The big problem with the CDC’s alcohol recommendations — besides the sexism

Pregnant woman with red wine

Many are rightfully upset with the CDC’s heavy handed alcohol recommendations for women of childbearing age. But as big a problem as the obvious sexism in the recommendations is — women (but not men) must not drink alcohol in order to avoid unintended pregnancy, women (but not men) must be using contraception before they take a drink, and, most egregiously, women (but not men) must abstain in order to avoid domestic violence — there’s an even bigger problem. It is a problem that afflicts many preventive recommendations issued by medical organizations: the recommendations are far out in front of the actual scientific evidence.

The biggest problem with the CDC’s alcohol recommendations for women of childbearing age is that they aren’t science; they’re supposition. The CDC doesn’t “do nuance” and if there was ever a need for nuance it is in regard to the issue of alcohol in pregnancy.

[pullquote align=”right” cite=”” link=”” color=”#FE7295″ class=”” size=””]What’s the relationship between alcohol consumption in pregnancy and FAS? We don’t know.[/pullquote]

According to the CDC:

Alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy.

The CDC’s recommendation is based on a scientific fact:

No one knows how low alcohol consumption in pregnancy must be in order to limit problems like fetal alcohol syndrome (FAS).

But instead of explaining why no one knows, the CDC decided to portray any amount of alcohol at any point in pregnancy as having a high potential to cause harm. Instead of explaining the nuances of research in this area, the CDC chose to portray the science as settled when it is anything but.

Why can’t we determine if there is a low level of alcohol consumption that is safe in pregnancy?

Nuance #1: There is no reliable relationship between drinking in pregnancy and FAS. Sure, large amounts of alcohol can lead to FAS, but many women drink moderately without any apparent harm to the developing child. Researchers have noted the “American paradox.” Though alcohol consumption per capita (among women and men) is much higher in European countries than in the US, the incidence of FAS is much lower there. Drinking wine with meals is widespread in Europe, so many women are drinking before they know they are pregnant and when they are pregnant, yet the incidence of FAS is just a fraction of what it is here. Perhaps FAS is more common with some forms of alcohol than with others; we don’t know.

Nuance #2: The likelihood of developing FAS depends on maternal genetics. Some ethnic groups (like Native Americans) have a much higher incidence of FAS than other ethnic groups even when comparable amounts of alcohol are consumed. In other words, some ethnic groups are “prone” to FAS while others are not.

Nuance #3: The likelihood of developing FAS also depends on fetal genetics. A study of twin pregnancy in heavy drinkers revealed an extraordinary finding; while there was 100% concordance among identical twins (if one had FAS, the other did, too), there was less than 70% concordance for fraternal twins:

… Sixteen pairs of twins, 5 MZ [monzygotic] and 11 DZ [dizygotic], all heavily exposed to alcohol prenatally, were evaluated. They represented all available twins of alcohol-abusing mothers who were on the patient rolls of the authors. The rate of concordance for diagnosis was 5/5 for MZ and 7/11 for DZ twins. In two DZ pairs, one twin had fetal alcohol syndrome (FAS), while the other had fetal alcohol effects (FAE). In 2 other DZ pairs, one twin had no diagnosis while one had FAE. IQ scores were most similar within pairs of MZ twins and least similar within pairs of DZ twins discordant for diagnosis.

So what’s the relationship between alcohol consumption in pregnancy and FAS? We don’t know.

The CDC transmuted uncertainty into certainty. Instead of acknowledging that we don’t know the safe limit of alcohol consumption in pregnancy because it depends on factors that we don’t yet understand, the CDC chose to state with certainty that NO amount of alcohol consumption is safe in pregnancy and that is almost certainly not true.

Instead of speaking to women as adults —we’re not sure of the relationship between alcohol and FAS, so we can’t tell you whether there is a safe level of alcohol — the CDC chose to speak to women as if they were children — don’t drink unless you’re using birth control, because we said so.

The CDC’s sexism in its recommendations is inexcusable, but the lack of nuance in the recommendations is hardly much better. When a public health organization doesn’t know the answer, they should acknowledge that they don’t know instead of getting out in front of the science and issuing definitive recommendations that may actually be wrong.

266 Responses to “The big problem with the CDC’s alcohol recommendations — besides the sexism”

  1. icastico
    May 15, 2017 at 12:31 pm #

    Without getting into the science of this, and without trying to defend the CDC’s ham-fisted wording, your post here misses the logic of risk assessment in the face of unknown risk. The reason for the “no known safe limit” information is because that is the most accurate information to share, particularly when to you are faced with making a decision about your own child. Because there are multiple factors that determine the risk of FAS or another Fetal Alcohol Spectrum Disorder (FASD), making an informed risk assessment for an individual mother is currently impossible. What is known is that there are children born after fairly low levels of exposure who end up with full-blown FAS, which includes severe CNS abnormalities, and growth deficiency. The mother faced with deciding what level of moderation will be safe for her child needs to know that there is a chance that they and their child are among those that are more highly susceptible to the damage that alcohol causes – for the reasons you list above. A very user friendly discussion of this with more of the numbers can be found here. and those interested in some of the more current science on the issue can go here

  2. Felicitasz
    February 12, 2016 at 4:15 pm #

    Oh great, THANK YOU for this piece.

  3. Amy
    February 10, 2016 at 9:18 pm #

    I’m not a medical professional, so there’s a good chance I’m wrong here, but….

    Can a mother’s alcohol consumption have ANY effect on the developing (at that point) embryo when there’s no placenta and the yolk sac is still providing nourishment? How would any alcohol even get to the baby at that point?

  4. demodocus
    February 10, 2016 at 3:10 pm #

    I have to say, i hope whatever is in that wine glass the lady is holding is *not* wine, ’cause that’s an unnatural color for wine.

    • Amy
      February 10, 2016 at 9:19 pm #

      Maybe it’s Arbor Mist.

    • Roadstergal
      February 17, 2016 at 11:44 am #

      It’s the same stuff they put in erlenmeyer flasks for Sciencey Lab Scenes in movies.

      • demodocus
        February 17, 2016 at 12:47 pm #

        All that red food dye. Just breathing the fumes will probably cause her baby problems. 😉

  5. Hannah
    February 10, 2016 at 2:11 pm #

    I wouldn’t go comparing Europe’s and the USA’s FAS rates at all, to be honest. America has a much bigger push towards diagnosis as part of treatment. so many kids over here with FAS are just ‘delayed’ or ‘have a learning disability’ and that’s it, no specifying WHICH learning disability it is. So the ‘rates’ of FAS in Europe are entirely likely not accurate and a significant underestimate.

    Everything else though, I agree with you on 🙂

    • Mom2Many
      February 10, 2016 at 6:08 pm #

      I also wonder if it is easier to call it a learning disability, rather than putting the FASD label on it. Being delayed could stem from a myriad of reasons, while it is my understanding that FASD implies ‘guilt’ on the part of the mom. As a doctor, perhaps it is kinder to leave it undiagnosed?

  6. Commander30
    February 10, 2016 at 12:58 pm #

    I was hoping you’d tackle this study. It pissed me off to no end when I first read it. Way to treat women as nothing but potential baby-making factories.

    And since a lot of people are “confessing”, I drank a bit in that time frame between conception and learning I was pregnant, and I think I might have had a sip or two of wine during my pregnancy as well. Baby is fine.

  7. demodocus
    February 10, 2016 at 9:16 am #

    OT: Interesting Zika article posted this morning on SBM. Novella says that although there’s only correlation between Zika and microcephaly, but it still seems the most likely candidate.
    Posting here because the first of the anti-vaxxers have found the 2nd zika post, and it probably won’t be long before they descend en masse

    • Sarah
      February 10, 2016 at 11:26 am #

      Umm, zika is caused by epidurals. Both sides are wrong.

      • Roadstergal
        February 10, 2016 at 11:27 am #

        Microcephaly is caused by epidurals. Yes, the timeline is off, but they’re so evil they go back in time even better than Zika does.

