She Started It
Mike has alluded to my mom's revelation over crepes that she drank throughout David's and my pregnancy. It all started with the seemingly innocent "I don't know why American women have taken it as an article of faith that you can't have anything to drink while you're pregnant. European women drink all through their pregnancies and think nothing of it." But, if you know my mom and you know me, you will recognize that she was baiting me, and that the answer "Because the NIH told them so," was not going to settle the matter. In fact, you have probably already guessed that I swallowed the bait whole as I always do, and that a debate ensued of great intensity and varying accuracy. I was unable to convince my mother that there was a scientific basis in the recommendation of abstinence from alcohol during pregnancy, and that it was not just "a plan to deny women pleasure." That is because I didn't have PubMed at Crepeville, but now I do.
I should warn you that this will be an exceptionally long post. Apologies. Adding a jump page is kind of an ass pain, but click the arrow below to finish reading what I have to say. I will take away the arrows in a few days; just put up with them till then.
A little bit of background: Most people are familiar with Fetal Alcohol Syndrome (FAS), a term which covers a range of disorders from misformed eyelids to brain damage. It is caused by alcohol crossing the placenta (which it always will if it's in the mother's system), where it damages the developing nervous system of the fetus. My mother correctly pointed out that FAS is almost always linked with alcoholism. However, it is not unheard of in moderate drinkers, and it is certainly completely preventable with abstinence. However, FAS is only part of the question. Fetal Alcohol Spectrum Disorder (FASD) is a more general term, and encompasses disorders that range in severity. In other words, just because a child isn't born with severe retardation doesn't mean she wasn't damaged by fetal exposure to alcohol. Drinking also increases the likelihood of miscarriage and stillbirth.
So, on to my mom's argument.
1. European women drink during pregnancy. Great. They also eschew deoderant. It's obviously possible to drink and still have a healthy child, but that doesn't mean it's a good idea. If I may quote Chris Rock, "You can drive a car with your feet, but that don't make it a good idea." Anyone who thinks FAS and FASD are uniquely American disorders should talk to the French winemakers facing legal action for failing to warn women of the dangers of consuming alcohol. That's French women, Mom, not alcoholic American tourists. Here are links to articles from Norway and England, demonstrating that even light levels of alcohol have health effects to fetuses.
2. David and I came out fine. I will resist the temptation to steal my father-in-law's line and say that my mom's drinking is what kept me out of Harvard. Instead, I will point out the fallacious reasoning behind saying that because she gave birth to two healthy children, there was no risk involved. That's like saying that because Dad survived World War II there was no risk involved in his joining the army. She, Dad, David and I got lucky. And I don't begrudge her the wine we shared while I was in utero; that is not the point. The point is that according to the NIH, who are not nudniks, every pregnancy is different, and it is possible to drink the same amount over two pregnancies and have two different outcomes with respect to FAS.
3. There's very little risk involved. The way I see it, it's like getting a tattoo. Rich once explained to me that although he only sort of keeps kosher, it's really easy to avoid getting a tattoo, so why not just avoid getting one? So far no one has published research that determines what level of alcohol is "safe" to consume while pregnant. It looks as though the same factors that lead to people getting drunk at different rates lead to some women's fetuses being damaged at different rates. But since there is no way to predict for any one woman what her fetus' vulnerability will be, the only way to be safe is to not drink at all. In other words, it is impossible to do assess your own risk in drinking while pregnant.
4. FAS only occurs in children of alcoholics. As I have mentioned, FAS is only the most severe of a number of types of disorder that can be prevented by abstaining from alcohol. Some early research points to the possiblity of a dose-response relationship, which is to say that only drinking a little might only hurt the fetus a little, like making it a little bit slower at mental functions. That doesn't mean it isn't doing anything at all. Here is a link to a study conducted in Detroit on seven-year-old children whose mothers drank moderately during their pregnancy. Even adjusting for socioeconomic and other confounding factors, those children scored lower developmentally and showed significantly more behavioral problems than normal.
5. This is a scheme to deny women pleasure. I understand that just because NIH, the CDC, and just about all of Western Medicine tells you something is true doesn't mean you have to swallow it whole. But many tragedies of public health have been fueled by the refusal to accept something that doesn't seem fair. Disease is inherently unfair. It's unfair that pregnant women can't drink and be assured of having healthy children, but it's also true. It's unfair that you can't have random unprotected sex without expecting to contract a host of virulent and sometimes fatal infections, but you just can't. 20 years ago it took a long time for safe sex to catch on telling people to stop having unprotected, random sex sounded like a right-wing conspiracy. But it wasn't a conspiracy, it was science. And what separates science from narrative is that the truth doesn't always make a good story.
Put that in your pipe and smoke it.
I should warn you that this will be an exceptionally long post. Apologies. Adding a jump page is kind of an ass pain, but click the arrow below to finish reading what I have to say. I will take away the arrows in a few days; just put up with them till then.
