easily misinterpreted. The uncertain level of individual risk to the developing fetus together with the possibility of misinterpreting a health promotion message mean that the only safe message in pregnancy is abstinence from alcohol.

    Raja A S Mukherjee, honorary lecturer, learning disability psychiatry

    Department of Mental Health, St George’s Hospital Medical School, London SW17 ORE (rmukherj@sghms.ac.uk)

    S Hollins, professor, learning disability psychiatry, Mohammed T Abou-Saleh, reader, addictive behaviour

    Department of Mental Health, St George’s Hospital Medical School, London SW17 ORE

    Jeremy Turk, reader, developmental psychiatry

    Department of Clinical Developmental Sciences

    Competing interests: None declared.

    References

    1. Jones KL, Smith DW. Recognition of the fetal alcohol syndrome in early pregnancy. Lancet 1973;2: 999-1001.[ISI][Medline]
    2. Lemoine P, Harouseau H, Borteryu JT, Menuet JC. Les enfants des parents alcooliques; anomalies observees apropos de 127 cas. Oeust Medical 1968;21: 476-82.
    3. Burd L, Martsolf JT, Klug MG, Kerbeshian J. Diagnosis of FAS: a comparison of the 4-digit diagnostic code: the Institute of Medicine criteria and the fetal alcohol syndrome diagnostic checklist score. Neurotoxicol Teratol 2003;25: 719-24.[CrossRef][ISI][Medline]
    4. Jacobson JL, Jacobson SW. Effects of prenatal alcohol exposure on child development. Alcohol Res Health 2002;26: 282-6.[Medline]
    5. Famy C, Streissguth AP, Unis AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry 1998;155: 552-4.[Abstract/Free Full Text]
    6. Riley EP, Guerri C, Calhoun F, Charness ME, Faroud TM, Li TK, et al. Prenatal alcohol exposure: advancing knowledge through international collaborations. Alcohol Clin Exper Res 2003;27: 118-35.[ISI][Medline]
    7. Ikonomidou C, Bittigau P, Ishimaru MJ, Wozniak DF, Koch C, Genz K, et al. Science 2000;287: 1056-60.[Abstract/Free Full Text]
    8. Charness ME, Safran RM, Perides G. Ethanol inhibits neural cell-cell adhesion. J Biol Chemistry 1994;269: 9304-9.[Abstract/Free Full Text]
    9. Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, et al. Prenatal alcohol exposure and childhood behaviour at age 6-7 years: dose response effect. Paediatrics 2001;108: e34-5.[Abstract/Free Full Text]
    10. Knupfer G. Abstaining for foetal health: the fiction that even light drinking is dangerous. Br J Addict 1991;86: 1063-73.[ISI][Medline]
    11. Kaskutas LA, Graves K. Pre-pregnancy drinking: how drink size affects risk assessment. Addiction 2001;96: 1199-209.[CrossRef][ISI][Medline]

  20. Don’t you guys get it, you can’t fuck with mainstreamman. Everytime you try to throw a punch, mainstreamman just comes back harder and stronger. With a longer post then the one before.

  21. So, deaf people who would intentionally deafen their children so they can participate fully in “deaf culture” are engaging in child abuse, but a pregnant woman who consumes alcohol is not?

    “Maternal alcohol consumption even at low levels was adversely related to child behavior; a dose-response relationship was also identified. The effect was observed at average levels of exposure of as low as 1 drink per week. Although effects on mean scores for Externalizing and Aggressive behaviors were observed at low levels of prenatal alcohol exposure, effects on Delinquent behavior and Total Problem Scores were observed at moderate/heavy levels of exposure. Children with any prenatal alcohol exposure were 3.2 times as likely to have Delinquent behavior scores in the clinical range compared with nonexposed children”

    The above quoted data seems to point conclusively that consuming even small quantities of alcohol can adversely affect fetal brain development which can potentially develop into emotional, psychological and behavioral disorders. It seems to me that intentionally consuming a product that you know MIGHT harm your fetus is as bad as intentionally removing one of a child’s senses so it can be more like its parents.

    I don’t think that a warning label on a bottle of beer is such a bad thing if it spreads a message about the potential damage that can be done to a fetus.

    I agree with the viewpoint that the government should stay out of everyone’s business and let an individual’s education and the market sort the wheat from the chaff…but in this case, I don’t see the why of the hub-bub over a label on a bottle of wine.

