“THEY know that they have a tummy mummy. And she drank alcohol when they were in her tummy.” That is how Alison, who lives outside Belfast, UK, explains things to her adopted sons Sean (13) and James (12). “I tell them alcohol made their brains different, so they learn different,” she told me. “But it also makes them very special.”
Fetal alcohol syndrome (FAS) has profoundly affected the brothers, causing intellectual delays and impaired mental processing. Alison’s stance is unambiguous. “If you drink whilst pregnant, you’re playing Russian roulette with that baby’s life,” she says.
Advertisement
New echoes this, recommending “appropriate attention… be given to prevention of drinking among pregnant women”. But this may harm mothers and babies, even as it seeks to save them.
FAS was first in three babies born to women with “chronic” 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’s 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’t possible to say light drinking (4 units spread over the week) harms a developing fetus. Public health organisations draw on the precautionary principle – broadly, “better safe than sorry”. 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. “Mama Beve, Bimbo Beve“, it reads: “Mother Drinks, Baby Drinks”. A desire to distinguish “bad” mothers from “good” ones endures.
The WHO’s 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 – 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’t possible to process a message beyond “this is for your baby’s good”. Shouldn’t we instead state that binge and heavy drinking may irrevocably harm a fetus, but that science doesn’t 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