    • Gatita
      February 10, 2016 at 1:34 pm #

      Damn that’s a depressing blog post. The description of the type of microcephaly that Zika causes is awful.

      • demodocus
        February 10, 2016 at 1:57 pm #

        It is pretty scary. I almost hope it were something as easy to fix as a bad batch of vaccines, but seems pretty damned unlikely.

        • Megan
          February 10, 2016 at 2:07 pm #

          What makes it even more scary is that it is possible to be transmitted sexually. Now its a whole new ballgame than just a mosquito-borne illness. Very scary…

          • Busbus
            February 17, 2016 at 11:40 am #

            What I still don’t understand is whether the real danger lies in becoming infected while being pregnant, or whether any infection—even past infections—put the baby at risk. I hope it’s the former as that would be somewhat easier to control.

  8. Who?
    February 10, 2016 at 1:38 am #

    This is off topic, and I really don’t know what to think about it, but unless it goes viral on some social media platform whose name I don’t know, you’ll all miss it.

    And I think that would be a shame.

    This may win the ‘Golden Boob’ ‘Projection’ category.

    For me the look on the orangutan’s face says it all.

    • CSN0116
      February 10, 2016 at 7:40 am #

      “I felt so proud and I felt she was proud of me and … I don’t know. It was just amazing.”

      Because an orangutan nodded at her? They nod their heads and throw them backward-like all the time. But whatever makes mom feel like the special snowflake that she is.


      • Who?
        February 10, 2016 at 7:55 am #

        I think the orangutan moved its head, like orangutans do.

        No affirmation.

        Like I said, nothing to make of it other than ‘slow news day’ and, as you so aptly put it JFC. Or, as the kids say WTF.

    • Allie P
      February 10, 2016 at 9:36 am #

      IMO, primates are commonly fascinated by babies in their enclosures. I used to work at a primate exhibit at a zoo, and they’d often come round to look at babies if they were out of strollers or carriers and therefore visible and doing something. Shocking — everyone likes babies. They also liked service animals, especially if they were puppies.

      • Allie P
        February 10, 2016 at 10:05 am #

        Which is not to say the interspecies interactions aren’t good and meaningful. It is enriching for the captive animals and educational for the human ones. I loved to have “moments” with the animals. That’s a big reason for zoos. I would have been tickled pink to have a private moment with some orangs.

        • Sarah
          February 10, 2016 at 11:20 am #

          I remember going to a zoo with one of mine when she was about 18 months, and looking at a lioness with her cub. The lioness was gazing right into my eyes. I may be anthromorphising terribly, and I know nothing about lions anyway, but I got the distinct impression she recognised that we were a mother child pairing just as she and her cub were.

          • Roadstergal
            February 10, 2016 at 11:22 am #

            Whenever a predatory animal looks at me like that, I always feel like it’s deciding how tasty I am.

          • Sarah
            February 10, 2016 at 11:23 am #

            I’ve had that with lions before! In fact I normally don’t like being near them with my kids when they’re roaring, even with a great big fuckoff fence between us. But not this particular lion. I guess because they’d not long been fed either.

          • Roadstergal
            February 10, 2016 at 11:24 am #

            Ha, along these lines… one of my favorite poems is Billy Collins’s The Revenant. A lot of folk think it’s horrible, but I like it as a warning to myself that what I think an animal is thinking might be 100% off…

          • Sarah
            February 10, 2016 at 11:27 am #

            I haven’t read it, I’m going to assume it’s about zoo animals having very strong feelings about breast v formula.

          • Roadstergal
            February 10, 2016 at 11:31 am #

            Is there any other topic worth discussing?

            The Revenant
            by Billy Collins

            I am the dog you put to sleep,
            as you like to call the needle of oblivion,
            come back to tell you this simple thing:
            I never liked you – not one bit.

            When I licked your face,
            I thought of biting off your nose.
            When I watched you toweling yourself dry,
            I wanted to leap and unman you with a snap.

            I resented the way you moved,
            your lack of animal grace,
            the way you would sit in a chair and eat,
            a napkin on your lap, knife in your hand.

            I would have run away,
            but I was too weak, a trick you taught me
            while I was learning to sit and heel,
            and – greatest of insults – shake hands without a hand.

            I admit the sight of the leash
            would excite me
            but only because it meant I was about
            to smell things you had never touched.

            You do not want to believe this,
            but I have no reason to lie.
            I hated the car, the rubber toys,
            disliked your friends and, worse, your relatives.

            The jingling of my tags drove me mad.
            You always scratched me in the wrong place.
            All I ever wanted from you
            was food and fresh water in my metal bowls.

            While you slept, I watched you breathe
            as the moon rose in the sky.
            It took all my strength
            not to raise my head and howl.

            Now I am free of the collar,
            the yellow raincoat, monogrammed sweater,
            the absurdity of your lawn,
            and that is all you need to know about this place

            except what you already supposed
            and are glad it did not happen sooner –
            that everyone here can read and write,
            the dogs in poetry, the cats and the others in prose.

          • Sarah
            February 10, 2016 at 11:33 am #

            Actually I would say that’s probably about vaccination. And baby led weaning.

          • Gatita
            February 10, 2016 at 1:36 pm #

            There are several videos on YouTube of lions trying to get at toddlers through a glass enclosure. “Oh, you brought me a snack? But you need to hand it to me. There’s a slot in this window, right?”

          • TheArtistFormerlyKnownAsYoya
            February 10, 2016 at 4:27 pm #

            Last time a lion stared at me from the zoo I’m certain he was saying “I would so eat you if this wall wasn’t here”.

          • Mariana
            February 13, 2016 at 2:08 pm #

            Me too!

      • Gatita
        February 10, 2016 at 1:38 pm #

        I spoke with someone who works with orangs at our local zoo and she described them as incredibly intelligent and incredibly patient. They would study their enclosures for hours a day and then suddenly execute a Houdini escape. Chimps, otoh, are also smart but completely ADD and can be distracted by anything shiny and new.

    • Sarah
      February 10, 2016 at 11:21 am #

      Nah, orangutans are well known for being very against formula feeding. I got shamed by one the other week when I was trying to bottlefeed at the shops.

  9. BeatriceC
    February 9, 2016 at 10:29 pm #

    On the topic of “a lot” being different from woman to woman, here’s a recent conversation between me and MrC:

    Me: I need beer, and a lot of it.
    MrC: that bad of a day?
    Me: Maybe.
    MrC: By a lot, do you mean normal people amounts or you amounts?
    Me: Me amounts. I might even drink a whole beer tonight!

    I rarely drink more than a half a beer. It’s sort of like dessert. I like expensive stuff and savor every drop.

    Also, random bird picture. I think he’s happy here.

  10. An Actual Attorney
    February 9, 2016 at 10:14 pm #

    OT, and random. Any thoughts about the best hospital in the Raleigh area to give birth at 34 weeks? Purely theoretical.

    • J.B.
      February 10, 2016 at 10:40 am #

      A friend chose Wake Med (big wake on New Bern Ave) for the NICU. They got great care. Best wishes.

      • An Actual Attorney
        February 10, 2016 at 11:00 am #

        Thanks. Last work trip of the pregnancy, and I like to have contingency plans.

        • demodocus
          February 10, 2016 at 12:22 pm #

          I hear you. My stepmother said (in Dad’s obit) that the funeral would be “in spring”. i’m due mid june, so…

  11. StephanieA
    February 9, 2016 at 8:54 pm #

    My first son wasn’t planned. The month he was conceived I drank heavily two weekends. I got a positive test at 5 weeks and didn’t drink the rest of the pregnancy. My son is just fine, but I still feel guilty about that month.

