Light Drinking During Pregnancy: CanFASD Responds to Confusing Information That Continues to Cloud the Issue
“It is well known that Fetal Alcohol Spectrum Disorder (FASD) is the most common type of developmental disability worldwide, some of the most important unanswered questions in the field are 'how much alcohol in pregnancy is too much?' or what is a 'safe' amount of alcohol consumption in pregnancy and can we remember information on how much we drink accurately,” says Dr. Jocelynn Cook, Executive Director of the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD).
“It is well known that Fetal Alcohol Spectrum Disorder (FASD) is the most common type of developmental disability worldwide, some of the most important unanswered questions in the field are 'how much alcohol in pregnancy is too much?' or what is a 'safe' amount of alcohol consumption in pregnancy and can we remember information on how much we drink accurately,” says Dr. Jocelynn Cook, Executive Director of the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD), Canada’s first comprehensive national research network on FASD.
Dr. Sterling Clarren, Scientific Director of CanFASD agreed that, “While the article is clear about the low dose of alcohol that they say is safe, we know that people may misinterpret this message and inadvertently place their fetuses at higher risk.” Canada’s Low Risk Alcohol Drinking Guidelines identify when no alcohol is the best choice, like during pregnancy. These guidelines recommend that “Zero is limit when you are pregnant or planning to become pregnant, or about to breastfeed.” The safest choice is no alcohol. Cook says that, “CanFASD strongly supports these recommendations.”
Cooks states, “Many factors, in addition to alcohol, can impact fetal growth and development including, maternal nutrition, genetics and drinking patterns. In fact, the timing of prenatal alcohol exposure during fetal development is also a very important issue. There are a number of critical periods of development when tissues and structures can be impacted – some are brief and some are prolonged. Data from animal studies, and some research in humans, show that organs and tissues that are developing at the time of exposure are particularly susceptible to the effects of alcohol, and the brain is vulnerable at any point during the nine months.”
With regard to the BJOG study, Cook said, “Drawing accurate conclusions from complex scientific studies is difficult. Study design, methods and the tests used to measure neurodevelopment, or patterns of alcohol consumption, and the accuracy of self-reported data must all be carefully considered.” Answers are not simple. Asking about how much alcohol has been consumed is not always accurate, especially when there is a length of time between when the alcohol was consumed and when the question was asked. There is also strong evidence that individual outcomes vary with any amount of alcohol at any time during pregnancy.
The Royal College of Obstetricians and Gynaecologists suggests that "consumption of alcohol offers no benefits in relation to the outcomes of pregnancy [and that] under reporting of alcohol consumption is thought to be widespread, such that adverse effects in the offspring may not always be recognized." Furthermore, many effects of prenatal alcohol exposure are often not evident by age seven, instead presenting later in life as brain development proceeds. It is these later emerging effects that have been linked to difficulties with judgment and effective independent functioning crucial to day to day activities in adolescence and into adulthood.
This BJOG research paper investigated the relationship between light drinking versus abstinence in pregnancy, and behavioural and cognitive outcomes in 7-year-old children. The findings of that paper suggest that light drinking during pregnancy is not linked to developmental problems in mid childhood, supporting the current United Kingdom’s (UK) Department of Health guidelines on drinking during pregnancy. “The UK Department of Health recommends that pregnant women, or women trying for a baby, should avoid alcohol altogether. If they do choose to drink, to minimise risk to the baby, the government’s advice is to not have more than one to two units of alcohol once or twice a week, and not to get drunk.”
The authors of this study clearly state that they remain unclear on what is the safe level for drinking safely and that the safest option for pregnant women may be to avoid drinking during their pregnancies. The study authors also use more “grey” language – “the picture for low levels of alcohol is 'unclear' and 'emerging literature suggests'.”