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Is it all right to drink a little during pregnancy?
Gideon Koren, MD, FRCPC Daniella Caprara, MSC Daphne Chan, PHD Sheila Jacobson, MD Kelly Porter
When I told a female patient who just transferred from another city to abstain from alcohol during pregnancy, she was surprised. She mentioned that, in the past, several doctors had told her it was all right to drink moderately. I am confused. Have I missed something?
No, you have not. Women should be advised to abstain from alcohol during pregnancy. There are insufficient data to suggest a safe threshold for fetal alcohol exposure.
Lorsque j'ai dit à l'une de mes nouvelles patientes enceintes, qui vient de déménager d'une autre ville, de s'abstenir de boire de l'alcool durant sa grossesse, elle s'est dite surprise. Elle m'a dit que, par le passé, quelques médecins lui avaient mentionné qu'il n'était pas dommageable de boire modérément. Je suis confus. Ai-je manqué quelque chose?
Non, vous n'avez rien manqué. Il faudrait conseiller aux femmes de s'abstenir de boire de l'alcool durant la grossesse. Les données sont insuffisantes pour déterminer un seuil qui soit sans danger d'exposer le foetus à l'alcool.
It is now almost 40 years since the effect of fetal alcohol exposure was recognized and recorded by Lemoine.1 The fact that fetal alcohol spectrum disorder has been described among children of alcohol-dependent women2 has been misinterpreted by physicians to suggest that mild, occasional drinking is safe.
A safe threshold for maternal alcohol intake has not yet been established, and virtually all medical societies and expert groups addressing this issue strongly recommend abstaining from alcohol during pregnancy. It is, therefore, surprising that Canadian women and many family physicians still believe that women can continue to drink during pregnancy.
A Motherisk study of 99 nonâ€“alcohol-dependent pregnant women in an obstetric ward found that 10 had a few drinks in the second trimester, and 15 had up to two drinks a week during the third trimester, long after they became aware of their pregnancies.3 One author (K.P.), a health worker in a northern Ontario community, has a sobering account of the advice given by family physicians. She polled eight women with children ranging in age from in utero to 7 years (and included her own experience): six were told by their doctors that drinking in moderation was all right. Moderation was not defined in any of these cases. Two reported that their doctors did not mention alcohol at all. Only one was told not to drink any alcohol at all, not even a little bit. It seemed clear that the pervasive attitude in the community and among community physicians was that drinking in moderation is still the accepted standard. One woman said, "I was told it was okay to have a few beers in one night provided I only did this once in a while." Another believed, "Anything is okay as long as itâ€™s done in moderation."
Approving even light drinking is scientifically unfounded and, we believe, unwise from a medico-legal standpoint. About 1% of babies of mothers who drink are born with (mostly undiagnosed) neurobehavioural dysfunction; it will be very difficult for physicians to explain why they advised women that even light drinking was all right when this advice goes against recommendations by virtually all expert groups.
- Lemoine P. The history of alcoholic fetopathies. J FAS Int 2003;1:e2.
- Koren G, Nulman I. The Motherisk guide to diagnosing fetal alcohol spectrum disorder. Toronto, Ont: Hospital for Sick Children; 2002.
- Chan D, Bar Oz B, Pellerin P, Paciorek C, Klein J, Kapur B, et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit 2003;25:271-8.
Motherisk questions are prepared by the Motherisk Team at the Hospital for Sick Children in Toronto, Ont. Dr Koren is Director and Ms Caprara, Ms Chan, Dr Jacobson, and Ms Porter are members of the Motherisk Program. Dr Koren is a Senior Scientist at the Canadian Institutes for Health Research. He holds the Ivey Chair in Molecular Toxicology at the University of Western Ontario.
Published Motherisk Updates are available on the College of Family Physicians of Canada website (www.cfpc.ca).