Alcohol: Just Say Maybe?

What studies on light drinking during pregnancy suggest

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New research is raising questions about the "just say no" stance pregnant women have been told to adopt regarding alcohol: Two Australian studies and one from the U.K. show no link between behavioral or cognitive damage to children and light to moderate drinking during pregnancy.

All-out abstinence from alcohol is a relatively new federal policy, adopted by the U.S. Surgeon General's Office in 2005. Before that, pregnant women were advised to "limit" their alcohol intake due to strong evidence that emerged in the 1970s linking heavy drinking to severe learning and emotional problems and physical deformities, aka fetal alcohol syndrome.

But in 2005, while acknowledging that the greatest risk comes from binge drinking (defined as five or more drinks at one time) and having seven or more drinks per week, then-Surgeon General Richard H. Carmona pointed out that it's unknown what, if any, amount of alcohol is safe: "Therefore, it's in the child's best interests for a pregnant woman to simply not drink alcohol." The American College of Obstetricians and Gynecologists concurs, urging women to avoid alcohol entirely while pregnant or trying to conceive.

No black-and-white answers Not so fast, some argue. "We should just tell the truth," says R. Curtis Ellison, M.D., professor of medicine and public health at Boston University and co-director of the International Scientific Forum on Alcohol Research. "Based on the current scientific data, binge or heavy drinking during pregnancy can be harmful, but increases in risk are not seen among women who have an occasional drink."

Research consistently shows that women with lower education and income levels and poorer access to prenatal care are at a greater risk of having babies born with abnormalities, regardless of whether they report drinking alcohol. And in the Australian study published in Pediatrics, about half of the conditions attributed to alcohol were found in children whose mothers did not report drinking during pregnancy. "There is a great problem in determining the [cause] of many such defects," Ellison says.

Indeed, the research can be puzzling. While recent studies found no harm and, actually, some improved behavior and learning ability among children of mothers who had one to six drinks a week during pregnancy, others suggest the opposite. A 2007 study, for example, found that daughters of mothers who had less than one drink a week had more behavioral and emotional problems at ages 4 and 8. Only higher levels of drinking were linked to the same effects in boys, however.

Until more is known, most experts advise caution. "We know the risk of alcohol-associated defects is dramatically reduced if a pregnant woman only rarely has a drink," says Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome. "A toxic substance is always a toxic substance, so we urge women to abstain."

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