    • Toni35
      February 10, 2016 at 12:32 pm #

      My second child was very much planned; we’d been trying for about 6 months. My husband and i were invited to dinner at a friend’s house the evening of the day I was due for my next period. So, being a responsible person (contrary to what the CDC thinks about women, apparently), I took an early pregnancy test. It was negative. I had a 4 beers, and a couple of shots that night. A week later, my period was still MIA, and cleaning up my oldest child’s ABC cheerios made my stomach turn…. very unusual for me; I’m not easily grossed out. That afternoon I went and bought another EPT – it was positive. I was worried, but everything went well and she is now a gorgeous, smart, funny, perfectly healthy 6 year old 🙂 I never really felt guilty about it – I really thought I wasn’t pregnant. Shit happens. BC isn’t perfect, pregnancy tests aren’t perfect… I think as long as you abstain or limit yourself to an occasional small drink (I’ve enjoyed a small amount of wine on special occasions with each one of my four pregnancies; after the first trimester queasies go away!) it really isn’t as much of an issue as they make it out to be. Chronic and/or heavy drinking is one thing, telling women to avoid alcohol until menopause is something else.

      • Toni35
        February 10, 2016 at 12:34 pm #

        Sorry, should have read: I think as long as you abstain or limit yourself to an occasional small drink *once you are aware you are pregnant*…

  12. Sue
    February 9, 2016 at 7:56 pm #

    In the interests of public health and safety, I suggest a guideline that recommends that men abstain completely from alcohol from puberty to the age of 65.

    Imagine how many road fatalities, assaults and episodes of domestic violence would be prevented!

    (Oh – and there is no known ‘100%safe’ level of consumption, so abstinence is the only rational solution).

  13. CSN0116
    February 9, 2016 at 7:37 pm #

    As if anti-vaxxers need another reason to dismiss the CDC. #waytodroptheballcdc

    Unrelated but promised 🙂 (Thank you Dr. T for the link to purchase)

  14. SF Mom & Psychologist
    February 9, 2016 at 6:05 pm #

    What about the yolk sac? I nervously “confessed” to my OBGYN that I had gone out celebrating before I knew I was pregnant. She told me not to worry because the embryo was being nourished by the yolk sac in the first few weeks, before the placenta is formed. She explained that this is nature’s way of protecting the embryo from what mother consumes in those first few weeks before a period is missed, before we know we are pregnant. Is this accurate?

    • Rachele Willoughby
      February 9, 2016 at 6:13 pm #

      And what about the first ten-ish days after conception before the embryo even implants in the uterine wall?

    • mostlyclueless
      February 9, 2016 at 7:41 pm #

      I don’t see how that would prevent transferring alcohol to the embryo. Presumably folic acid makes its way from the mother’s diet to the embryo well before the placenta forms, so why wouldn’t alcohol?

  15. Jules B
    February 9, 2016 at 6:05 pm #

    I can kind of understand public health orgs being black-and-white in their front line communications, in order to avoid potential confusion for the lowest common denominator, but what I really wanted when I was pregnant four years ago was some reliable source I could turn to regarding the actual current known risks. Some type of “further reading” thing with reliable data if someone wanted to know more. For example, a few times I did something/ingested something that I found out after the fact was considered “potentially harmful.” I lost a lot of sleep over those incidences, and all I wanted were some reliable stats that could tell me my risk was 1 in X versus just saying that, say, getting a pedicure was maybe-dangerous-maybe-not-but-we-are-not-sure-so-better-safe-than-sorry-so-don’t-do-it. Like, how is that helpful when I have already accidentally done the thing?? Which I think is VERY easy to do, because again, there is SO MUCH that “might” be harmful, it is genuinely hard to remember it all. Especially with pregnancy brain!

    • Madtowngirl
      February 9, 2016 at 6:29 pm #

      And so much that isn’t harmful at all, but keeps being perpetuated as such, like dying your hair.

      • Jules B
        February 9, 2016 at 6:45 pm #

        Yes exactly. It was challenging sometimes to distinguish the folk-tale or partly-true type stuff from the actual potentially-harmful things. Someone I respected and thought knew a lot about pregnancy and babies told me that I shouldn’t even have my cat in the house while I was preggo, not just avoid the litterbox. She suggested I give my cat away! (I didn’t, but I sure did some panicky Googling after that convo.)

        • Allie
          February 11, 2016 at 5:09 pm #

          I had my poor old cat tested twice for toxoplasmosis while I was pregnant. She was negative both times, which kind of put me at ease because I figured if she hadn’t gotten it by then (almost 20!) she was unlikely to get it while I was pregnant, especially since her hunting had been curtailed by a gradual loss of most of her teeth. Of course, as Murphy’s law would have it, she got real sick while I was pregnant and had to have a litter box for the first time in years. I was just extra careful and about washed the top layer of my epidermis off several times a day. A friend’s daughter is a veterinarian and I just learned she is pregnant. I doubt she has banned cats from her practice : )

    • Allie
      February 10, 2016 at 12:26 pm #

      Yes! I remember once having an anxiety attack because I ate some soft cheese at a restaurant and convinced myself it could have been unpasteurized. Seems silly when I think back on it, but I still remember how anxious I was about everything. Women don’t need more fear-mongering, just reliable, evidence-based information.

  16. Madtowngirl
    February 9, 2016 at 5:23 pm #

    A bit OT, but also semi-relevant:

    I’ve had quite a few X-rays in my time. Here in the U.S., I’ve always been given a lead apron, even before I had begun menstruating. I happened to break my leg while living in Japan, and the tech walked out of the room and I panicked because I hadn’t been given the apron. After some attempts to explain, he reluctantly gave it to me. My boss freaked out and asked if I was pregnant- I wasn’t. Apparently it’s not standard practice to use the apron there, unless one is, or could be, pregnant. Is this another example of being overly cautious?

    • Roadstergal
      February 9, 2016 at 5:26 pm #

      Whenever I go for an X-ray, they put a lead apron over my womb, but nothing over my head.

      • KeeperOfTheBooks
        February 9, 2016 at 9:05 pm #


      • Who?
        February 9, 2016 at 9:25 pm #

        What is that about?

        There’s a joke in there somewhere about the relationship between brains and gonads, but today I can’t find it.

    • demodocus
      February 9, 2016 at 5:26 pm #

      Dunno. I know they put a lot of lead on kiddo when they were giving him xrays this summer. ‘Course we are in the US and the first batch were of his entire body on section at a time. (checking for other breaks and/or signs of abuse, i imagine.)

    • CharlotteB
      February 9, 2016 at 6:53 pm #

      I’m a twin, and back in the early 80s when I was born, apparently my mom’s doctor didn’t have easy access to an ultrasound machine. So guess how they confirmed the twin pregnancy? Yes, yes, X-Ray. On my 30-weeks pregnant mother. I guess the tech was freaking out, but we were fine! (Well, normal-fine anyway. )

      I really wish my mom had the image because I bet it was SUPER cool looking.

      • Megan
        February 9, 2016 at 7:03 pm #

        I’ll never forget as a resident when a women came in after a car accident around 36 weeks and to rule out internal injuries, the trauma team got a cat scan of the chest, abdomen and pelvis. The reconstructed 3D image was so cool. Fortunately the mom and baby were both also fine. I was on OB at the time and monitored them overnight. If I were that mom I would’ve wanted a CD of that cat scan!

        • Puffin
          February 9, 2016 at 10:52 pm #

          I LOVE those 3D CT reconstructions of pregnant women. Obviously not done unless absolutely necessary, but they are so amazing. I’ve seen foetal MRIs for prenatal diagnosis of certain defects and those are just outstanding.

          There’s a number of these on Figure1, which is an educational image-sharing app for medical professionals. I’m a med student and I have learned a LOT on Figure 1.

      • Medwife
        February 9, 2016 at 8:39 pm #

        Yup, that’s how they confirmed I was breech. X-ray. Then I had hip dysplasia, and who knows how many x-rays I got during that diagnosis and treatment, right around the ol’baby makers.

      • February 10, 2016 at 5:11 am #

        Prior to ultrasound, X-rays were the only way to confirm multiple pregnancies or malpresentations. Generally speaking, even if a problem was discovered early on, doctors would delay, for as long as possible, doing the X-ray to be as close to term as they could get. What always worried me was the HUGE amount Of exposure premies got in the NICU — X-ray was the only way to be sure that feeding tubes/intubation for ventilation, etc. was where it should be. I don’t know if followup was ever done to see if there was damage from this.