  22. “My wife’s obstetrician, OTOH, recommended an occassional (1-3 a week) glass of wine or bear in the third trimester, but no spirits.”

    Trouble with that recommendation is a misunderstanding of the differential impacts of alcohol based on timing. Later exposure has more of an impact on the processes involving myelination. Later exposure is associated with executive functioning deficits.

    “it’s somewhere above “none””

    It is, but it seems to be lower than 1 drink per week.

  23. Mainstream,

    in case you haven’t noticed yet — you’re making a perfect ass out of yourself (to that extent perfection is ever achievable of course)

  24. I guess MainstreamMan and DanT have really shown me who’s boss. Except for all of the actual evidence presented by people who have gone through a pregnancy and have found that an occasional drink has had “no effect whatsoever” on the child. And then there is the fact that if drinking had truly affected pregnancy and humanity we would have ceased to exist as a species a long time ago.
    As Karen pointed out most women want nothing to do with alcohal and other things early in their pregnancy. This is known as inherent species survival. After the second trimester “when the baby is already baked” the inherent risk is nil, unless falling down drunk after a bottle of Jack is in the offering.
    PS: MSM, I have about 10,000 scientific studies that show global warming will doom mankind anyway. So you might as well drink up.
    PPS: DanT, Isn’t it the Libertarians’ job to questions the existing dogma.

  25. But Dan T. has not yet learned the critical distinction between “influence” and “mandate”.
    He might just want to be careful with that…

    On the other hand, he’s a self-confessed troll, so why pay him any mind at all?

    no hugs for thugs,
    Shirley Knott

  26. Fetal alcohol syndrome is just another form of natural selection. There is no need to get all worked up about a few soggy apples. In the end it will probably turn out ok, they dont all have to be gems:)

  27. Doctors just say “no alcohol” to cover their asses. Pure and simple.

  28. But does child-rearing lead to alcoholism?

  29. “After the second trimester “when the baby is already baked” the inherent risk is nil, unless falling down drunk after a bottle of Jack is in the offering.”

    Please provide the evidence you have for that…

    “Except for all of the actual evidence presented by people who have gone through a pregnancy and have found that an occasional drink has had “no effect whatsoever” on the child.”

    We are, of course, supposed to be swayed by anecdotal evidence.

    You seem not to understand the difference between risk and outcome.

    “in case you haven’t noticed yet — you’re making a perfect ass out of yourself (to that extent perfection is ever achievable of course)”

    I’ve never aspired to anything less.

    I wonder why presenting actual information instead of unsupported opinion is considered to be a trait of a perfect ass.

    The article asserted that “learn there’s no evidence that light to moderate drinking during pregnancy harms the fetus. ”

    This is just false. It is nice to assume that recommendations that seem nannyish are not supported by evidence… but sometimes it is the other way around.

  30. Of course a lot of alcohol is worse than a little alcohol which is worse than no alcohol. That is why my wife chose no alcohol. It is simple risk aversion.

  31. I see you guys with all the “data” and statistics are not getting the point.
    This “attempt to influence public health in a positive manner” has led to a massive screening of pregnant women for alcohol, drugs, HIV, depression, all of the current polically correct causes. In many cases the resulting “treatment” is as Shirley pointed out not to influence but is mandated by the state. Many of these “treatments” have proven of dubious help and in many cases cause more harm than the original “problem.” In fact we now live in a world were we justify every intervention into people’s lives as a “public health initiative” to save the children and taxpayers dollars.
    I agree it is not a good thing for there to be drunken pregnant women wandering the streets. But a public health advocate in a women’s womb is far more dangereous to society than a bottle of Bud.
    MSM – Your sure are prolific but maybe you should get your nose out of the books and spend some time running an inner-city health center like some of us.

  32. Art,

    I work directly with the disabled on a daily basis. This means I keep up to date on the research.

    As for your point about force being a counter productive element, you are correct. I would not advocate anything beyond getting the information to mothers. Programs that work to support at-risk mothers and follow up with mothers that have given birth to a child with a fetal alcohol spectrum disorder are far more effective.

    If you indeed run an inner-city health center, you should look into the program model used by the Washington State FAS DPN ( fasdpn.org ) they have demonstrated reductions in incidence through education and follow up programs. The PCAPS program is also very effective.

  33. But without a substantial blood alcohol level, my mom would not have gotten pregnant in the first place. Is it too late for me to sue her for my mental deficits?

