5 Things You Need To Know About Drinking & Pregnancy

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All summer, rumors swirled that Beyoncé was pregnant again — until she posted an Instagram of herself sipping bubbly in September. “Drinking alcohol is obviously a big no-no when you’re pregnant, and with a glass of champagne in hand, Bey’s making it clear that she’s definitely not with child,” reported Hollywood Life.

And that’s that, right? Pregnancy means not one single drop of booze. Our collective American attitude seems to be — she’s holding a glass of champagne, so of course she can’t be pregnant. If she were, she wouldn’t touch the stuff!

The numbers, meanwhile, paint a different picture. According to data from the CDC, one in 10 pregnant women reported “alcohol use,” defined as at least one drink in the past 30 days. We’ve long known that heavy drinking during pregnancy is linked to fetal alcohol syndrome. But light drinking — one small glass at a New Year’s party, for example — is being embraced by a growing number of pregnant women and their doctors. Click through to find out what we do and don’t know about drinking and pregnancy.

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Illustrated by Tristan Offit.
Heavy Drinking & Pregnancy Don’t Mix
Ample research has shown that drinking to excess while you’re expecting puts your baby at risk of learning problems, behavioral issues, and other maladies. Experts call this fetal alcohol spectrum disorder (FASD), and it affects an estimated 40,000 infants each year. On the severe end is fetal alcohol syndrome (FAS), which is marked by facial features like a flattened upper lip, as well as central nervous problems, including mental retardation. As many as 1.5 infants out of every 1,000 are born with FAS in the U.S., according to the CDC.

Physical deformities are easy to identify, but something like a behavioral or neurocognitive problem can be more difficult to pinpoint, explains Janet Williams, MD, a pediatrician in San Antonio, and former chair of the American Academy of Pediatrics' (AAP) committee on substance abuse. “It takes more subtle testing, and it also takes time — you can’t detect these issues at birth,” she explains. “You have to watch how the child develops and learns.” People don’t always think to ask about exposure to alcohol in utero when they’re diagnosing these problems — so there could be many cases of FASD that go unidentified, Dr. Williams explains.
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Illustrated by Tristan Offit.
Is There A “Safe” Amount Of Alcohol?
For obvious ethical reasons, researchers can’t conduct a classic double-blind study where they give pregnant women different amounts of alcohol and see how their babies turn out. So studies looking at prenatal booze intake usually get their data from questionnaires in which women report on their drinking habits. This is one of the reasons why we can’t determine the precise amount of alcohol that causes FASD. Another reason, of course, is that our bodies don’t behave in exactly the same way. People metabolize alcohol differently, and “each fetus and pregnancy is affected by lots of factors, like genetics and environmental conditions,” Dr. Williams explains.

There’s been some compelling research showing that light drinking during pregnancy isn’t associated with childhood behavioral problems, including a series of papers produced in Denmark and funded by the CDC. But we don’t know for sure if there’s a safe amount of alcohol a pregnant woman can consume. And so, here in America, pregnant women are told to add booze to the long list of substances and experiences to avoid (along with deli meats, hot tubs, and horseback riding). This “better safe than sorry” approach can be very frustrating for women.

“In the U.S., we seem perfectly happy to put lots of restrictions on pregnant women, even when there’s no data to back it up. We tell women, you can’t do this or that — it’s all for the baby,” says Marjorie Greenfield, MD, an ob-gyn in Cleveland and author of The Working Woman’s Pregnancy Book. “We’re basically saying, you don’t have autonomy right now. You’re not allowed to live like a normal person.”
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Illustrated by Tristan Offit.
Why Some Women Drink
Questioning the “better safe than sorry” rules led Emily Oster to write her influential (and controversial) pregnancy book Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong — and What You Really Need to Know, a few years ago. An economist by trade, she pored over the data behind the many warnings given to pregnant women. In the case of drinking alcohol, she concluded that the evidence shows there’s no harm in having two drinks per week in the first trimester, and up to a drink a day in the second and third trimesters. Oster got a lot of heat for this, but her advice is somewhat similar to what’s recommended in other parts of the world. In the U.K., for example, the Royal College of Obstetricians and Gynecologists states that “there is no proven safe amount of alcohol that you can drink during pregnancy” but then says, “it is recommended that you do not drink alcohol during the first three months of pregnancy. Drinking small amounts of alcohol after this time does not appear to be harmful for the unborn baby, but you should not drink more than one or two units, and then not more than once or twice per week.”