    • HappyMom
      February 10, 2016 at 2:19 am #

      We took one of our 16mo twins for an X-ray two weeks ago. They didn’t put a lead apron on her, but handed one to dh to put on. I was startled and I asked how come, and he asked when he returned the following week. She said the very small amount of radiation is aimed directly where they take the pic. It’s just actually for the comfort of the patient, or the parents. At one time that would have worried me, but I’m now a reformed crunchy, and I trust the professionals.

    • Sarah
      February 10, 2016 at 11:25 am #

      I suppose everyone is fertile for the first time a couple of weeks before they begin menstruating.

  17. Spamamander
    February 9, 2016 at 4:32 pm #

    After my amnio with kidlet #3 the doctor told me to go home and have a glass of wine to relax the uterine wall and such. HORRORS!

    • KeeperOfTheBooks
      February 9, 2016 at 9:05 pm #

      I like your doctor.

    • attitude devant
      February 10, 2016 at 12:10 pm #

      I had premature labor at 28 weeks with #2. This was decades ago. Was treated with everything we used at that time…..and we used a LOT of stuff we no longer use….but when I had breakthrough contractions I had a standing recommendation from my partners to have a beer. I kid you not.

  18. CharlotteB
    February 9, 2016 at 4:24 pm #

    I’ve been pondering this whole thing since it came out, and there’s another undercurrent I don’t like–and that is that somehow it’s the Worst! Thing! Ever! to have a baby who ends up with learning disabilities or difficulty concentrating, etc. etc. I obviously understand that no (or almost no) mothers wants to do anything that would potentially damage her child, but kids are allowed to be human, you know? And have issues or problems or learning disabilities–I’m not saying it’s ideal, necessarily, just that I really dislike the idea that if we do everything “right” we’ll have a perfect baby. Um, no, we’ll have a little human with all that entails.

    And for everybody who says “It’s only 9 months! Surely you can do (or avoid doing) X for 9 months!!” That’s a school year. I know this because I got a positive pregnancy test on the first day of fall quarter, and had my son during finals week of spring quarter–I was a teaching assistant, and had him on the day of the final. (Thank God I was the TA and it was an online class!) My trimesters lined up pretty much perfectly with the quarters. Anyway, point being–if you had to, oh, skip 11th grade because of mono, for example, people would see that it was a BIG DEAL. But if you’re pregnant? It’s “only” 9 months!

    • Spamamander
      February 9, 2016 at 4:34 pm #

      Kind of like the woman who asked what I “did” during my pregnancy to “cause” my daughter’s Down syndrome?

      • CharlotteB
        February 9, 2016 at 4:39 pm #

        Oh my God.

        • Spamamander
          February 9, 2016 at 4:45 pm #

          Amazingly, I didn’t end up in jail for assault. This was after she asked what was “wrong” with her eyes and i explained she had DS…

          • KeeperOfTheBooks
            February 9, 2016 at 5:03 pm #

            No jury of your peers would have convicted you.

          • Puffin
            February 9, 2016 at 10:56 pm #

            You have more restraint than I would have. Wow.

      • BeatriceC
        February 9, 2016 at 5:17 pm #

        Been there. I’ve been told I must have somehow caused the boys’ disabilities. Nope. It’s a mutation of a particular allele, and it was passed down by their father. What I “did” was allow one of the affected sperm to fertilize one of my eggs. It’s a dominant gene, so I had a 50-50 shot if I did it the old fashioned way.

      • Gatita
        February 9, 2016 at 6:06 pm #

        What. An. ASSHOLE. Jesus!

      • February 10, 2016 at 5:16 am #

        That’s just stupid.

      • demodocus
        February 10, 2016 at 7:56 am #

        Flaming idiot woman

    • demodocus
      February 9, 2016 at 5:24 pm #

      Mom averaged 0-3 drinks a year, and somehow 2 of her 3 that i know of have some learning disability. Almost like there’s a genetic component to some of this. (I never met the twins she gave up for adoption)

    • StephanieA
      February 9, 2016 at 8:48 pm #

      That’s one of my conservative mother’s arguments against abortion- it’s only 9 months! Right, 9 months that some women can’t afford to spend pregnant. I got SPD with my current babe, and it can be debilitating. Luckily mine isn’t, but if I had a physical job there’s no way I could’ve done it.

      • Amy M
        February 10, 2016 at 7:43 am #

        ha! Yeah, I spent 2 months on bedrest, one of those in the hospital. Luckily my job has short and long term disability, and a paid maternity leave policy. I realize not everyone is so lucky.

      • Roadstergal
        February 10, 2016 at 11:22 am #

        9 months of massive bodily changes, hormonal changes, varying levels of sickness, incontinence, and various permanent bodily changes. And potentially being forced to have a VB you don’t want, with the long-term effects on continence and sexual function. And PPD, intrusive thoughts, all of the mental health effects. Plus, a substantial risk of becoming sensitized, which makes your life much harder (and can even shorten it substantially) if you need a solid organ transplant. It can be pretty bad to go through if you want a baby, and then, if you don’t…

        • demodocus
          February 10, 2016 at 11:46 am #

          i’m not crazy, i’m differently sane

    • Puffin
      February 9, 2016 at 10:55 pm #

      My oldest has autism and my second has what appears to be dyslexia (she’s too young to diagnose, but it’s looking pretty likely and runs strongly in my husband’s family.)

      People tell me “I’m sorry” when they hear that my son has autism or that my daughter is showing signs of LD. As if that’s so damn hard for me.

      I’ve lost 7 pregnancies plus my daughter’s twin. Frankly, I’m just glad my kids are alive and here. The rest is just details. They are perfect to me, no matter the fact that we have to do some things in different ways. I wanted children, not robots.

      • February 10, 2016 at 5:15 am #

        Absolutely! (I have two dyslexic children, now adults. One is well on his way to being a millionaire, the other, more severely dyslexic, has developed “workarounds ” and is a legal secretary (!).)

    • Guest
      February 10, 2016 at 8:20 am #

      That undercurrent is basically and overcurrent (not a real word, I know) when you get to anti-vax folks. Of course we all want our children to be as healthy and normally functioning as they can be. But when we become rabid and angry and can’t accept any risk whatsoever, it starts to sound like any imperfection in a human being is unacceptable. And yet, we’re all imperfect somehow.

      Nine months is not only a whole school year, but it’s often a family member’s wedding, an anniversary, birthdays, multiple holidays, multiple stressful projects at work, bad days, raging hormones, discomfort, feeling disconnected from your own body, sleep deprived, etc. And then you take away one of the most common things people use to relax. I drank almost nothing while I was pregnant, but I would never say “it’s just nine months!” to someone.

    • TheArtistFormerlyKnownAsYoya
      February 10, 2016 at 4:41 pm #

      The reverse of this is also the suspicion heaped upon you (and sometimes by yourself) that you didn’t do everything perfectly and are responsible. If your child has a learning disability, well, did you do something? Are you sure you didn’t have any wine? Have a bath that was too hot? Get too much vitamin A…etc. etc.

      I HATE that “it’s a small thing to give up” argument but can’t put my finger on why. Who is deciding it is a small thing? And how many “small things” must there be before it’s ENOUGH? It’s like if it’s a “small thing” then there’s little to no justification required for the demand to give it up.

  19. prudentplanner
    February 9, 2016 at 4:20 pm #

    It bothers me so much that the CDC and the States aren’t even able to collect accurate data on drinking during pregnancy.

    I had one 4oz serving of hard Cider at 24 weeks, a 1/2 glass of champagne at 33+ish weeks, and a 4 oz serving of beer at around 36-38 weeks.

    When I was given the alcohol question at L&D check-in, I relay this information to the nurse (I’ve had about three 4oz servings in the last 1/2 of the pregnancy). She says “OK, Ill mark you down as never having any alcohol at all”.

