Fanning the Flames: Advice on Drinking in Pregnancy

The comments on JJ’s recent post on breastfeeding have strayed off-topic to a related and rather interesting question: is it okay for public health advice to be false if it’s perceived to benefit the public? To that end, I bring you the lingering tension between Nice, the Royal College of Obstetrics and Gynaecology, and the Royal College of Midwives; and the poor innocent beer producers forced to take sides.

In 2007, the National Institute of Clinical Excellence (Nice) changed the UK guidelines for advice on drinking during pregnancy.

  • Pre-2007 guidelines: Pregnant women are advised to limit their alcohol intake to no more than 1-2 units of alcohol, once or twice a week.
  • New Guidelines: Pregnant women and women trying to conceive should abstain from alcohol.

You are dying to know the big important new piece of scientific evidence that has prompted this change, aren’t you? Well don’t hold your breath. In fact, there was no new evidence*. So why the change?

Dr Gillian Leng, of Nice, said the advice was tightened partly because of the recognition of the harm excessive drinking was doing in society generally.

So, stop preggos drinking their 5 ounces of wine twice a week, so as to cut down on binge drinking. Makes sense, right? No; no it doesn’t. Let’s try again:

Mervi Jokinen, of the Royal College of Midwives, said: “We are concerned that many women will be unsure about what a unit of alcohol is, and therefore may drink more than the guidelines recommend.”

Does this make sense? Well, only if you’re keen on the idea that policy should be shaped—even bent and falsified—around the needs of that massive underclass of pregnant women who are innumerate. Beer, wine, and spirit bottles are all labelled as to their alcohol content. True, a glass in a pub is not, but if we’re worried about that (surely some innumerate people are nonpregnant, after all), why not change pub labelling, instead of giving deliberately misleading pregnancy advice—ESPECIALLY if your concern, Dr Leng, is binge drinking in society at large.

And what have obstetricians had to say about the change?

… the Royal College of Obstetricians and Gynaecologists said there was no evidence that drinking small amounts did any harm.

Oops. Looks like Doc is not willing to collude**. My heart aches for the poor babies of innumerate pregnant women for whom nothing further could possibly be done, now the two-units cat is out of the bag.

Of course, I could go on and on about this. Instead, I will entertain you with visual evidence of the discord. On the left is the French pictogram that, one by one on a voluntary basis, has become standard labelling for bottled beer in Britain since 2007. And on the right is a new maverick, caution-to-the-wind label from the Freeminer Brewery that has the NERVE, the AUDACITY to assume that its customers—even the pregnant ones—can do basic maths. (Or perhaps: that it’s their duty to print true things on their labels!) How vicious of them!

*Further, in the years leading up to and since 2007, several good studies have been published that support claims of alcohol safety in moderation, even above the 1-2 units once or twice limit.
**In fact, I was pregnant in 2006, and am again now. If anything, Doctors and most midwives seem more intent on letting women know that it’s okay to have a glass of an evening these days. So perhaps there is backlash within the profession.

I think I might be confused about how much a unit is. Hmm. How would I, silly pregnant lady that I am, determine how much a unit is...?...
bad pregnant woman! no no no! shoo!
bad pregnant woman! no no no! shoo!

27 thoughts on “Fanning the Flames: Advice on Drinking in Pregnancy

  1. Lol – I was amused in a grim sort of way when I discovered the no pregnant woman label on a bottle of wine the other day. I wondered why there were no symbols for people with liver problems, heart disease, taking various forms of medication, cystitis, kidney problems, and so on.

  2. I also thought it would be funny if each type of alcohol had a symbol banning the alcohol that is not good to drink with it – e.g., no beer on the wine bottle.

  3. i find it so insulting! it’s not advice; it’s not even a directive. it’s…what…well, like i say, i read it as “no! bad pregnant lady!” a scold, i suppose. i make myself feel better about it by choosing to interpret it as a prohibition against drinking *while standing* while pregnant. i just sit down with my wine and all’s well.

  4. “Don’t drink and drive” is another simplification. Public health messages tend to be simplified. I think the idea is that this gives them more clout, especially with the people who need such messages most.

  5. there’s a difference between simplifying and handing out misinformation. telling pregnant women that small amounts of alcohol are unsafe is the latter.

  6. Hey, maybe that’s why the use the image instead of the words– there’s no lie that way.

  7. true. but it’s so simplified as to be uninformative, if you don’t read it as not making the false claim. what is it telling me? don’t hydrate myself? don’t put my hand on my hip while hydrating myself? don’t wear a pony-tail while up the duff and three sheets? –no wait, no wait: ‘this product does not contain hydrated pregnant women’!