  34. MSM
    I actually have a new found respect for you.
    But you are still not getting it. The whole point of Jacob’s article is that zero tolerance policies are bullshit, your own OB/GYN confirmed it, as have many of the people who wrote in to comment. You and your wife chose complete abstinence, and I also assume she gave up coffee, tea and over the counter drugs (more fallacies). That was your choice, but because of these policies many people are no longer given a choice and the rules with which to comply grow exponentially.
    The Telegraph had an article a few days ago that abortions in England are increasing and citing one of the reasons that parenting is just too hard. How come in the most comfortable realm man has ever seen it is to hard to accomplish the most basic of human functions. The suggestion was made that government mandates and intervention into parenting is what made it so hard.
    This isn’t a question of one drink or ten, it is about how far you are willing to let government intervene in the womb.
    Lamar: I actually agree with you for the first time. They do say it just to cover their asses.

  35. Art,

    “The whole point of Jacob’s article is that zero tolerance policies are bullshit”

    There is an important difference between a zero tolerance policy and a recommendation that pregnant women abstain from alcohol. Jacob seems to be missing that point. He makes the additional mistake of spreading disinformation in support of his position. It is important that people make their decisions based on accurate information. The misconception that only heavy drinking during pregnancy is a problem should not be perpetuated no matter what role you think the government has in public health.

    “your own OB/GYN confirmed it”

    As for me and my wife, you are confusing us with madpad and his wife. Their doctor gave them bad advice. The average MD has very little training regarding disabilities and their etiology.

    As someone who works directly in public health, by the way. I would think you would want to have the correct information yourself. I hope you take the time to look at some of the information I linked to above. When a mother comes into your clinic and asks about safe levels of drinking during pregnancy, you can point her to those sources. But please don’t pass along advice like…

    “After the second trimester “when the baby is already baked” the inherent risk is nil, unless falling down drunk after a bottle of Jack is in the offering.”

    It is inaccurate. The woman deserves accurate information.

  36. Jacob,

    Looking back. You may not be confusing a mandate and a recommendation in your post. But it is important to distinguish between things that are motivated by political correctness and those that are motivated by empirical evidence.

  37. I’ve always wondered… if alcohol is safe in the last trimester, but unsafe in the first trimester… how about in the first half hour of pregnancy… Face it, many of us would not even be here, so I’d say it probably is not only safe, but recommended 🙂

  38. Jacob,

    Indeed. I am of the opinion that your mistatement…

    “Readers who can suppress their urge to call the cops long enough will learn there’s no evidence that light to moderate drinking during pregnancy harms the fetus.”

    is worthy of a correction…

    But that is your decision based on your sense of journalistic ethics.

  39. “if alcohol is safe in the last trimester, but unsafe in the first trimester… how about in the first half hour of pregnancy…”

    Measurable negative effects can occur at any time during pregnancy. First hour, first trimester, second trimester, third trimester.

    “Face it, many of us would not even be here…:)”

    This is an accurate statement.

  40. MSM’s ability to produce this much evidence this quickly in refutation of Julia Moskin’s claim is either sheer coincidence (maybe it’s his precise area of expertise) or a frightening, awe-inspiring display of speed-researching (kudos). Either way, it seems that Moskin’s is a pathetic effort at journalism. That’s the real issue.

    Conclusion once again: never, ever believe anything a newspaper reporter writes about science.

    Or economics. Or business. Or the arts or politics. Maybe some sports.

  41. MSM:
    Your right. Now let’s go to the end of your logic. Parents are just bad for children. Until we have perfected the artificial womb no procreating will be allowed. This will protect the m from alcohol, drugs, AIDs, STDs and organic food. (Sorry to jump to the nuclear option but this string is getting old)
    JeffS: No matter how large the quantity of bullshit, it is still bullshit.

  42. Art,

    Wow.
    How do you get that from my logic.
    I would say the most important protective factor for children is a loving parent. With that they can deal with almost any adversity.

    I do, however, find it troubling that you see well designed research as bullshit. Really. You work in public health, and you want to pretend that providing accurate scientifically based information to women it the wrong way to go? I am very confused by your position.

    JeffS.
    It is very close to my area of expertise. As it is for anyone who works with children with disabilities. Prenatal alcohol exposure is the single largest preventable cause of developmental disabilities and mental retardation. Prevention is the best approach to any public health problem. Prevention requires accurate information be given to the public.

  43. Huge thanks to MainstreamMan for setting the record straight! I think the only remaining holdouts now are the ones with their fingers in their ears singing “Mary had a little lamb!”

