Thursday 15 November 2018

Drinking when pregnant: Is it harmless or an act of denial?

With 80 per cent of women in Ireland admitting to drinking alcohol when pregnant, Aoife Stuart Madge asks if we are ignoring the risks.

WOMEN who are better off and well educated are more likely to drink alcohol while pregnant, despite the health risks, a new report reveals today
Clare Reilly and Annie
Allison Keating
Eleanor McAlister and her family

Aoife Stuart Madge

As a doctor and first-time mother, Maria 35, from County Down, wants to do everything in her power to give her 18-month-old son the best start in life.

While pregnant, she read up on all the childcare and pregnancy manuals, baby-proofed her home and made sure the nursery was decked out in the very best baby gear. Controversially, she also drank - not excessively - but just a couple of glasses a week over dinner. "I enjoy unwinding with a glass of wine and didn't see why I had to sacrifice that just because I was pregnant," she says.

And Maria is not alone. Increasingly Irish women are breaking the biggest pregnancy taboo and partaking in a drink or two - and it's educated women like Maria who are leading the charge.

Last year, a study funded by the Health Research Board found that 80pc of Irish women drank at some point during their pregnancy; while a separate study in 2010, titled Growing Up in Ireland, found that women with the highest levels of education are most likely to consume alcohol during pregnancy.

Read more: Drinking in pregnancy could be made criminal offence in the UK

Maria is quick to point out that it is not a case of choosing to ignore official health warnings (earlier this year, the country's three largest maternity hospitals, The National Maternity Hospital, The Rotunda Hospital and the Coombe Women & Infants University Hospital, joined forces with Alcohol Action Ireland to launch a campaign in an attempt to tackle the problem), which advocate avoiding alcohol during pregnancy. Rather, it's an informed choice, she insists, and one she is capable of making. "I'm a GP, so I am well-placed to know what is responsible drinking. I've done my research, and I know that a unit a day or the odd glass of wine does no harm to an unborn baby."

WOMEN who are better off and well educated are more likely to drink alcohol while pregnant, despite the health risks, a new report reveals today
WOMEN who are better off and well educated are more likely to drink alcohol while pregnant, despite the health risks, a new report reveals today

As a health care professional, Maria may be well-placed to know what constitutes a safe level of alcohol for her to consume during pregnancy, but Dr Aoife Mullally, a consultant obstetrician/gynaecologist at the Coombe Women & Infants University Hospital says that for most expectant women, the facts are blurred. "There is a lot of confusion out there because women are getting conflicting advice from their health care professionals and even from their peers and their family," she says.

Read more: Gestational diabetes: the facts

Part of the problem is that at the same time as Irish health officials are issuing warnings to pregnant women to abstain from drinking altogether, conflicting reports emerge which claim that low levels of alcohol during pregnancy are safe. Take the 2012 Danish study of 1,628 pregnant women, published in the British Journal of Obstetrics and Gynaecology, which found that a small alcoholic drink a day had no affect on a growing baby. A previous study by the Royal College of Obstetricians and Gynaecologists concluded that low to moderate drinking (10.5 units or seven glasses of wine a week) showed no adverse affects on a baby's development.

There have even been studies to suggest that the children of mothers who drank moderately throughout pregnancy had a higher IQ than those that abstained. It's hardly surprising then that women - especially those going through such an emotionally exhausting and anxious time as pregnancy - are reaching for a glass of wine to relax.

However, Dr Mullally warns that what is regarded as moderate levels of alcohol consumption during pregnancy is a grey area, especially in the age of three-unit wine measures (not to mention generous home measures). With so much conflicting information out there, it's easy to get misled (am I allowed two or three units? And was it once or twice a week?)

"There is no good evidence to suggest that having the occasional drink or even drinking continually at low levels during pregnancy is harmful," explains Dr Mullally. "But the problem is there is no known 'safe' level. Women also under-report how much they drink, and one person's idea of a unit, glass or measure of alcohol may vary. There are some babies that are more sensitive to the effects of alcohol than others, and there is no way of telling if your baby will be affected."

Read more: Forty shades of green

And when you consider the potentially devastating effects of alcohol misuse during pregnancy, there is little room for error. Most women who have considered drinking in pregnancy are aware of Foetal Alcohol Syndrome (FAS), which is characterised by distinctive features: small and narrow eyes, a small head, a smooth area between the nose and the lips and a thin upper lip.