In this country, some ob-gyns are now advising their patients that light drinking is probably fine. Anne*, who gave birth to her daughter in June, was told by her doctor that it was okay to have a half a glass of wine occasionally. “I think at one point he said one glass was fine, but I never wanted more than half anyway. I had a few half glasses throughout my pregnancy. Personally, I’ve always felt that anything in moderation is fine.”

Like Anne’s doctor, Dr. Greenfield tells her patients not to worry about having a drink now and then, if that’s what they want to do (she believes it’s a personal decision the mother should make based on her own values). “I don’t think there’s any data saying there’s a reason to be dogmatic about light drinking,” says Dr. Greenfield, who recommends her patients keep it to one or two drinks per week.

Joanna*, who has a 6-year-old daughter and a 7-month-old son, says she drank moderately during both pregnancies. “I would have a couple of glasses of wine here and there. Generally no more than one per week, but I wasn't really strict about it.” She considered the cultural norms of places like Europe and Canada when forming her decision, which she didn’t run by her ob-gyn for approval. “I see doctors as partners in my care, not authorities on my body. I felt comfortable making the choice on my own,” Joanna says.

*Names have been changed
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Illustrated by Tristan Offit.
The Argument For Quitting Booze
Despite — or perhaps because of — the growing number of pregnant women who admit to light drinking, the AAP recently issued a report stating that “there is no safe trimester to drink alcohol” and “no amount of alcohol intake should be considered safe.”

“Here’s how I look at it,” says Dr. Williams, who co-wrote the report. “We know alcohol has some effect on a fetus. There are other factors that can affect the health of your pregnancy that you have no control over — but this is something you can control. It’s about protecting our kids and their intelligence. Do you want to question yourself for the rest of your child’s life?”

This was how Tara, who gave birth to a baby boy in June, approached drinking during her pregnancy. “I completely abstained. For one thing, I felt pretty sick until 20 weeks, so alcohol was the last thing I wanted (I went off tea and coffee, too). I also felt the evidence and advice on drinking while pregnant was conflicting. Some experts advise none at all, others say here and there is okay, and I didn't feel it was worth it.”
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Illustrated by Tristan Offit.
The Bottom Line
“There are a fair amount of studies that show that light drinking is not unsafe. It’s just that nobody knows exactly where the cut off is,” says Dr. Greenfield. So where does that leave an expecting mom? Like a lot of decisions in life — whether or not you climb on the motorcycle, sample the street food, or stay in the Airbnb with no reviews yet — choosing to drink or not drink while pregnant “is in that crux between wanting to live your life and wanting to avoid risk, and we all weigh those decisions differently,” Dr. Greenfield says.

Polling a few people to get their opinions won’t really help because, let’s face it — you can find people who will tell you what you want to hear. “If you want to be told not to drink, talk to someone who works with children with fetal alcohol syndrome. If you want someone to tell you it’s okay, talk to a French obstetrician,” Dr. Greenfield jokes. Dr. Williams agrees. “I’m biased,” she admits. “I’m a pediatrician, and we’re invested in children’s growth and development.” She recommends you give extra weight to guidelines based on consensus. “For example, when the CDC puts together their statements, they have lots of entities contribute. People should lean more toward that advice as opposed to one person’s opinion.”

Ultimately, Dr. Greenfield gives her patients this guidance: “Make this decision based on how you see the world — your tolerance for risk and how much you value autonomy. For some people, it’s why would I bother? For other people, [being able to drink is] important to their sense of well-being and belonging to their community. If you clarify your own values, this decision will become clear to you.”