    As MSM said, the distinction between risk and outcome is key. More research could always vindicate the other side but in the meantime, if you’re drinking during pregnancy you’re stupid (not criminal, just stupid).

  44. Actually isn’t MSM problem is that he is attributing correlation with causality?

  45. “German-Americans (and presumably Germans too) brewed a type of beer for pregnant women, similar to beer brewed for children, with low alcohol and lots of nutrients.”

    They call it Miller, now.

  46. “I agree it is not a good thing for there to be drunken pregnant women wandering the streets. But a public health advocate in a women’s womb is far more dangereous to society than a bottle of Bud.”

    Keep your goddamn hands offa my liver!

  47. Dan I’m real happy that you resolved all those issues but it was hard to hear you with Mary had a little lamb playing in the background.
    MSM I understand you are passionately involved with the disabled and its causes but you need to understand that you are dealing with a defined population. All of your clients have been affected in some way. This creates a bias you internalize.
    This is not the general population and by your own reports FAS affects 5 out of 10,000 children, even among heavy drinkers (8 or more drinks per day)according to Abel and Sokol the rate is 6%.
    I finally looked through some of your data. The only data that was substantiated was based on heavy drinking in Claren & Streissguth. The zero tolerance reports, such as Gusella and Fried, have no more documentation than passing subjective analysis.
    MSM I have not recomended drinking during pregnancy, but there needs to be some balance in public health.
    What I believe Jacob is trying to say is, A women who wants to have a drink at her baby shower is not a criminal. And if your values say that a loving couple is the best thing a child can have (which I believe) than why would you advocate for policies that would force compliance on the mother and possibly seperation after birth or criminal charges, as has happened.
    PS: All of the research I was able to access you had recomended were non clinical studies whose summaries of zero tolerance were not documented in their findings but extrapolated from the heavy drinking studies. Kinda the way the EPA does their well designed research.
    Prevention is the new politically correct way of solving all of life’s problems. Unfortunatly life doesn’t work that way, people still get sick and in the end most preventative measures are marginal at best.
    If we can reach out to the 8 a day mom we can do some good but it seems we spend most of our time nagging, counseling and coercing the one drink a month mom because it is an easier target.
    Welcome to the crazy world of public health where a sense of humor is not required.

  48. “Actually isn’t MSM problem is that he is attributing correlation with causality?”

    This is often a problem in observational science. There have been many experimentally controlled studies demonstrating the effects of prenatal alcohol on brain development. The case is as good as it gets for a teratogen.

    Art,

    “The only data that was substantiated was based on heavy drinking in Claren & Streissguth.”

    I am not sure what you are using as a metric of “substantiated” in this sentence. When you have many studies that converge on similar results using different methods and populations it is usually considered evidence that the finding is real. If you dig even superficially on this topic you will find that there is evidence from cellular studies, animal studies, retrospective and prospective epidemiological studies that indicate low levels of prenatal alcohol exposure are associated with structural, functional and/or cognitive CNS deficits. The trend after 30 years of research is that the impact of prenatal alcohol exposure is apparent even at low doses. The more it is looked into, the more that finding is supported.

    Now what to do with that finding in terms of public health policy is an important question.

    While I agree with you that you should concentrate your efforts on the high risk mothers, there is no reason to send the message to everyone else that low levels of alcohol exposure are safe. If you are going to base your recommendations on the science, there isn’t good evidence for saying…”a few drinks are okay.”

    Even Abel (in the NYT article) points out that “a binge can be as few as two drinks, drunk in rapid succession, or as many as 14, depending on a woman’s physiology.”

    Given the difficulty in defining the risky versus safe behavior any more specificially than “drinking during pregnancy puts your child at risk,” why default with the assumption that a particular behavior is safe?

    “And if your values say that a loving couple is the best thing a child can have (which I believe) than why would you advocate for policies that would force compliance on the mother and possibly seperation after birth or criminal charges, as has happened.”

    You are projecting here. I have never advocated such policies. We are talking about what recommendation should be giving to pregnant women… the recommendation that is most supported by the science is…

    Don’t drink while you are pregnant… there is no known safe level of prenatal alcohol exposure.

    “MSM I understand you are passionately involved with the disabled and its causes but you need to understand that you are dealing with a defined population. All of your clients have been affected in some way. This creates a bias you internalize.”