A little bit of background: Most people are familiar with Fetal Alcohol Syndrome (FAS), a term which covers a range of disorders from misformed eyelids to brain damage. It is caused by alcohol crossing the placenta (which it always will if it's in the mother's system), where it damages the developing nervous system of the fetus. My mother correctly pointed out that FAS is almost always linked with alcoholism. However, it is not unheard of in moderate drinkers, and it is certainly completely preventable with abstinence. However, FAS is only part of the question. Fetal Alcohol Spectrum Disorder (FASD) is a more general term, and encompasses disorders that range in severity. In other words, just because a child isn't born with severe retardation doesn't mean she wasn't damaged by fetal exposure to alcohol. Drinking also increases the likelihood of miscarriage and stillbirth.
So, on to my mom's argument.
1. European women drink during pregnancy. Great. They also eschew deoderant. It's obviously possible to drink and still have a healthy child, but that doesn't mean it's a good idea. If I may quote Chris Rock, "You can drive a car with your feet, but that don't make it a good idea." Anyone who thinks FAS and FASD are uniquely American disorders should talk to the French winemakers facing legal action for failing to warn women of the dangers of consuming alcohol. That's French women, Mom, not alcoholic American tourists. Here are links to articles from Norway and England, demonstrating that even light levels of alcohol have health effects to fetuses.
2. David and I came out fine. I will resist the temptation to steal my father-in-law's line and say that my mom's drinking is what kept me out of Harvard. Instead, I will point out the fallacious reasoning behind saying that because she gave birth to two healthy children, there was no risk involved. That's like saying that because Dad survived World War II there was no risk involved in his joining the army. She, Dad, David and I got lucky. And I don't begrudge her the wine we shared while I was in utero; that is not the point. The point is that according to the NIH, who are not nudniks, every pregnancy is different, and it is possible to drink the same amount over two pregnancies and have two different outcomes with respect to FAS.
3. There's very little risk involved. The way I see it, it's like getting a tattoo. Rich once explained to me that although he only sort of keeps kosher, it's really easy to avoid getting a tattoo, so why not just avoid getting one? So far no one has published research that determines what level of alcohol is "safe" to consume while pregnant. It looks as though the same factors that lead to people getting drunk at different rates lead to some women's fetuses being damaged at different rates. But since there is no way to predict for any one woman what her fetus' vulnerability will be, the only way to be safe is to not drink at all. In other words, it is impossible to do assess your own risk in drinking while pregnant.
4. FAS only occurs in children of alcoholics. As I have mentioned, FAS is only the most severe of a number of types of disorder that can be prevented by abstaining from alcohol. Some early research points to the possiblity of a dose-response relationship, which is to say that only drinking a little might only hurt the fetus a little, like making it a little bit slower at mental functions. That doesn't mean it isn't doing anything at all. Here is a link to a study conducted in Detroit on seven-year-old children whose mothers drank moderately during their pregnancy. Even adjusting for socioeconomic and other confounding factors, those children scored lower developmentally and showed significantly more behavioral problems than normal.
5. This is a scheme to deny women pleasure. I understand that just because NIH, the CDC, and just about all of Western Medicine tells you something is true doesn't mean you have to swallow it whole. But many tragedies of public health have been fueled by the refusal to accept something that doesn't seem fair. Disease is inherently unfair. It's unfair that pregnant women can't drink and be assured of having healthy children, but it's also true. It's unfair that you can't have random unprotected sex without expecting to contract a host of virulent and sometimes fatal infections, but you just can't. 20 years ago it took a long time for safe sex to catch on telling people to stop having unprotected, random sex sounded like a right-wing conspiracy. But it wasn't a conspiracy, it was science. And what separates science from narrative is that the truth doesn't always make a good story.
Put that in your pipe and smoke it.
1 Comment(s):
- Posted by
BrooklynDodger at April 14, 2005 5:35 PM |
Permanent Link to this Comment
BrooklynDodger hesitates to enter a discussion which has expanded beyond hazard identification, exposure-response assessment, exposure assessment and risk characterization, the canonical taxonomy of risk assessment.
Assuming, for the sake of argument, that high dose Fetal Alcohol Syndrome is an accepted phenomenon, the question is whether there is an exposure response relationship extending to intake at lower levels.
This becomes a very difficult issue scientifically, because effect levels in animal models are relatively high compared to human exposures, yet there is a considerable literature suggesting a lower exposure risk for organic solvents. Physiologically, alcohol shares a CNS mechanism with anaesthetic gases and organic solvents, acting directly on neurons.
Human health effects studies on neurological developments likely depend on IQ measurements, themselves highly suspect and confounded with social class.
The Times recent article on wine
http://www.nytimes.com/2005/04/13/dining/13alcohol.html?
suggested that a couple of glasses would produce a blood alcohol of 0.04 in a moderate sized woman.
The Dodger has gotten bored with this post, and can't bring it to a conclusion.
