Volume 199 - Issue 11
Advising pregnant women to avoid alcohol
Author: Tracy W Soh
Med J Aust 2013; 199 (11): 757. || doi: 10.5694/mja13.11208
Published online: 16 December 2013
Published online: 16 December 2013
To the Editor: I thank Cameron and colleagues for their timely report,1 particularly in the context of publicity for a new self-help book by economist Emily Oster, which questions advice about avoiding alcohol during pregnancy.2,3 I note with interest that Cameron et al’s study reports that proportionally more of the women who consumed alcohol beyond the first trimester were older and more highly educated.
Oster has ...
To the Editor: I thank Cameron and colleagues for their timely report,1 particularly in the context of publicity for a new self-help book by economist Emily Oster, which questions advice about avoiding alcohol during pregnancy.2,3 I note with interest that Cameron et al’s study reports that proportionally more of the women who consumed alcohol beyond the first trimester were older and more highly educated.
Oster has commented in the media on the lack of randomised controlled trials and poor evidence of causality, even where there is a proven association.2,3 While unsurprising that someone without a health background can misunderstand how evidence is used clinically, it is concerning that responsible health advice is being questioned on this basis. The concept of a clinical trial of a recreational substance (such as alcohol or caffeine) to see if it causes any harm in pregnancy is plainly ridiculous.
Alcohol is a known neurotoxin that crosses the placenta.4 Studies of the effects of alcohol have consistently shown that even intermittent moderate to heavy (binge) drinking during pregnancy increases risks of cognitive and behavioural problems for the child. Although no correlation has been shown between light drinking during pregnancy and developmental problems in the child, methodological inconsistencies between studies limit meta-analysis of combined data.5 A safe level of alcohol consumption in pregnancy has not been established.5,6
Women seek pregnancy information from many sources, and more highly educated women will have access to more information sources. Doctors need to be aware of what information is out there and be willing to counter misinformation when it arises. Consumption of alcohol has no health benefits in pregnancy, so when weighed against known and unknown (but plausible) possible risks, surely the best advice that we can give our patients is to avoid alcohol during pregnancy.
Competing interests
No relevant disclosures.
References
- Cameron CM, Davey TM, Kendall E, et al. Changes in alcohol consumption in pregnant Australian women between 2007 and 2011. Med J Aust 2013; 199: 355-357. CHDGJJJG
- Oster E. The pregnancy studies to take notice of. Essential Baby 2013; 31 Aug. http://www.essentialbaby.com.au/action/printArticle?id=4708242 (accessed Sep 2013).
- Oster E. Take back your pregnancy. Wall Street Journal 2013; Aug 9. http://online.wsj.com/article/SB10001424127887323514404578652091268307904.html (accessed Sep 2013).
- Wattendorf DJ, Muenke M. Fetal alcohol spectrum disorders. Am Fam Physician 2005; 72: 279-285. i1142883
- Flak AL, Su S, Bertrand J, et al. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin Exp Res 2013; 1 Aug [Epub ahead of print]. doi: 10.1111/acer.12214. i1142885
- National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf (accessed Sep 2013).