    There is little in this statement that impacts the larger public health issues. As I pointed out earlier… FAS costs us all around 5 billion dollars a year in the US by the best current estimate. FAS accounts for about 10 percent of the disorders associated with prenatal alcohol exposure. These other disorders share a similar range of functional deficits. This means that when you take into account the lost productivity and excess health care costs we are looking at figures many times that 5 billion dollar figure just in the US. Reducing this social cost is certainly a reasonable public health goal. This can be most effectively done by prevention. The best method for prevention in this arena is information for moms. The best information converges on a nice simple easy to implement message…

    “Don’t drink while you are pregnant.”

  49. All of us are going to die, and some of us are going to have stupid kids no matter what we do. Pour me another drink. Got a match?

  50. “but extrapolated from the heavy drinking studies.”

    I don’t know which studies you were able to access, but as an example

    Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, et al. Prenatal alcohol exposure and childhood behaviour at age 6-7 years: dose response effect. Paediatrics 2001;108: e34-5.

    alcohol was measured every two weeks in this prospective study…

    This is the study I posted results from at 12:02 above.

  51. I don’t think I have a big problem with the expectant mother who has a beer or a glass of wine now and then.

    But can I rant for a minute on the businesses that have “FUTURE MOTHER” parking spaces next to the handicap spaces at the store.

    HEY PEOPLE, if (absent actual medically diagnosed complications) there is one group of people who can benefit from lots of physical activity it is pregnant women.

    HEY LADY, you’re eating for two, you need to be exercising for two!!

    I am convinced, having watched the women I have loved, that plenty of exercise in pregnancy will result in, not only, healthier children, but also shorter and less painful labor.

  52. MSM
    You have a lot of data but it is just not that good. You have selectively picked not only your studies but especially your predetermined outcomes. I am sorry to say but your goal of educating the public is hidden by your firmly held belief that they are too stupid to know any better.
    You are not in the busines of public health but have joined that ever growing group of absolutist activists that believe there is only one “truth” and one solution, which never truly takes on the issue and creates more problems than it solves.
    Enjoy your life in self remorse.

  53. Art,

    You are quite mistaken.

    The information presented here was picked to refute the statement

    “There is no evidence…”

    As such, any presentation of evidence is valid. If I had time to do a carefully designed meta-analysis, I would publish it in a peer-reviewed journal, not on a political blog.
    As far as whether I came to my conclusion based on predetermined beliefs… this is inaccurate. I came to the conclusion based on reading a lot more of this research than is presented here. I read it as skeptically as I would any other research. If you want me on your side on a “don’t panic” public health issue, I’ll help you argue against those that suggest vaccinations lead to autism, or that the best response to the increase in diabetes is to ban corn syrup. In the case of prenatal alcohol exposure, however, there is very strong evidence, even at low dosage. Should I assume that you are coming to the conclusion that I am wrong based on your predetermined bias that there is no evidence? You sling a lot of accusations, but haven’t provided a single piece of evidence yourself. Do you think others are too stupid to understand your amazingly subtle point?

    “your firmly held belief that they are too stupid to know any better.”

    You are confusing me with someone else Art. The reason I posted abstracts and citations is because I believe the public is smart enough to read the stuff and make their own decision (nay even you Art, even you). That is the reason I advocate the dissemination of accurate information rather than gut feelings and folk tales.

    “ever growing group of absolutist activists that believe there is only one “truth” and one solution, which never truly takes on the issue and creates more problems than it solves.”

    I don’t think I fit into that category. I work directly on real problems with real people. If you think a public information campaign is creating more problems than it solves, you have a very warped view of the term “problems.” Families dealing with the chronic consequences of FAS and other fetal alcohol spectrum disorders should not have their challenges minimized.

    So since your bring up the balance between effort and outcomes…try this one.

    Effort: no drinking for 9 months
    Outcome: no risk of alcohol related birth defect

    Effort: only a little drinking during pregnancy
    Outcome: some risk of alcohol related birth defect that can include severe chronic behavior and learning problems, attention-impulse control problems and even mental retardation (only a risk, but damned if those consequences don’t suck).

    Which risk equation makes more sense to you?

  54. MSM:

    As you were kind enough to do for us on the previous thread about how drinking and driving is really ok as long as you know in your heart that you are really ok to drive, despite what evidentially supported objective measurements have to say about the matter (loose paraphrase/borderline mischaracterization, whatever), you have brought actual scientific evidence into what was originally a thread driven by ideology. As before, you have not received the props you deserve. So: props to you. Keep it up.

