Yesterday's news from the British National Institute for Healthcare and Clinical Excellence drew me into a familiar mind spin. As reported in the Guardian, the standard-setting agency now is suggesting that pregnant women who tipple a small glass of wine a day won't harm their babies. After reviewing the evidence, a Nice spokesperson told the Guardian: "There is no consistent evidence of adverse effects from low to moderate alcohol use during pregnancy but the evidence is probably not strong enough to rule out any risk." Ready to crack open a bottle and count your baby's kicks over a glass of pinot? Not so fast. The new report contradicts recommendations from the U.K.'s Department of Health that women abstain completely from alcohol during pregnancy.
Ambiguity around alcohol guidelines during pregnancy isn't limited to the pub-luving Brits. According to a report from the International Center for Alcohol Policies, Belgium, France, Germany, the Netherlands, Portugal, Spain and Switzerland had no stated guidelines in 1999 for drinking during pregnancy. Currently the Australian government counsels women to "consider not drinking at all" and "never become intoxicated," and if you do drink, "have less than 7 standard drinks a week" and "no more than two drinks on any one day" and "note that the risk is highest in the early stages of pregnancy" -- such a timidly worded abstention guideline that it has drawn sharp criticism from other Australian medical experts. (For more international guidelines, go here.)
In America, the counsel from official bodies is far from ambiguous -- the AMA has advised women to avoid all alcohol during pregnancy, as has the CDC, which has even begun focusing on curbing drinking among potentially pregnant women.
I know this roller coaster all too well and the weird position it puts many well-meaning mothers in. When I got pregnant with my second child, I decided I was going to be a European mother. With my first, I'd been maniacally Californian -- abstaining from every verboten substance known to modern woman: caffeine, alcohol, nonorganic meat or dairy. I guzzled whole milk, indulged every healthy hedonism and gave birth to a little girl who received a rare Apgar score of 10 (every newborn's first medical test) -- despite being two weeks late and enduring a two-day labor. But there was an obsessiveness I didn't like about myself during that pregnancy, so for the second child I decided to relax a little, have a little more faith and little less anxiety (which of course, releases stress hormones into the blood stream, and can adversely affect the fetus). European women, I'd read, eat raw cheese, take the occasional anti-nausea pill, and most important, enjoy an occasional glass of wine. But what exactly does occasional mean? And what about glass? And doesn't alcohol content in wine vary nowadays? And weren't there some weeks that you should avoid even a sip?
After some late nights of thoroughly unscientific Googling, I was even more confused. This was back in 2000, when the official opinions ranged from the not-ever-a-sip American Medical Association to the British Royal College of Obstetricians and Gynaecologists' 1996 guidelines recommending no more than 15 units (two small glasses of wine a day). Oy! That would have kept this lightweight pretty much snookered my entire pregnancy. My "Europeans do it, why can't we?" conundrum seemed to be a common one: This thread of the Berkeley Parents Network is completely devoted to the issue. In the end, I did drink the occasional half-glass of wine, but when my 2-year-old was only beginning to form words, the decision haunted me. What if I had had wine on the day her language center was forming? How selfish and idiotic could I be? Even though logic (and her subsequent loquaciousness) suggested I was being paranoid, I learned something about myself: I couldn't be European even if I tried.
If Americans' risk-averse healthcare guidelines reflect our own national character, the Brits' teeter-tottering around pregnancy and booze also needs to be put in perspective. In a place where pub culture almost endorses alcoholism as a national right, safe-drinking guidelines are the public health response to an acknowledgment that some women are not going to stop drinking, so the best one can hope for is that they slow down. In any case, the guidelines advising abstemious pregnancy seems to be a growing consensus, if only because the risk can't be ruled out. Of course, women around the world have drunk a little during pregnancy and given birth to healthy babies, but when it comes to government and medical experts who see the ravages of fetal alcohol syndrome, it shouldn't surprise us that most want to simplify on the side of caution.
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