According to Dublin-based alcohol abuse charity the Hanly Centre, between 177 and 354 babies are born each year in Ireland with FAS, while the number of babies being born with FAS in the UK has risen 40pc in the last three years. But while the recorded incidences of FAS are relatively rare, the figures may be deceptive. It's estimated by the Hanly Centre that the number of cases in Ireland increases to 1,770 annually, if you factor in all alcohol-related neurological disorders.

Alcohol has a spectrum of effects on pregnancy, explains Mary Brosnan, Director of Midwifery and Nursing at The National Maternity Hospital. "The term Foetal Alcohol Spectrum Disorder (FASD) describes the range of alcohol effects on a child. The problems range from mild to severe. Alcohol can cause a child to have physical or mental problems that may last all of his or her life," she says.

"Aside from distinctive facial features, a child may have growth problems and there are linkages with impairment of brain development and behavioural and learning problems with children as they grow older." These can include more subtle behavioural and neurological problems, such as attention deficit disorder, problems with decision-making and problems with socialising.

The spotlight was firmly on FAS last month with the news that a local authority in the north west of England is seeking criminal injuries compensation for a six-year-old girl in care who has 'growth retardation' caused by her mother's alcohol consumption during pregnancy. If the Court of Appeal agrees that the mother committed a crime, the ruling could lead to the criminalisation of alcohol consumption during pregnancy.

Read more: Dr. Ciara Kelly: 'Breast is best for baby and mother

It's worth noting that it's not just pregnant women who are drinking more - we are drinking more as a country. According to Alcohol Ireland, 14,000 people are admitted to hospital for treatment for alcohol dependency every year while St Vincent's Hospital in Dublin has reported a 335pc increase in admissions with alcoholic liver disease between 1995 and 2010. Let's face it, most Irish women drink habitually, but do pregnant women need to pay more attention to that large glass of pinot with lunch or that warming glass of red at Christmas time?

In the US, only 22pc of women drink during pregnancy, almost a quarter of the percentage of Irish women, perhaps because drinking is not so culturally widespread in America, but also because our US cousins hammer home the affects of Foetal Alcohol Syndrome in hard-hitting public service announcements, with a similar shock value to our drink-driving adverts.

A recent USA anti-prenatal drink campaign shows a small girl taking a bar stool beside a 30-something woman, telling the barman, "I'll have what she's having." This is followed by a solemn reminder from the voiceover that, "Pregnant women never drink alone."

Dr Mullally sees these campaigns as a more effective way of educating women, rather than criminalisation. "In the UK and Ireland we haven't been very good at getting the message out there about the kind of problems drinking in pregnancy can cause, whereas in the US, they have been much better at naming the specific problems. If we did have more targeted messages like that, I think that would be more helpful than criminalising drinking in pregnancy," says Dr Mullally.

Let's face it, no mother wants to deliberately harm her child, and the majority of Irish mothers who are drinking during pregnancy are not reckless or uninformed. In fact, according to Growing Up In Ireland, the demographic most likely to drink during pregnancy are university-educated mothers in their 30s - the same group most likely to breastfeed and to give up smoking when pregnant. They know the effects binge-drinking can have on an unborn baby. But do they need a wake-up call when it comes to moderate drinking during pregnancy too? Mary seems to think so.

She warns: "Due to the emerging evidence of even small amounts of alcohol having a negative effect, we always advise abstinence as the best option. What is very clear is that there are no benefits for the unborn child from exposure to alcohol, just risks."

As far as Anna is concerned, she would like more trust given to women to judge what is right for them, and that they know how to drink responsibly. "Making pregnant women feel guilty, scaremongering them or patronising them is not the answer. We need to educate mums and give them access to all the information so they can do their own research and make their own informed choice."

'I enjoyed a glass (or three) when I was pregnant'

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Clare Reilly and Annie

Clare Reilly, 35, a freelance writer, is mum to Eddie, 10, Sammy, 6 and Annie, 3. She drank moderately throughout all her pregnancies.