    I don’t believe that a well-respected journal like Neurotoxicology and Teratology has some secret hidden agenda to keep pregnant mothers from enjoying alcohol. I think they put their research out there in a good faith effort to apply the scientific method to obtaining information relevant to developmental health. I think their results are sufficient to refute Jacob’s claim that “there’s no evidence that light to moderate drinking during pregnancy harms the fetus.” I furthermore believe that this evidence deserves a response from Sullum, which it has not received.

    As a quick side, I too am a health professional, and though not in the field of Obstretrics I can say in all confidence that any Obstetrician who claims that up to 3 drinks per day is acceptable during pregnancy is completely off their ass. That would be 21 drinks per week, which far outpaces the maximum healthy number of drinks per week for a non-pregnant woman of normal weight (10 drinks/week in case you are wondering). To state that this level of alcohol intake is safe for the fetus is ludicrous and borders on malpractice. It is fortunate that your natural reaction to alcohol at that time prevented you from taking them at their word.

  55. *

    Thanks for the kind words.

    :~)

    Nice catch on the 3 drinks a day…

  56. Well, if we’re going to be so pissy about what the expectant mom takes into her body, I see no reason why we shouldn’t have similar expectations of the dad in making sure he’s got healthy sperm.

    Ok guys! No smoking! No drinking! Forever!

  57. Excuse me there, * , but you’re claiming that a mere 1 1/2 drinks per day (7 * 1.5 = 10.5) is too much to be healthy? Now who the hell is completely off of their ass?

  58. You have a prospective study, but when its end points are defined by such subjective observations as antisocial behavior, you’re going to need blinding & randomiz’n to convince me. Subject blinding may be problematic, but not out of the question, because people can feel drunk or un-drunk by suggestion independently of alcohol levels.

  59. Robert,

    If’n I recall, you had some randomiz’n. Blinding is all but impossible in this kind of research, but I do believe those that used the validated tool for quantifying social behaviors were blinded to alcohol consumption levels…I’d have to double check.

  60. “I see no reason why we shouldn’t have similar expectations of the dad in making sure he’s got healthy sperm.:”

    I just couldn’t resist on this one…

    “Alcohol consumed by the male can lead to a variety of problems in the reproductive system. Unlike females, whose eggs are all made during pre-birth development, males continuously make sperm throughout their lives. Some studies have shown that alcohol consumed by the male can enter the testicles through the bloodstream. The drug then seems to mutate some characteristics of the sperm. After exposure, they can end up with deformed heads or tails, hindering their mobility. Alcohol could also be transported to the ova via the semen and expose the embryo to levels of this toxicant. In addition, alcohol-affected semen could alter embryo maturation.”

    http://www.fasalaska.com/DadsBirthDefects.html

    For a more technical look…
    http://pubs.niaaa.nih.gov/publications/arh25-4/282-287.htm

  61. MSM
    Alright I give up. We will now replace the reality and outcomes of the actual population with your mouse studies, heavy drinking studies extrapolated to present the researchers bias and let’s not forget that most scientific of research studies the meta-analysis.
    By the way my studies were based on the literature provided by Jacob in his article which I realize was very hard to see from that postion on your high horse.
    You have got to lighten up. People who think like you are the most dangerous obstacle to public health.

  62. Art,

    Now you aren’t even making sense.

    “replace the reality and outcomes of the actual population”

    That would be…? I linked to a couple of epidemiological studies that used actual populations. Are those not good enough for you?

    If you search harder you will find many more (here’s another good place to look for research http://depts.washington.edu/fadu/index.html).

    You seem to think that all research that comes to a different conclusion than you would like is too subjective and biased. Your postings here seem to say that you prefer the anecdotal/expert opinion as evidence (in the NYT article and the posts here).

    “mouse studies…that most scientific of research studies the meta-analysis.”

    I didn’t post any meta-analysis because I am not aware of any that have been completed. FYI, when properly conducted a meta-analysis is the strictest source of evidence. You know that right? And what problem do you have with animal models as a basis for medical research?

    “By the way my studies were based on the literature provided by Jacob”

    My studies? You didn’t present any studies…Literature provided by Jacob?
    If you are referring to the related articles linked in the NYT, you will quickly find information like this…

    “Drinking in the first trimester can lead to facial malformations, while in the second it can interrupt nerve formation in the brain, Dr. West said. During the third, it can kill existing neurons and interfere with nervous system development, he added.”

    “You have got to lighten up. People who think like you are the most dangerous obstacle to public health.”

