Last November, The PediaBlog examined an American Academy of Pediatrics report concluding that any consumption of alcohol during pregnancy is ill-advised. The reason is summed up in the report’s first sentence:
Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities.
In order to prevent the birth defects associated with fetal alcohol spectrum disorder (FASD), the AAP made four important points:
▪ During pregnancy:
◦no amount of alcohol intake should be considered safe;
◦there is no safe trimester to drink alcohol;
◦all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and
◦binge drinking poses dose-related risk to the developing fetus.
We considered the compelling statistics regarding the risks women of childbearing age take by consuming even one drink of alcohol, and we asked the obvious question:
Here’s the big problem the AAP’s report highlights: By the time a woman finds out she’s pregnant, many weeks have passed since conception. The best advice would be that any woman of childbearing age should not drink any alcohol if pregnancy is even a remote possibility. But how realistic is that?
Apparently, not very. Last week, the Centers for Disease Control and Prevention announced that birth control, in addition to abstinence from alcohol, would be the most effective way to approach the problem of fetal alcohol spectrum disorders, which are “100% completely preventable”:
Alcohol use during pregnancy can cause fetal alcohol spectrum disorders (FASDs), which are physical, behavioral, and intellectual disabilities that last a lifetime. More than 3 million US women are at risk of exposing their developing baby to alcohol because they are drinking, having sex, and not using birth control to prevent pregnancy. About half of all US pregnancies are unplanned and, even if planned, most women do not know they are pregnant until they are 4-6 weeks into the pregnancy. This means a woman might be drinking and exposing her developing baby to alcohol without knowing it.
David Templeton says the CDC’s recommendations for women of childbearing age to use birth control is based on “overwhelming evidence” that alcohol consumption during any stage of pregnancy, from conception to delivery, puts the fetus at high risk for birth defects:
“An estimated 3.3 million women between the ages of 15 and 44 are at risk of exposing their developing baby to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy,” the CDC Vital Signs report says.
Of every four women who stop using birth control to become pregnant, three continue drinking alcohol, it said, recommending they stop drinking or use birth control to prevent irreversible birth defects in their unborn children.
“Alcohol can permanently harm a developing baby before a woman knows she’s pregnant,” stated Anne Schuchat, CDC principal deputy director. “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking. The risk is real. Why take the chance?”
Olga Khazan thinks she knows the answer:
Why do it? Why is it that whenever public-health officials talk about alcohol, they act like they’re Puritan robots from outer space who could never understand earthlings’ love of distilled spirits. “Why take the risk?” is a naive question. Both men and women drink alcohol because it is extremely fun.
The debate over the risk of drinking while actually pregnant, meanwhile, is as old as time. In recent decades, medical science has taken a much more conservative stance on this issue. Alcohol is considered by most doctors to be a leading cause of preventable birth defects and developmental disorders in the U.S. As one pediatrician put it to me last year, “the very worst thing that a mom could do during pregnancy is drink alcohol.” And women are drinking more in general, so it’s logical that this issue would be on the CDC’s radar.
Julie Beck pushes back on the CDC’s new recommendations:
The American Academy of Pediatrics has taken a hard line on this, saying in October 2015 that “no amount of alcohol intake should be considered safe” at any point in a woman’s pregnancy. Fine. The science of drinking during pregnancy is contradictory and confusing and a “better safe than sorry” approach to official policy is reasonable until the research is clearer. On a policy level.
On an individual level, pregnancy is an exercise in abstinence. Women are told to give up not just alcohol, but caffeine, too. And seafood and lunch meat and soft cheeses. And sometimes, things that are much harder to go without…
I think what gets me is the tone. This report reads as though this is just another good preventative health practice for young women—eat your vegetables, get your pap smear every three years, and don’t drink if you’re fertile. Suddenly it’s not enough that society expects pregnant women to be superhuman models of willpower and sacrifice. This report is holding all women to a higher standard. The language insinuates that your womb is a Schrodinger’s box and you shouldn’t pour alcohol into it unless you’ve peeked in there to be 100 percent sure the coast is clear.
Kaitlin Ahern puts it all in perspective:
On the one hand, this seems a little absurd, as if the CDC is viewing women not as autonomous human beings, but as baby-making machines who must be primed for childbirth at all times. On the other hand, yes, of course, we all want to give our kids (or potential kids) the healthiest start possible. The whole point here is to prevent fetal alcohol disorders, and the less children born with these complications, the better.
The tricky part is that about half of all pregnancies in the United States are unplanned, says Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention. Even if a woman is off birth control because she’s trying to get pregnant, she won’t know there’s a baby brewing for the first month or so—which, if she’s drinking, is enough time to potentially cause harm to the developing fetus. And in fact, according to the CDC, 3 out of 4 women continue to drink while they’re actively trying to conceive.
That last stat is a little shocking. Women are much, much more than baby-making machines. But if you are priming your body for a baby, make sure you aren’t taking that prenatal vitamin with a glass of Pinot.
Family planning applies to all women of childbearing years, including adolescent teenage girls. It empowers women, not men, to be the deciders of when to start becoming sexually active, when to start (and stop) birth control, and when to begin taking steps (like exercising regularly and eating properly, stopping alcohol, tobacco, and drugs, taking a multivitamin with folic acid) to help bring healthy children into this complex and dangerous world. The CDC’s recommendations are a reminder that women, much more than men, have the ability to affect the health and prospects of the next generation in very positive ways. That responsibility begins before conception.