"I'm not some selfish woman who doesn't care about the health of her children. In fact, you'll struggle to find anyone who isn't a doctor who knows more about drinking during pregnancy than me. I'm a proud mother of three wonderfully healthy, happy and smart children. I drank through each of their pregnancies, mostly one glass of wine in the evening after dinner but, sometimes - if it was a special occasion - I would have two or three over the course of a meal. I'm not advocating that pregnant women get drunk, just that they be allowed to drink responsibly.

"I've read practically every piece of literature and study on the effects of drinking during pregnancy and have come to the educated conclusion that my alcohol intake during each of my three pregnancies has not adversely affected any of my three children. Like most mothers, I'm aware of Foetal Alcohol Syndrome, but the studies used to scare us away from alcohol are all based on results from heavy drinkers and alcoholic mothers-to-be.

"Pregnant women aren't trusted to know when light-to-moderate drinking stops and heavy drinking begins. I've been fortunate enough to have all three doctors I've seen through each of my pregnancies tell me the truth; the current medical advice to abstain entirely comes from the medical profession's distrust for the public."

Allison Keating is a psychologist at the Bwell Clinic in Dublin

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Allison Keating

She says: "We have a dysfunctional relationship with alcohol in general Ireland. Women as a whole are drinking more, and it's an issue for 30-something women in particular. Stressed working mothers are struggling, and feeling anxious and overwhelmed trying to balance careers with family life. Pregnancy is an anxious time anyway. You can feel very tired and you are having massive hormonal surges up and down, so you can understand why someone wants to sit down at the end of the day, have a glass of wine and watch some TV. That becomes their only out.

"There is also a lot of pressure that comes from other people. Drinking alcohol is considered so normal that it is nearly unacceptable to not have a drink. It makes other people uncomfortable. There is a lot of projection going on, so if one pregnant woman sees another pregnant woman not drinking, it makes them feel uncomfortable.

"Middle class, educated pregnant women tend to get a lot of their information from their peers. It's common to hear people say, 'Well, my consultant said it was fine to have one.' Then that anecdotal evidence becomes fact. People then think, 'Sure I'll only have one.' Most women know the effects of serious drinking and about FAS, and that is very much frowned upon, but perhaps we need to sit back and think, 'Do I really need that glass?' It's important to open your mind and make sure you are not just taking information from your peer group when it comes to the good health of your baby.

Read more: Older parents make for happier mums and dads

"Being pregnant is a big sacrifice and it takes a lot of effort. We are living in a society where people are harried and stressed.

"Pregnant women need something else to relax. The best thing is to go out for a 20-minute walk to clear your brain completely. Learn techniques to use your five senses to soothe yourself: the taste of a cup of tea, the texture of a body lotion, the scent of a candle...

"These are simple things you can do at home. Women will always put family first, and that's where alcohol creeps in and has a negative effect. Instead, consciously take 10 minutes to half an hour at the end of the day for yourself, to wind down and reconnect with yourself."

'Drinking while pregnant is not worth the risk'

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Eleanor McAlister and her family

Eleanor McAlister, 33, a teacher, is mum to Cara, 2, and Ben, 10 months. She didn’t drink at all throughout any of her pregnancies.

“When my first pregnancy ended in miscarriage, it impressed on me the fragility of pregnancy — sometimes it goes away for no known reason and leaves you feeling shattered and empty. So when I found out I was pregnant again with Cara I was willing to make sacrifices to ensure the health of my baby.

"Any risk, no matter how small, is too big a risk for me. In the same way I cut out blue unpasteurised cheeses, shell fish, eggs with runny yolks to name a few, I also cut out alcohol. To be honest it didn’t seem like that big a deal for me. I think I’ll have plenty of time to enjoy a glass of wine in my life and only a short time to be pregnant.

Read more: How to ease back into exercise after having a baby

“I am aware that a lot of women have a glass or two of wine during pregnancy and that is their choice. In fact, everyone insisted on reminding me when I refused a drink at social occasions that ‘you’re allowed one!’ Some people seemed to think that by my refusing to drink I was judging their choice to have a glass of wine.

"To be clear, I’m not. I made my own choice. When I fell pregnant with my second child, Ben, I made the same choice again. While there is a lot of conflicting information and arguments around this subject, I felt that an unknown risk wasn’t one I was willing to take.”

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