    I’ve got to lighten up? That’s funny. You are the one that is threatened by a little information that contradicts your preconceived notions. You are the one that runs an “inner-city health center” and yet spout unsupported opinions like “After the second trimester “when the baby is already baked” the inherent risk is nil, unless falling down drunk after a bottle of Jack is in the offering.” You are the one who seems to think that providing accurate recommendations to mothers does more harm than good.

    Look Art, you will need to provide me with counter evidence if you want to convince me that my opinion is incorrect. My position is simple…

    The “politically correct” recommendation to abstain from alcohol during pregnancy is a reasonable, scientifically supported, and wise recommendation to pass along to mothers. To build an argument against that recommendation requires that you demonstrate evidence that low-levels of alcohol exposure are not dangerous. No research that I am aware of has come to that conclusion. There are reasons … it is hard research to conduct. But until it has been done, the best evidence suggests that the recommendation Jacob has labeled as politically correct is, in fact, just a practical recommendation based on the available science facts.

    I think you might need to consider a vacation, or a change of vocation. You’re showing evidence of burn-out (paranoia, irrational thinking, general crankiness).

  63. BTW Art,

    I think you might benefit from some education in evidence-based practice.

    Wikipedia has a little introduction with some decent links at the bottom

    http://en.wikipedia.org/wiki/Evidence-based_medicine

  64. To continue the overkill here…

    Now that I am at work and have quicker access to the better articles. Here is the most informed discussion of the issue of dosage and effect in prenatal exposure that I have read…

    http://ehpnet1.niehs.nih.gov/members/2000/suppl-3/421-428sampson/sampson-full.html

    “As argued above, the answer to the question of whether there are thresholds of exposure should be addressed taking note of biological mechanisms underlying threshold effects, carefully designed low-dose animal studies, and the most comprehensive (multivariate) calibration of alcohol-related brain damage in human studies. The latter provide our best representation of low-dose effects in humans. We do not claim that there is no threshold, but that on the basis of our data… there is no evidence of a threshold.”

  65. Robert,

    FYI.From the Sood et all study Pediatrics Vol. 108 No. 2 August 2001, p. e34

    “All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5% random sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development.”

    It looks like the used the CBCL with the mothers…No formal blinding was possible in this case as mothers knew if they had drinks during pregnancy. They could have done the study using teachers and the CBCL… would have been a better choice. I doubt, however, that mothers knew which alcohol consumption group they fell into given the years between report and child assessment.

    “The CBCL, a parent questionnaire that is applicable to children ages 4 to 16 years, is used widely in the clinical assessment of children’s behavior problems and has been used extensively in research.17 Designed at a fifth-grade reading level, it can be completed in 15 to 20 minutes and consists of 118 specific problem behaviors scored on a 3-category Likert scale. The test-retest reliability of the CBCL problem scores is high (r = .89).”

  66. MSM
    I will hand it to you. You are prolific, detailed, organized and passionately involved in this topic.
    But you are still fanatically wrong. The information in Jacob’s article might not fit your philosophy but it makes a lot more common sense then the information you keep presenting.
    I know you will never take no for an answer on this topic, but consider that I do run a very large and very successful inner city clinic. One of the main reasons we are successful is that we present a large amount of health education to a very eneducated population without being judgmental, absolute or fanatical.
    That is how you reach people and get them to come back. Maybe that’s not how you see the role of a Health Center but I see it as being there for the community when they need help first and them not being afraid or uninterested to access our services. And if we can get them to cut down on the cigs, get tested for TB and actual show up for their prenatal care then we have really moved the population one step further. Preaching to them is contraindicated to these goals.
    And thank you I will be taking a vacation at the end of the month and I appreciate you noticing that I am currently getting over a very bad cold.

  67. Art,

    If it funny how you see my recommendations as being somehow different from presenting “a large amount of health education to a very uneducated population without being judgmental, absolute or fanatical.”

    I have stated several times that this is the best course. But the information you present needs to be accurate whether or not if passes your “common sense” filter. Anecdote and expert opinion do not provide a good basis for making medical recommendations. I don’t see how you can characterize this opinion as “fanatical,” but as long as you do, I am sure that I will not be able to convince you that best practice is based on best evidence.

  68. That is

    “I find it funny…”

  69. “Preaching to them is contraindicated to these goals.”

    Of course.

    There is a difference between preaching and educating.

    You know that.

    If you can convince someone to cut down on the cigs without preaching, it should be easy to recommend that they abstain from alcohol while they are pregnant without preaching.