    I’m trying to give them the correct data! I guess the form isn’t set up to process the data on ‘perfectly moderate’ drinking in pregnancy. Unsurprisingly, the baby has no FASD.

    • Monkey Professor for a Head
      February 9, 2016 at 4:35 pm #

      I must admit that I had a couple of sips of wine during pregnancy (maybe had 2 glasses total in the whole 9 months) but when I had my booking in visit I said I was drinking no alcohol at all. I didn’t want to risk getting lectured on it, and I saw no reason why they would need to know about such a negligible alcohol intake.

      • tariqata
        February 9, 2016 at 9:50 pm #

        When I pre-registered at the hospital where I gave birth, I had to fill out a questionnaire that included “Do you drink?” I also answered “no” to avoid any lectures (I did in fact have a half-glass of wine every month or so after the first trimester), but it struck me as a ridiculous way to frame the issue precisely because it left no room for nuance, not even “yes, but not for the past 9 months”.

        • Puffin
          February 9, 2016 at 10:58 pm #

          Similarly, when I was pregnant with my oldest, they asked “Did you smoke during your pregnancy?”

          Yes… until I found out about it. Then I stopped.

          I still got lectured.

  20. Glia
    February 9, 2016 at 4:17 pm #

    When I was pregnant, I spent quite a bit of time reading studies about the risks of various things labeled “too dangerous for the walking incubators” by materials aimed at the lay population*. I was pretty disheartened by the exact problem you discuss. Not everything in life is all-or-nothing, and treating it like it is sounds like scaremongering, not to mention how patronizing it is to act like adults are utterly incapable of understanding anything other than a straight ban. At this point, so many things are on the “not for pregnant people” list that it seems almost guaranteed most of them will “cheat” at some point. Shouldn’t they have access to realistic descriptions of the actual risks?

    *I have a PhD in neuroscience, meaning I was lucky enough to be better prepared ahead of time to understand what the articles actually say, and I’d miscarried a long-awaited and much wanted pregnancy already, meaning that I was deeply anxious about the many various risks. The difference between what lit meant for the general population said (“there is no known safe limit!”) and what I learned from the actual studies (the lack of a safe lower limit might be at least in part due to how high the lower limit is often set for the sake of the study–“mild” drinking is very often defined as multiple drinks per week, meaning the data in that cohort may very well be utterly irrelevant to women who do what I would consider “mild” drinking). No one ever attempted to police me on alcohol or caffeine while I was pregnant. I was slightly disappointed, I was so prepared to ask someone to cite their references so I could look them up right then.

    • Cartman36
      February 9, 2016 at 5:53 pm #

      I agree. Thanks for posting this and I am sorry for you pregnancy loss.

      • Glia
        February 9, 2016 at 7:50 pm #

        Aw, thanks. It was a horrible time in my life, but I’m doing great now. I tend to talk about it a fair amount as overcompensation for feeling like nobody talks about it, but that is a whole other issue.

    • Puffin
      February 9, 2016 at 11:16 pm #

      I’m sorry for your pregnancy loss. For the same reason, I discuss my own losses because I think it’s really important to start bringing the topic out of the shadows; too many women suffer in silence.

      Like you, I took to the literature to make decisions about my habits whilst pregnant and was really dismayed by how poorly what is *actually* known ends up translated to the public.

      As an example, I’m on a drug that is pregnancy category C and my family physician told me to go off it while trying to conceive. I disaree, as does my RE. The reason it is category C is that there was a tiny, but statistically significant, uptick in a congenital cardiovascular malformation in studied species which was not replicated in other species. Studies of tens of thousands of women who took it during pregnancy have not shown this to be the case in humans. I’m comfortable continuing on the drug (we’re trying to conceive) but I’ve seen women who agonize over having taken this med before they knew they were pregnant and it’s frustrating that the simplified pregnancy categories lack the sort of nuance to make it clear that they likely did no harm to their babies.

      • CharlotteB
        February 10, 2016 at 1:08 am #

        I took a category C drug while pregnant.

        I had a psychiatrist tell me that she didn’t know anything about it, but I probably shouldn’t take the medication. As she was googling what category C meant.

    • guest
      February 10, 2016 at 8:29 am #

      I teach college classes and drink coffee during lectures. I taught into my third trimester. I researched the effect of caffeine on pregnancy extensively (though I don’t have a PhD in science, I read the actual research). I did lower my consumption of caffeine, but I wasn’t going to give it up. I was really hoping someone would challenge me on it so I could get all self-righteous about it, but no one ever did. I also developed an aversion to coffee in the first a second trimester, so the joke was on me. But I drank up to two cups a day in the third trimester. My healthcare providers were fully informed and fine with it.

      And you know, I did have one small baby and two premature babies, but it wasn’t from the caffeine, and it wasn’t from having to walk through second-hand smoke to get into my building every day (I really hated that, but I wasn’t going to overstate the risks to get them to move). I had pre-eclampsia and twins.

    • Mariana
      February 13, 2016 at 2:29 pm #

      I don’t have a PhD on anything… But I think the list of things banned to pregnant women is ridiculous… My ob said the only forbidden thing was undercooked pork, and to use common sense for the rest (no day-old sushi, no running a marathon for the first time while pregnant). She did say I could do any phisical activity I was already doing before getting pregnant (at the level I was before pregnancy), that freaked people out a bit… Both pregnancies were normal and easy and the babies were just fine

  21. demodocus
    February 9, 2016 at 4:16 pm #

    And then there’s the part where no birth control is 100% effective.

    • Rachele Willoughby
      February 9, 2016 at 4:17 pm #

      Which means no woman of childbearing age should drink ever, I guess.

      • indigosky
        February 9, 2016 at 4:31 pm #

        That’s not too far off from what some people already think. I badly injured myself and the first doctor I saw refused to give me the more powerful version of a painkiller. He said that my birth control (Nexplanon) might fail and that medicine would cause birth defects. Needless to say he became my ex doctor after I yelled at him and called my insurance and let them know that I needed a new doctor ASAP due to getting a bull**** one.

        Second doctor thought first doctor was a moron and prescribed me the stuff that actually alleviated the pain so I could get through physical therapy.

        • demodocus
          February 9, 2016 at 5:20 pm #

          i had an argument with an Emergency department nurse about whether i could get the stronger advil or only tylenol for my thumb scalping, because i might be pregnant. (I don’t bother to remember when i last had my period most of the time.) My husband is effectively sterile (he makes sperm but they can’t go anywhere) and I’m monogamous.
          I joked to my pastor (who drove) that if the pregnancy test the nurse insisted on came back positive, it’d be something for her to tell her colleagues. She joked back that she does specialize in miracles.

          • momofone
            February 9, 2016 at 9:34 pm #

            When I had my last colonoscopy, the nurse asked for a urine sample for a pregnancy test. I tried, but was not able to provide one due to the prep. She asked about last period and I gave her the date (which was easy, as it was the day before), and I told her I would be glad to sign something verifying that I was not pregnant and absolving them of any responsibility. In this singsongy little voice, she said, “Well, we never know!” I was furious. I told her she might not know, but as a grown-ass woman I certainly did. It was not my finest moment, but I do know how babies are made, and there were none making!

          • BeatriceC
            February 9, 2016 at 10:13 pm #

            I pissed off a nurse in the ER when they wanted to do a pregnancy test before giving me meds. I was in a lot of pain (appendicitis) and didn’t really want to wait. I told her it didn’t matter, if I was knocked up I was aborting it, no questions asked, and besides, I had a tubal ligation years ago. She gave me a rather dramatic cat-butt face over my frankness on the topic, but it’s true. The risk to my life is too great. My last one nearly killed me, and that was nearly 14 years ago (well, the child will be 14 in a couple months). Now I have advanced maternal age to add to the list of complications. There’s no way I would attempt to carry a pregnancy to term.

          • Rachele Willoughby
            February 9, 2016 at 10:14 pm #

            But… but… didn’t you know that you’re a sacred vessel?!?

