Drinking Alcohol During Pregnancy

There's no shortage of harsh measures or threats of harsh measures against pregnant women who drink but are these helping to accomplish the goal of healthier babies that's the topic of this week's healthcare triage in many areas of health policy the best of

Intentions can lead to more harm than good such as the case with America's approach to alcohol and pregnancy the best evidence shows the punitive policy such as ik waiting drinking while pregnant as child abuse and threatening

To involve child protective services can dissuade women from getting prenatal care fetal alcohol spectrum disorders refer to a collection of problems and babies and children these include low birth weight impaired

Growth and problems in the heart kidneys and brain children can have developmental delays communication difficulties learning disabilities and lower IQ some of these last a lifetime time to know how many American children

Are affected studies done by the Centers for Disease Control and Prevention have estimated that between 2 and 15 infants per 10,000 born in the United States have fetal alcohol syndrome the most severe form of the disorder some

Community-based studies that use the broader definition of the disorder have found more affected children up to 5% we know that infants of women who drink alcohol in pregnancy may develop these disorders the problem is what we don't

Know we don't know the level of alcohol exposure in utero that could cause a child to develop these disorders we don't know if the timing of the exposure matters we don't know why some women who drink little might have a child who's

Affected while some can binge drink during pregnancy and have a child with no apparent problems because of all of this most medical organizations including the American Academy of Pediatrics and the

CDC recommend that women forego alcohol during pregnancy the only known dose to be safe is none they say and therefore women should not drink at all many women in the United States comply with this directive but a significant number do

Not a study published this April found that 11.5% of women who were pregnant report drinking alcohol almost 4% report binge drinking defined as four or more drinks on any occasion in the last month given that women may be ashamed to

Acknowledge this the true numbers may be higher to combat this 43 states have enacted policies to try and curb this drinking the can be affirmative measures like giving pregnant women priority for substance

Abuse treatment or punitive ones like defining drinking alcohol during pregnancy as child abuse or neglect proponents of such policies believe that they are making things better especially for children a reason studies suggest

They're wrong researchers gathered birth certificate data for more than 155 million live births from 1972 to 2015 the researchers were interested in how many children were born in a low birth weight or prematurely they compared the

Rates of those undesirable outcomes in times and places when alcohol pregnancy policies did and did not exist they controlled for a number of demographic and related factors including those known to be associated with poorer birth

Outcomes like poverty and cigarette smoke they found the policies which defined alcohol use during pregnancy as child abuse and neglect were associated with an increase of more than 12,000 preterm births these early births led to

More than five hundred and eighty million dollars in costs in the first year of life alone policies mandating warning signs where alcohol was sold were associated with an increase of more than 7,000 babies born at low birth

Weight at a cost of more than a hundred and fifty million dollars a previous study looking at how these policies affected women's drinking found mixed results states with punitive policies had more

Drinking not less overall neither type of policy seemed to be associated with lower levels of drinking it's possible that states that already had more drinking might have put such policies in place in response to it but the research

Methods used accounted for this and state-level data on drinking and the prevalence of fetal alcohol spectrum disorders weren't available when most of these policies were enacted making it hard to believe that the relative levels

Of problems were what spurred policymakers to act dr. Sarah Roberts an associate professor of obstetrics and gynecology at the University of California San Francisco was an author of this study and other related work

Doctors have long discussed potential dangers with patients one-on-one with many benefits but policies that punish women for a public and warned them against harms from alcohol or drug use during pregnancy she said may lead to

Further harms by scaring women into forgo prenatal care such policies may even convince them that talking with their physicians isn't a good idea quoting her here

Qualitative research finds the pregnant women who use drugs avoid prenatal care out of fear that if their providers find out about their drug use they will be reported to Child Protective Services and lose their children our study found

That child abuse neglect policies led to decrease prenatal care use other research confirms this hypothesis three years ago researchers including me published the findings of a survey on legal requirements for drug testing and

Prenatal care although most women were tolerant of laws requiring screening of pregnant women 21 percent reported that they'd be offended if their doctors asked them about drug use as part of prenatal care

And 14 percent said that mandatory testing would discourage prenatal care attendants it's that last bit that most concerns physicians avoiding medical care is not what we'd like to see happen the goal of all of these policies is to

Improve the health not only of pregnant women but also of the children they bear many people assume that a physician simply provide more information if women are just warned things will improve without research these assumptions are

Just unproven hopes doctor Roberts had two suggestions for what might work better the first start over and go through a rigorous process of engaging with women who drink during pregnancy to find out from them what would help

Second stop treating pregnancy is a special case when it comes to alcohol quoting her again there is some evidence the general population alcohol policies such as limiting where alcohol can be sold are associated with improved birth

Outcomes this makes sense as research shows that the biggest predictor of drinking during pregnancy is drinking before pregnancy women don't start drinking during pregnancy if they drink during pregnancy it's usually a

Continuation of the way in the amount they were drinking prior to pregnancy it might be better to spend time making sure that women are connected to the healthcare system in general and that they enter pregnancy healthy rather than

Focusing on the nine months of pregnancy as if that's the only time that matters it's easy to stigmatize women who drank during pregnancy with words with policy the goal though is healthier mothers and infants to

Achieve that policymakers may need to stop stigmatizing and start over page enjoy this video you might also enjoy this video on alcohol cancer and how we think about risk and if you like to show in general it's really nice to be

Supported at patreon.com slash healthcare triage we'd especially like to thank our research associate Joe sevens and of course our Surgeon Admiral Sam my book the bad food Bible still on sale in stores