    It goes like this.

    Mom: Does that mean I can’t have even an occasional drink.
    Doctor: I can’t tell you that is okay. We know that even a little drinking puts your child at risk. If you do have an occasional drink be sure it is only one, you drink it slow, and you eat something with it. It would be safer to just have a club soda or a non alcoholic beer. The safest way to go is to not drink until after your baby is born.

    I know this may sound like “fanatically wrong” preaching to your ear, but believe me, expectant Moms understand it.

  70. From the Sood et all study Pediatrics Vol. 108 No. 2 August 2001, p. e34

    “All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5% random sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development.”

    It looks like the used the CBCL with the mothers…No formal blinding was possible in this case as mothers knew if they had drinks during pregnancy. They could have done the study using teachers and the CBCL… would have been a better choice. I doubt, however, that mothers knew which alcohol consumption group they fell into given the years between report and child assessment.

    But that’s not the chief problem with asking them. The chief problem is that there could be covariance between some of the judgements the parents would make in answering CBCL questions and the choice of whether and how much to drink. Given that one reason persons drink is in response to anxieties produced by other people’s behavior, I would think that drinkers would estimate as more problematic the behavior of people in their lives than would non-drinkers.

    What would’ve been a useful control would’ve been for them to answer a CBCL about another child of theirs, during which pregnancy (or even better, adoption) their drinking behavior might’ve been different. Next best would’ve been having them fill out a CBCL for an unrelated child they knew. Of course that’s still not as good as having a blinded observer, such as a teacher as you suggested.

    Of course my real problem with this is skepticism that most behavioral problems are in any way a fx of neurology.

  71. Robert,

    Indeed in this type of research everything is correlated to everything else to a degree.

    “Of course my real problem with this is skepticism that most behavioral problems are in any way a fx of neurology.”

    There is, of course, a dynamic developmental interaction between the neurological system and experience. Certainly there are types of damage to the neurological system that change the capacity a child has to learn particular kinds of behavior…as well as other types of damage that make basic monitoring and feedback more problematic. In prenatal alcohol exposure, a common source of structural damage is hypoplasia of the white matter that allows efficient communication between various remote loci in the brain.

    In FASD these seems to result in slow processing which has the potential to create a cascading impact on working memory and executive functioning since inefficient encoding limits the processing capacity needed to multidimensional inputs from the environment that facilitate in the learning of behavioral control.

    It would seem unlikely that all differences in behavior and executive functioning are a completely attributable to differences in experience. Neurology/genetics has to play a role in the ability to benefit from experience.

  72. I seem to have neurological limitations on my typing today…

    “In FASD this…”

    “needed for multidimensional…”

  73. Art,

    I am pretty certain this thread is done.
    But if you check back, I want to make clear that I have respect for anyone working in, or running, an inner city health clinic. I am sure that for the most part your guts on the best way to interact with your client base are accurate. You have wisely advocated targeting the highest risk moms for intervention, have wisely advocated keeping coercive regulations out of the picture, and have wisely advocated a non-judgmental approach to providing healthcare information. You deserve credit for that wisdom.

    We may differ on what we consider the message that should be sent, but we agree on the method of sending that message.

    Just one last point. Another advantage of the abstinence during pregnancy message: simplicity. You don’t have to get into qualified statements. A clear consistent message is usually easier to communicate and more effectively internalized.

    Keep doing good work.

    John

  74. MSM
    Don’t know if you will see this but I hope you do.
    I give you much credit. You have very articulately stated your case and are a tenacious debater who could not be swayed from your beliefs.
    We do disagree on the message and interpretation or selection of the data but there are many health issues out there that I am sure we could agree with, maybe. I am also passionate about helping people for over 30 years and as you can tell do not like it when obstacles get in the way on that pupose. Although I guess one man’s obstacle is another’s truth.
    I can’t believe we kept that string going for two days.

    PS How do you manage to type so fast and so much and actually make sense?

    Art

  75. MSM
    Sorry about the grammar on the last post I spell checked but did not do to good a job of proofreading.

    Have a good weekend.

  76. The last (and only) baby shower I attended was a gathering of 20 or so physicians and their spouses. The very pregnant woman (also a doctor) had a couple of beers while opening her gifts. She made some offhand remark about the baby being fully baked. Everyone laughed. So, 20 out of 20 doctors agree; a pregnant lady and two beers is funny, not exactly scandalous.
    tks for sharing.

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