          • BeatriceC
            February 9, 2016 at 10:14 pm #

            This vessel broke years ago.

          • BeatriceC
            February 9, 2016 at 10:20 pm #

            Oh, and to add this: The surgeon was a bit taken aback by my frankness, but simply replied something along the lines of “well that makes surgery easier!”

          • guest
            February 10, 2016 at 9:12 am #

            I had dental x-rays recently, and of course I was asked if I was pregnant. I simply said “nope.” And for whatever reason the technician gave me a look and said “well, we’ll just take your word for it.”

        • guest
          February 10, 2016 at 8:56 am #

          Jeez, that’s awful. Like a woman doesn’t deserve pain relief because of something that may not even happen.

  22. Carolyn the Red
    February 9, 2016 at 4:04 pm #

    I always wonder about the effect on a woman who becomes unexpectedly pregnant after drinking alcohol. I mean, maybe she had a birth control failure, or hadn’t planned on having sex, and then they read this kind of advice, or have it in the back of their mind.

    I could see a woman who would otherwise embrace the unplanned pregnancy being so worried about getting drunk around conception they’d consider termination, or just not be able to relax about the pregnancy. I could also see some women think “Damage is done, might as well continue drinking” if they really think they’ve already doomed the kid.

    • Rachele Willoughby
      February 9, 2016 at 4:07 pm #

      So much this. Or, even worse, if a single woman aborts a wanted fetus because of the CDC’s scaremongering they have blood on their hands.

    • Sue
      February 9, 2016 at 7:13 pm #

      What disturbs me is that the alcohol message for young woman seems to be a combination of moralising and guilt-fuelling about fetal welfare, rather than the welfare of the young woman herself.

      There has been a rise in binge-drinking in young women in some of our (mainly Anglophone) societies in recent decades, which is not only poor for the person’s health but also puts them at greater risk for unwanted, and unprotected, sex.

      Let’s encourage safe drinking culture throughout life, including minimising intake to within safe limits during pregnancy.

      We CAN define safe limits – like everything in life, it’s statistical. At ‘x’ grams of alcohol per day, the risk of alcohol-related harm to the fetus is ‘y’%. Simple data crunch.

      • Valerie
        February 9, 2016 at 8:30 pm #

        I seem to be alone with this impression on this blog, but I think that is exactly who they are targeting- women who are heavy drinkers, many of whom may be at risk of pregnancy. I don’t think this press release was about every fertile woman or light drinking- it’s about women who abuse alcohol. That’s why they have the giant infographic about counseling all women, pregnant or not, about alcohol use.

        Also, that data about safe limits during pregnancy simply does not exist and they aren’t going to do well-controlled experiments (eg, dosing pregnant women with measured amounts) because it wouldn’t get past an IRB (some kids would get FASDs). They rely on self-reporting, which is notoriously unreliable, especially for something as stigmatized as drinking during pregnancy. I think it would be great if they could say “x grams per day is safe, provided you pass this genetic screen,” but that doesn’t exist yet.

      • Who?
        February 9, 2016 at 8:40 pm #

        My 21 year old daughter was telling me the other day that she is, on paper, a binge drinker. Which makes you a binge drinker, said I. But everyone does it, said she. It’s unhealthy and unsafe however many of you are doing it, said I.

        The association made her really uncomfortable: she doesn’t see herself that way, and she is the antithesis of the party girls on the telly news bite. She’s left uni and is starting a professional job in a couple of weeks so I’m hoping the pattern will change. One of the things that has kept her safe is her network of friends, but that will be much smaller as she’s moving cities.

        My concern is about her health and safety, it had honestly never crossed my mind she might be pickling my future grandchild. Treating all young women as though their potential as baby bearers is the main thing to worry about isn’t the best approach to giving them the information they need to make good decisions.

      • Valerie
        February 9, 2016 at 8:42 pm #

        P.S. Here:

        The CDC does have a page on binge drinking for women. It’s just the FASD one that has been making the rounds on the internet.

  23. Roadstergal
    February 9, 2016 at 3:39 pm #

    “Excessive alcohol use is commonly involved in sexual assault.17 Also, alcohol use by men increases the chances of engaging in risky sexual activity including unprotected sex, sex with multiple partners, or sex with a partner at risk for sexually transmitted diseases.4”

    That whole page reads like “Why in hades was our alcohol graphic targeted at women??”

    • KeeperOfTheBooks
      February 9, 2016 at 3:53 pm #

      Because we all know that pregnancy is 100% a woman’s responsibility, and never, ever that of the man who got her that way, never mind the circumstances?
      /sarcasm, to state the obvious

      • Rachele Willoughby
        February 9, 2016 at 3:57 pm #

        Well, what else is pregnancy for if not to punish irresponsible, promiscuous women?

        • TheArtistFormerlyKnownAsYoya
          February 10, 2016 at 4:54 pm #


  24. Elisabetta Aurora
    February 9, 2016 at 2:51 pm #

    How about, don’t have sex unless you’re using birth control or planning a baby for BOTH women and men? Why was that not the CDC recommendation?

  25. AirPlant
    February 9, 2016 at 2:35 pm #

    I am not a heavy drinker, but I get pretty excited about my occasional glass of wine and I feel like it is a reasonable hardship to give it up. The plan has always been that I would abstain during pregnancy and nothing about that is controversial, but I had always sort of assumed that my partner would abstain as well in a show of solidarity. Like it is kind of a dick move to drink delicious wonderful wine in front of someone who can’t have any, and my husband will presumably love me so why would he be a dick to his pregnant wife?
    I made the mistake of mentioning this assumption to a guy and you would have thought that I had suggested that he cut off his own arm. The same guy who is all “Nary a drop shall touch your lips for you are a pure gestational vessel now” was like “IT IS COMPLETELY INHUMANE TO EXPECT ME TO GIVE UP ALCOHOL”

    • Roadstergal
      February 9, 2016 at 3:33 pm #

      Seems like pretty close to the literal ‘least you can do,’ on the part of the other person responsible for that condition.

      This whole thread is making me think about other drugs pregnant women could mention they’re switching to when people get huffy about alcohol and caffeine. “I’ve been reading PiHKAL, and it’s given me so many ideas for home projects!”

      • KeeperOfTheBooks
        February 9, 2016 at 3:51 pm #

        See, I encourage DH to drink beer while I’m pregnant…
        …’cause then I can cheerfully steal a sip or two from his over the course of the evening. 😀 If a literal sip or possibly two of beer consumed with food a few times/week will cause FAS, then we as a species are doomed anyway.
        But I do take your point.

        • Rachele Willoughby
          February 9, 2016 at 3:55 pm #

          I think that drinking during your partner’s pregnancy is like watching porn; it’s fine if your partner doesn’t mind but it would be awfully unkind to refuse to abstain if they ask you to.

    • Zornorph
      February 9, 2016 at 4:00 pm #

      That really is dickish. Had I succeeded in maintaining a pregnancy with my ex-wife, I had every intention of not drinking during that time – certainly not in front of her.

    • demodocus
      February 9, 2016 at 4:21 pm #

      Wow, he’s a bitch. My husband asks if i mind. (personally, i don’t since i don’t much care for the flavor of alcohol).

    • attitude devant
      February 10, 2016 at 12:12 pm #

      Oh, I have a better one for you: during my first pregnancy a colleague asked me to care for his daughter and I did, and as a thank you he gave me a really delicious cognac, breathtakingly expensive….which my husband proceeded to drink up, as in all of it, before I delivered. Grounds for divorce, don’t you think?

      • Rachele Willoughby
        February 10, 2016 at 12:13 pm #

        Or murder.

      • Roadstergal
        February 10, 2016 at 1:00 pm #

        The Geneva convention specifically prohibits that.

        (One of my husband’s clients gave him a 750mL bottle of Hanger One. He gave it all to me. Well, he doesn’t like vodka, but still, he knows fine alcohol is one thing not to withhold.)

    • Commander30
      February 10, 2016 at 12:52 pm #

      That is TOTALLY a dick move.

