This fall, Dr. Emily Oster, an economist and professor at
the University of Chicago, published a book titled “Expecting Better,” which
examines standard health and diet recommendations often made by prenatal providers
and current evidence. Many of her
findings are seen as somewhat controversial, including her claims that bed
rest may do more harm than good, it’s
okay to avoid exercising for the 9 months of your pregnancy (Saint Louis,
2013), and eating
that turkey sandwich is probably fine (Oster, 2013). Her conclusion that has garnered the greatest
response from the media and the public, however, is that “light” consumption of
alcohol during pregnancy will not result in adverse outcomes (Oster,
2013).
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| Research presented in economist Emily Oster's new book suggests that a glass a day in later trimesters is fine. Photo from the NY Daily News. |
Oster indicates that, in the two
larger, longitudinal studies she based that portion of her book on, “no difference between the children of women
who abstain and those who drink up to a drink a day” exists (Oster,
2013). She suggests that, “based on
this data, many women may feel comfortable with an occasional glass of wine –
even up to 1 a day – in later trimesters” and “1 to 2 drinks a week in the
first trimester” is (Oster,
2013, Saint
Louis, 2013). Oster’s explanation is
that, drinking slowly decreases the quantity of alcohol that reaches the fetus
and that episodes of binge drinking are what put children at risk for birth
defects and cognitive disabilities (Saint
Louis, 2013).
Health organizations from across the country, including the
American College of Obstetricians and Gynecologists (ACOG), the Centers for
Disease Control and Prevention (CDC), and the National Institute on Alcohol
Abuse and Alcoholism (NIAAA), have been responding to the release of Oster’s
book (Saint
Louis, 2013). Most recognize the
dangers of misleading women to believe that their fetus will not be exposed to
alcohol at all and that there is plenty of room for variation in how
limitations are perceived by women and how individual women metabolize
alcohol. Others strictly maintain that
abstinence from alcohol during pregnancy is the only safe option, citing
statistics regarding fetal alcohol syndrome and the lack of a precise
understanding its effects (Oster,
2013).
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| Some experts have expressed concern that limitations may be easily misinterpreted. Photo from Pennlive.com |
What I find to be the most challenging question raised by
Oster’s book is not necessarily whether or not women should feel free to have a
couple glasses of wine during pregnancy. Educating individual patients about what
drinking “lightly” means during different trimesters and the risks of
consumption beyond those limits seems both manageable and ethically correct. What seems more troublesome is deciding what
health care providers’ message to the general public should be. It seems unethical to continue telling the
public that absolutely no alcohol
should be consumed if that is not what the evidence suggests. However, it also seems irresponsible to
endorse “light” alcohol consumption, as that could be widely misinterpreted, whether
or not specific limitations are provided (for example, “one drink a day” can
easily be interpreted as “seven drinks a week”). I am definitely interested in continuing to
explore the way providers and other experts in the field of public health weigh
the risks and benefits different approaches to providing new evidence to the
public.
Very interesting points, Ashleigh! My thoughts while reading your post were similar to the questions you raised in your last paragraph. While it's unfair to neglect telling pregnant women they can safely consume alcohol in moderation, there must be education to clarify the recommendations. It's evident that pregnant women receive conflicting information regarding safe practices during pregnancy, which makes it even more difficult for them to know which recommendations are from credible sources. Regardless of the topic or source of information, I think the bottom line is approaching each woman as an individual and allowing her to decide what is best for her and her baby at that point in time.
ReplyDeleteMegan, I completely agree with you about the need for care providers, in this case physicians, NPs or CNMs, to approach patients individually and provide them with all of the information we have available so they can make informed decisions about their health. And, while that can still be challenging, it's manageable. Individual providers (the Oster article says up to 40% of them) have long been telling women they see for prenatal care that some alcohol during pregnancy will not be harmful. And, I think that it would be great if the results of this book are that more women question the blanket recommendations that their care providers give them.
DeleteI think what I find so difficult about this specific issue is looking at it from the public health perspective. The idea that "light drinking during pregnancy is fine" is getting so much media play right now. We can tailor our messages to individual women and families, but how can we (health professionals) successfully present a message to the general public that both provides accurate information and doesn't leave room for potentially harmful misinterpretation of the recommendation?
Ashleigh, great topic! My greatest concern is probably the fact that the author of this book 'Dr' Oster is an economist and professor, not a physician. I reckon the opinion of an ObGyn would have been more valuable, that being said, it is unfortunate that an economist would believe herself to be in a position to give pregnant women advise on such a potentially 'hazardous' topic as alcohol consumption during pregnancy. I worked with children who had been diagnosed with Fetal Alcohol Syndrome and can attest to the devastating effects alcohol consumption during pregnancy can have.
ReplyDeleteWhile I agree that women should be educated on the evidence as we understand it, I still feel that we, as responsible practitioners, should discourage drinking during pregnancy in general. I personally don't feel that abstaining from alcohol for only 9 months is a huge burden for an expectant mother, when considering the burden of the risk. As the other ladies mentioned, people often misinterpret what "one drink" means due to the varying size of containers and alcohol contents. I just don't think 9 months of drinking is worth the chance of developmental delay, in a risk/benefit analysis.
ReplyDeleteAshleigh, this is a very interesting post. I have heard before that one beer or one glass of wine is not detrimental to the pregnant woman or her baby, but I have never looked at evidence behind it. Like you mention, education is a large part of this topic. There is a large amount of education on alcohol and consuming safely for the college aged person. I know I have been flawed in my thinking at times related to the amount of drinks I have consumed. One glass of wine is 5 oz but the size of the average wine glass could easily hold much more. I have poured myself one glass of wine and then realized that my one glass is holding closer to two servings. I have also experienced that people can lie about their alcohol consumption. I think those two things are a barrier to educating the safe use of alcohol during pregnancy, but agree that puts health care providers in a difficult ethical decision.
ReplyDeleteIntriguing post, Ashleigh. It's interesting to observe the evolving viewpoints of consuming alcohol during pregnancy throughout the generations. Family members of older generations have disclosed to me that their mothers would have a drink once in a while, and it was not taboo or frowned upon. I agree with Abby's comment that intimate education is very important for the expecting mother. She should be aware of what the different perspectives are, how opinions have changed over the years, and most importantly, what "drinking lightly" actually means for her. I have to say that I enjoyed your second photo in this post, not only because it's comical but because it does represent a percentage of women who aren't sure what a glass of wine technically is!
ReplyDeleteThis is very interesting Ashleigh! It makes me wonder how people with poor health literacy would respond to the statements in the book. We talked a lot about the potential negative effects of poor health literacy and the need for nurses to adjust our care to accommodate the needs of all patients. It seems as if this would be a challenging concept for high literacy Americans, let alone low literacy Americans or people from other countries. Also, to tie in Molly's post, my family also drank once and a while pregnant and all their children were born without complications. Regardless, I agree that education is needed on what "drinking lightly" means while a woman is pregnant.
ReplyDelete