鈥淭HEY know that they have a tummy mummy. And she drank alcohol when they were in her tummy.鈥� That is how Alison, who lives outside Belfast, UK, explains things to her adopted sons Sean (13) and James (12). 鈥淚 tell them alcohol made their brains different, so they learn different,鈥� she told me. 鈥淏ut it also makes them very special.鈥�
Fetal alcohol syndrome (FAS) has profoundly affected the brothers, causing intellectual delays and impaired mental processing. Alison鈥檚 stance is unambiguous. 鈥淚f you drink whilst pregnant, you鈥檙e playing Russian roulette with that baby鈥檚 life,鈥� she says.
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New echoes this, recommending 鈥渁ppropriate attention鈥� be given to prevention of drinking among pregnant women鈥�. But this may harm mothers and babies, even as it seeks to save them.
FAS was first in three babies born to women with 鈥渃hronic鈥� alcoholism. Later reports highlighted the typical physical features of FAS: a thin upper lip, narrowed eye openings, restricted growth and smaller head.
Successive directives advised moderating alcohol intake during pregnancy, followed by backed by what is now the US Centers for Disease Control and Prevention; the former chief medical officer for England, ; and the UK鈥檚 Royal College of Obstetricians and Gynaecologists. The legacy of FAS on Sean and James suggests alcohol abstinence in pregnancy represents a small sacrifice. The truth is more complex.
A 2017 of 26 studies concluded it isn鈥檛 possible to say light drinking (4 units spread over the week) harms a developing fetus. Public health organisations draw on the precautionary principle 鈥� broadly, 鈥渂etter safe than sorry鈥�. But abstinence directives, issued in the face of equivocal evidence, have wide ramifications.
Firstly, expectant mothers are subjected to value-laden campaigns, such as an Italian one showing a fetus in a glass. 鈥�Mama Beve, Bimbo Beve鈥�, it reads: 鈥淢other Drinks, Baby Drinks鈥�. A desire to distinguish 鈥渂ad鈥� mothers from 鈥済ood鈥� ones endures.
The WHO鈥檚 guidance could harm the babies it aims to protect. Several US states support mandatory reporting of certain behaviours during pregnancy to law enforcement or child welfare agencies. A 2016 study found that once reported, have frequently faced involuntary treatment and jail time for their alcohol consumption, and have had their children removed 鈥� irrespective of whether they have come to harm. In such states, more babies are born . This could be because those who think they are drinking more than they should during pregnancy may be reticent to seek broader prenatal care or alcohol counselling.
Discriminatory judgements ensue. have found that pregnant Black women are than white women to be screened for alcohol use, and more likely to face legal action, even after treatment for alcohol dependence. Tragically, they are also more likely to lose custody of their child, and to be reunited with them. findings exist for pregnant women in lower socio-economic groups, whether they are a member of an ethnic minority group or not.
Abstinence directives rooted in the precautionary principle imply it isn鈥檛 possible to process a message beyond 鈥渢his is for your baby鈥檚 good鈥�. Shouldn鈥檛 we instead state that binge and heavy drinking may irrevocably harm a fetus, but that science doesn鈥檛 provide the same indisputable link for light drinking? Public health groups should elevate the subtlety and sensitivity of their messaging. We must hold Sean and James in our minds, but these conversations are necessary, to protect mothers as well as their babies.
Jules Montague is a neurologist and author of