      Luckily I had it easy… my husband doesn’t drink, so he was never a source of temptation for me. Now we’re back to our old ways of him being the DD when we go out to eat.

  26. guest
    February 9, 2016 at 2:21 pm #

    Yes! This is why I was hoping Dr. Tuteur would address this report, because I wasn’t sure how much weight to give to the studies on the risk of FASD in very early pregnancy.

  27. mostlyclueless
    February 9, 2016 at 2:17 pm #

    Dr. A, the reason that Europe hasn’t reported high levels of FASDs is because no large-scale epidemiological studies of FASDs have been performed there.

    • Rachele Willoughby
      February 9, 2016 at 2:22 pm #

      Maybe. But we don’t know because there haven’t been any large-scale epidemiological studies. It’s all conjecture, making this kind of blanket recommendation awfully premature.

      • mostlyclueless
        February 9, 2016 at 2:27 pm #

        I’m not commenting on the validity of the recommendation, just that any comparisons to Europe are pointless because European pediatricians aren’t trained to diagnose FASDs and European studies of FASDs have been extremely minimal.

        • Inmara
          February 9, 2016 at 3:00 pm #

          I just looked up what’s to be find in my country, there is one report from 2009. of one newborn with FAS and overall 51 registered cases of FAS (is it credible for a population of roughly 2 million?). So it is recognized here, but probably not very well, although recommendations to avoid alcohol during pregnancy are based mostly on danger of FAS.

    • Dr Kitty
      February 9, 2016 at 4:18 pm #

      But kids with learning disabilities are well diagnosed in Europe, and causes of those diagnoses are actively sought.
      The that FASD is under diagnosed in Europe because no-one is looking for it is a stretch.

      Maybe it is that the incidence of people who are 1/16th or 1/34th Native American is enough to chance the incidence through increased genetic susceptibility, maybe it is because American women are more likely to use prescription medication or illicit substances than European women. Who knows.

      • fiftyfifty1
        February 9, 2016 at 7:49 pm #

        “The that FASD is under diagnosed in Europe because no-one is looking for it is a stretch.”

        Although “not looking” may be a piece of the puzzle, at least for some populations in some countries. As an example, children adopted from the former Soviet Union are frequently diagnosed with FAS here in the US. The children get full physicals prior to adoption in Russia, but they are not diagnosed with FAS by the doctors there.

      • Grace Adieu
        February 10, 2016 at 3:31 am #

        I also think that drinking patterns are different in Europe. While people may drink alcohol daily, with their meals, it’s not really socially acceptable to “binge drink” (Eastern Europe excluded). There’s a big difference between drinking 7 glasses of wine a week at the rate of 1 glass a day, and drinking 7 glasses all in one go and abstaining for the remaining 6 days.

        • Monkey Professor for a Head
          February 10, 2016 at 5:04 am #

          I would say that Ireland and the U.K. also have issues with binge drinking.

          • Grace Adieu
            February 11, 2016 at 3:50 am #

            Agree, I was thinking of continental Europe.

  28. demodocus
    February 9, 2016 at 2:05 pm #

    It’s ludicrous. When you’re preaching to the lowest common denominator, you should remember to take common knowledge (or what people *think* they know anyway) into account. Just about everybody knows several women who were drinking shortly before they realized they were pregnant but how many people know anyone with FAS? Lots of women are gonna write this off as more governmental foolishness.

  29. MaineJen
    February 9, 2016 at 1:41 pm #

    I would suspect that in nearly 100% of pregnancies (excluding those where the mother is purposely abstaining or just doesn’t ever drink), there is some amount of “accidental” drinking during that murky time between conception and the knowledge that you are pregnant.

    I went to a St. Patrick’s Day bash about 7 years ago…you can imagine…there were jello shots involved, that’s all I’ll say. 😉 About 4 days later, I got a positive pregnancy test. (I thought I had gotten my period that month, but it was just breakthrough bleeding). I felt terrible about it. But then I realized…that must happen all. The. Time. I made sure to tell my doctor, and she didn’t seem fazed by it.

    I think everyone needs to calm down a bit on this subject?

    • Inmara
      February 9, 2016 at 1:48 pm #

      We conceived our baby while on a (delayed) honeymoon trip, and obviously I had a drink or two almost every evening. Where I did gamble a bit was to have more than one glass of wine in a party after my period was already a few days late. Then I stopped drinking at all and resumed only in 3rd trimester (again, occasional glass of wine or beer). My guide into decision making was this post

    • Suzi Screendoor
      February 9, 2016 at 5:47 pm #

      Well, if we’re having confessions…

      I had many drinks just a few days after conception. My husband and I had decided to start trying back in August, although my periods had been very irregular and we suspected that I would ovulate during my planned girls trip or later. It took four months to conceive the first time and my periods had been more regular then, so I didn’t even consider abstaining on the girls trip because I thought it would take months to conceive. Three weeks later, I was wondering where my period had got to.

      My husband was quite freaked out about this, but I’ve not been overly worried about it.

  30. Are you nuts
    February 9, 2016 at 1:36 pm #

    I’d be curious to know how common FAS is in a baby born to a woman who only drank until she found out she was pregnant (assuming it’s not a TLC show I didn’t know I was pregnant until the baby came out in the toilet situation). I suspect it’s not very common at all.

    • AirPlant
      February 9, 2016 at 1:40 pm #

      Anecdotally I know a solid half dozen women who drank a LOT in the two weeks between ovulation and the positive pee stick. Their doctors uniformly told them that they were fine and there was absolutely nothing to worry about. It could have been a damage done, no point in stressing situation, but it still makes me feel a bit better about things

      • The Bofa on the Sofa
        February 9, 2016 at 1:54 pm #

        One of my former students found out she was pregnant a couple days after getting back from a conference, where she had imbibed significantly (it’s one of those types of conferences where the grad students let loose; she did).

        She expressed concern, but in the end, of course it wasn’t a deal, much less a big one.

    • TheArtistFormerlyKnownAsYoya
      February 9, 2016 at 2:05 pm #

      I think it would probably be absolutely none.

    • mostlyclueless
      February 9, 2016 at 2:19 pm #

      I think the concern from the CDC is that women who aren’t actively trying to conceive, but also aren’t using contraception, can be pregnant for a lot longer than those two weeks before realizing it.

      • guest
        February 9, 2016 at 2:27 pm #

        And that would be a fine concern, but they don’t target their recommendation to that group (really, they should be urging contraceptive use for women who don’t want to get pregnant) so that even women undergoing AIT are supposed to follow their advice even though they are *very* aware of when they are and aren’t pregnant. I mean, for the five days my embryos were in a lab I was advised not to drink and I didn’t, but you can hardly expect that my kids would have gotten FAS if I’d had a drink on day three while they weren’t even inside my body.

        • mostlyclueless
          February 9, 2016 at 2:32 pm #

          I’m extrapolating here but I suspect it’s hard to draw a bright line between target groups of women who are vs. aren’t trying to get pregnant because there seem to be an uncomfortably large number of women in some gray area — women who might say they aren’t trying to get pregnant, but they also are sexually active and refuse contraception. It’s hard to say women in that category aren’t trying to get pregnant, even if they might deny that they’re trying.

          • AirPlant
            February 9, 2016 at 2:41 pm #

            I honestly didn’t think that could possibly be a thing until my hairdresser got pregnant. She had told me that the pregnancy was an oops and they were making the best of it and I didn’t think any of it because shit happens and they seemed happy, but she told me after the baby was born that she needed to pick a type of birth control and didn’t know what to choose because she had never been on it before. And then I found out that she had had two previous miscarriages before the baby that took and the whole thing just blew my mind. How on earth can you get pregnant three times with no birth control involved and still call it an accidental pregnancy? That is pretty much exactly what trying for a baby looks like. There is no shame in trying for a baby. What is this madness?

          • Roadstergal
            February 9, 2016 at 2:45 pm #

            Some of the younger girls* I know are a bit iffy like that – and I feel like they don’t really want a baby, but society at large is just pushing pro-baby at them as a constant background hum, and many of their friends have babies so they just default to not doing anything in particular to have one, but not taking any BC either…

            I do not think this is a good thing.