  8. Consider all the women who actually did drink a bit during their pregnancy and had something going on, a miscarriage, some birth defect, perpetual crying kid, too small kid, whatever, and being eaten by guilt over this.
    It is a bloody outrage, really.

    I actually knew this already; I looked into alcohol consumption studies when I was studying physiological psychology. And generally, with adults (women over 21, men over 25, roughly) drinking 1-2 units of alcohol a day is in many ways healthier (like 20% lowered chance on heart failure (see also jender bro’s post at the breastfeeding topic on how to interpret that) than not drinking any at all. As a matter of fact, it showed that if you drank 3-4 units a day, the risk of heart failure lowered with 50%. Also, people with an – according to the WHO – less than moderate intake had significantly diminished chances of developing dementias.
    Alcohol is actually pretty good stuff :D, but the downsides are:
    – not so good for developing brains (generally, non-adults should not drink alcohol at all, not even in moderation)
    – it’s addictive
    – many calories in there
    – negatively affects cerebellum activity (motor coordination)
    – negatively affects judgment
    – it’s expensive
    This is about units of alcohol per day, so 4 units a day, every day absolutely does NOT equal not drinking during the week and downing 28 units in the weekend, because that does have adverse effects on the brain, and the effect on the arteries and heart are grandly diminshed with binge drinking.

    Foetal alcohol syndrome has triggered this whole thing about pregnant women drinking back in the late 60s I think. Pregnant alcohol syndrome develops in the first 4 weeks of gestation. After that, it’s done, it doesn’t get worse or better. That’s tricky, of course, because generally, you don’t KNOW yet that you’re pregnant then. You have to be a pretty heavy boozer to have your foetus develop that though.

    So… cheers elp! to your health and the health of your scion!

  9. going WRONG, not going ON.
    Lysdexia is such fun.

    Oh, and the negative effects on motor coordination and judgment are transient.

  10. 1973, in fact, hippocampa. –FAS, i mean. until the mid-80s, actually, they were using alcohol therapeutically in pregnancy to stave off pre-term labour. women were put on an ethanol drip. one doctor described a ward where this was conducted as a floor full of big belligerent pregnant women who smelled like fruitcakes. apparently one reason it easily fell out of use is that nurses didn’t like having to look after unruly drunk pregnant women. (they were often restrained in their hospital beds.)

    other facts to add to your excellent ones re alcohol:

    -fewer than 5% of *heavy*-drinking pregnant women give birth to babies with any abnormality. in other words, over 95% of babies of serious-alcoholic mothers are totally normal!

    -several studies have shown a strongER correlation between socioeconomic factors and FAS than between FAS and alcohol intake. one 1987 study, which looked at women who had more than 3 drinks per day (i think that would be, what, 6-8/day in unit speak) found that 71% of babies of low-income mothers showed evidence of FAS, compared with *4.5%* of middle-class babies. the socioeconomic differences were also found to be highly correlated with differences in nutritional status during pregnancy.

    -AND FINALLY, leading researchers in placental transfer (i can find at least one name and a link if anyone wants it) are agreed that the amount of alcohol in a glass of beer or wine is too little to get past the liver in quantities sufficient to pass through the placenta. in other words, the occasional drink *doesn’t even reach the fetus*, let alone damage it!

    the only reason i can think of to worry at all about having a glass of wine with dinner is that it’s a lot of empty calories. so, on that front, i wouldn’t have both a glass of wine and a pudding. but otherwise, cheers, fetus!

    (but btw hippocampa, are you sure about your first-4-weeks figure? i don’t think the placenta is even formed at that point, is it? i thought 4 weeks was still in ball-of-cells-doing-simple-cell-division phase…?)

  11. I am pretty sure 4 weeks is what I learnt, though, particularly because all was over and done with before you’d be actually knowing you were pregnant. But heck, since when is memory reliable? :D
    The placenta not being formed yet could be exactly the reason of the detrimental effects, actually.

    When my mom was pregnant of me at the eve of the seventies, she got admonished for drinking wine at some point, and although she is (and was then) a qualified neonatal nurse. Since I was number three, and before she hadn’t been confronted with it, I assumed this issue came in vogue around that time.

    The fruitcake story is amazing! And to be honest, also very demeaning to pregnant women.
    Man, what were they thinking of?

  12. demeaning, do you think? does it help if i explain that american fruitcake smells strongly of cheap booze? so, i think what the doctor was saying was that they were pumping so much ethanol into these women that their bodies actually stank of booze. oh wait, maybe you mean that restraining belligerent pregnant women was demeaning. yes, indeed!

    i heard a story about one woman (the wife of a philosopher i met at a conference) who went into early labour at 6 months, and was put on bed rest and ethanol drip *for the rest of her pregnancy* . so, she was pissed for three months straight while pregnant. her now-adult son, btw, is by all accounts a friendly, clever, fine specimen of a man.

  13. wait, eve of 70s. right. that’s actually surprising. did you say you’re from someplace northern-european? i’d be interested to find out if there was different/earlier research going on outside of the anglo world around that time.

  14. Hilarious. If you look carefully, the woman in the picture appears to be holding a pint glass – not a wineglass. Also, if you cover up the ponytail, it is no longer clear that it is a woman, and so no longer clear that it is a pregnant person. Without the ponytail the label might read that people with beer bellies shouldn’t drink wine. Aren’t pregnant women also told not to eat shellfish these days too? Why haven’t packets of prawns got these labels on them? Or peanuts? Or onions? Or any of the other things they tell pregnant people to avoid?

  15. if they labeled everything that pregnant women weren’t supposed to eat/drink, they’d have to label everything but water! (until next year, when they decide that even water isn’t proven safe and is therefore too risky for pregnant women!)

  16. Yes – which is why it’s kind of interesting that they’ve chosen to label alcohol. Don’t have any fun, pregnant women. Or am I reading too much into it?

  17. My reference to ‘them’ isn’t supposed to suggest there’s some kind of global food-labelling conspiracy.

  18. i do think it’s something like that, monkey. (the having fun thing. not the global conspiracy thing.) you’re going to be a mother; you need to be a nice demure little lady now. none of this acting like a man, drinking pints and such, any more.

  19. My son was born in Oxford, England in 1972. I remember my GP, bless him, saying that all this VERY NEW stuff about alcohol was nonsense. If GPs hadn’t noticed a trend, then there wasn’t one.

    At the time, Oxford was generally pickled. I mean, two sherries before dinner, 2 or 3 glasses of wine at dinner, and then port or claret in the common room. Of course, I didn’t dine in every night, but you get the idea of the state of people’s drinking habits.

    My son seems fine, though. Jender may meet him very soon, so she might secretly report back otherwise.

  20. Looks to me, Monkey, like she’s just smelling the pint. And maybe that *is* a bad idea, given smell-sensitivity during pregnancy.

  21. ah yes, it does look like she’s smelling! too bad it’s not a wine glass. then we could interpret it as a prohibition on wine tastings while pregnant!

    jj, that’s the thing that’s so strange about it all. i mean, find me *anyone* over the age of 30 whose mother didn’t drink while pregnant. we should be swimming in deformity.

  22. Hmm, well maybe I am actually deformed without knowing it :P
    I was born a stones’ throw from Gouda (cheeeeeeeese) and one of the other specialties from Gouda are stroopwafels. You can wake me in the middle of the night for them (for cheese too, btw, I wonder if this is significant, hmmm). Anyway, the point is that they are just laden with cinnamon.
    Now… google cinnamon and pregnancy… *sighs*
    Not to mention raw cheeses.
    I am not sure whether all those things one should NOT eat during pregnancy have any effect at all, except for making people cranky.
    I do know, though, that taking folic acid does decrease the risk of a child with spina bifida (my sister had that, things might have been so different if things were known about folic acid in the late 60s).
    It is just annoying to be told off from ingesting all kinds of things, while having to take a tablet generally is not.

  23. cinnamon has abortive qualities! good god!

    no, i don’t mind the folic acid thing for two reasons: (a) it’s based on (so far as i know) good sound science, rather than ‘better safe than sorry’; (b) marmite is very high in folic acid, and i am in favour of any excuse–especially such a good one–to regularly consume marmite!

    nothing at all wrong with getting good solid help-your-fetus-grow-right advice; it’s the ‘we don’t know what the fuck we’re talking about, so why don’t you just go ahead and give up anything and everything that might’ve given you pleasure or personal comfort so that, if anything does go wrong, we’ll at least know you weren’t being selfish’ sort of advice that makes me cross.

    i feel yet another angry pregnant woman post coming on. there’s an excellent (if old) article i should put up….
    (now i want gouda.)

  24. That label on the back of the beer actually says: BEFORE/DURING PREGNANCY.

    Before???? So, women shouldn’t have more than 2 units at all *just in case* they get pregnant….

  25. yes, jessica, the current ‘official’ advice is to abstain if you’re pregnant or may become pregnant. (in other words, don’t drink if you’re a woman of childbearing age!) i think the label on the right is just reacting to that advice, rather than making its own claim about pre-pregnancy drinking. that is, i think it should be read as saying ‘there’s no reason to abstain altogether either before or during pregnancy’, rather than as suggesting that women who may become pregnant should only have 2 units.

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