            *Younger than me, I mean. A good spread. Actually, one of the ‘younger’ gals I know has a male GP who pushed her away from hormonal BC because of the side effects of the Pill, and didn’t give her any info on the other hormonal methods. I was quite horrified and told her to go to an OBGYN and get proper counseling

          • Valerie
            February 9, 2016 at 3:19 pm #

            There are people who think that nobody should have a family on purpose until they are super financially stable with a house and savings, and anything else is irresponsible and selfish. If your family is full of these types, you might be inclined to frame your pregnancy as unintended, even if you took no steps to prevent it. There are also people who are internally conflicted about if it’s a good time to have a baby or not- eg. people who want kids but know it’s self-sabotage for their career. I think there is some kind of subconscious compromise they make with themselves that they can half-ass NFP but happily keep any pregnancy that results. And finally, I think some people make a distinction between “trying” for a baby, which includes tracking ovulation and hoping that they become pregnant, and babies that happened because they weren’t using birth control (eg religion forbids it, didn’t feel like using it at the time, it wasn’t readily available, etc).

            In short, not everybody decides “Yes, let’s try our best to have a baby” or “No, let’s not have a baby” and then behaves in the most sensible way to achieve that goal.

          • Inmara
            February 9, 2016 at 3:28 pm #

            I found out that “trying for a baby” in several internet boards means exclusively the kind of tracking ovulation and peeing on a stick every other day. Going off birth control (which I deemed to be “trying” for me and my husband) is called “not trying not preventing”.

          • swbarnes2
            February 9, 2016 at 3:57 pm #

            That seems like a poor label. The key difference should be intent, not effort: either the couple is affirmatively choosing and ready to start the decades-long process of parenting now, or they aren’t. A couple that just takes folic acid and otherwise carries on as usual is still affirmatively choosing to get pregnant, even if the extra effort exerted is minimal.

          • Monkey Professor for a Head
            February 9, 2016 at 5:05 pm #

            I know my husband found it much easier to process the idea of us stopping contraception and seeing what happened as opposed to actively having sex in order to get pregnant. As far as I’m concerned, we were trying to get pregnant. 🙂

          • fiftyfifty1
            February 9, 2016 at 8:01 pm #

            “I honestly didn’t think that could possibly be a thing ”

            It is for sure a thing. A common thing. Many women are very ambivalent about using birth control, especially because myths about it are so common. Many young women are convinced that use of hormonal birth control is likely to leave them sterile. This is especially true in low income populations. In middle and higher socioeconomic groups the reason for avoiding birth control is usually fear of side effects. There are certain symptoms that everyone “just knows” are due to birth control pills: moodiness, weight gain and acne etc.. No amount of scientific proof to the contrary will change their minds.

            And then there is plain old ambivalence. And so no decision is made. Which means that by the end of 12 months, 85% of women will have conceived.

          • Medwife
            February 9, 2016 at 8:49 pm #

            Whatever ails you is either birth control or chronic Lyme disease.

          • fiftyfifty1
            February 9, 2016 at 10:31 pm #

            “Whatever ails you is either birth control or chronic Lyme disease.”

            So true! I see the 2 as falling into different camps however.

            The Chronic Lymes is just the quack diagnosis de jour. Before it was Systemic Yeast or Hypoglycemia, or Hysteria. Eventually it will be something else. But there will always be a trendy quack diagnosis that will consume and render a small portion of the population functionally disabled. It’s sad, but I see it as inevitable.

            But I see the myth of birth control side effects as being a different phenomenon and more dangerous because it is more widespread. Many otherwise normal and sensible people avoid hormonal birth control because of the beliefs about its side effects. None of the claimed symptoms are bizarre. Most of them are, as others have pointed out, real things that commonly happen to regular people: acne, weight gain, changing emotions. But women believe their pills are to blame and waste so much time and energy insisting on pill switches or stop their pills altogether. They spend their entire 20s trying to find “the perfect pill” and never end up addressing their acne or depression or bad boyfriend or whatnot directly.

          • Rachele Willoughby
            February 9, 2016 at 10:38 pm #

            And don’t get me started on post-tubal ligation syndrome. Who’s symptoms (heavier, crampy periods, acne, etc.) are mostly either signs of no longer being on hormonal birth control or symptoms of peri-menopause.

          • Who?
            February 9, 2016 at 8:52 pm #

            Scary numbers. A number of those young women are likely just out of school-a notorious time for weight gain, at least in our circle-and going through a lot of change in life, which can make anyone moody.

            I have friends who are mothers of these girls, telling them a pregnancy wouldn’t be the end of the world, that hormonal contraceptives are bad, etc. Sometimes I think it’s a way of keeping the family together and close by, locking in a new generation.

          • Mariana
            February 13, 2016 at 3:26 pm #

            Well… Hormonal birth control makes me feel like PMS from hell 30 days a month… I think for me it works well as a contraceptive because my husband is too scared to try and touch me (much less have sex) LOL. So I don’t do hormonal birth control for the side effects… ( but I’m ok with a less reliable form and a possible “oops” pregnancy or two).

          • guest
            February 9, 2016 at 2:48 pm #

            I’m sure, and I don’t expect the CDC to give advice on drinking specific to IVF procedures, but they are painting recommendations so broadly that no woman I know is taking them seriously. They should have focused on women who are not trying to get pregnant, and not using any form of contraception. The wording they used led many people to think condoms didn’t count.

        • demodocus
          February 9, 2016 at 4:35 pm #

          I don’t remember them actually saying that for my intervals (though i could well have forgotten it). Maybe one or another of the drugs doesn’t play well with alcohol?
          I did have a whole pot of caffienated tea on day 2 or 3.

  31. Valerie
    February 9, 2016 at 1:34 pm #

    I get the impression that their target audience is women who are heavy alcohol users, not so much healthy women who enjoy a single glass of wine with dinner. I’m guessing the fear is that nuanced recommendations will be misused. For example, a pregnant woman with serious substance abuse problems tells her doctor that she regularly has a glass of wine with dinner and he says that’s fine. In actuality, though, she is drinking a whole bottle and then some. This kind of underestimation is really common. So now you have somebody who is definitely endangering her fetus, who may not realize it because her doctor signed off on her behavior based on her self-reporting.

    I guess the question is whether the purpose of educating the public should be for women to make informed choices or to produce behaviors that limit FASDs as much as possible. By supplying accurate and complete information, women can make their own cost-benefit judgements, but some women will be confused and make choices they later regret. If they target the message to prevent as many FASDs as possible, they have at least a couple of problems: one, their credibility, and another is that they don’t know that their abstinence-only message “works” optimally to reduce FASDs.

    • Roadstergal
      February 9, 2016 at 1:38 pm #

      “For example, a pregnant woman with serious substance abuse problems tells her doctor that she regularly has a glass of wine with dinner and he says that’s fine.”

      The thing is, denial/underreporting is indeed a Thing. But no other guidelines take that into account, only the You Might Be A Baby Incubator ones*.

      And I agree that the abstinence-only message is problematic from a few angles. Firstly, women who drink moderately, whose drinking probably isn’t a problem, will find it much easier to do that than a woman with a serious problem.

      Secondly, a woman who has ‘just one drink’ might go, shite, I’ve blown it, I might as well have a few more…

      *And off of the ‘pregnancy’ thing, I can see this guideline being used as a rape defense – I mean, even more than now. “The CDC clearly warned her not to drink, and she had beer.”

      • TheArtistFormerlyKnownAsYoya
        February 9, 2016 at 2:08 pm #

        Also, a woman who’s had “just one drink” might go, shite, I should probably have an abortion!

    • guest
      February 9, 2016 at 2:29 pm #

      I think it’s dangerous to mislead the public, if that’s the case. If we all get on board the “Don’t Drink If You’re Fertile” Train, will we start seeing arrests and jail time for women who have that single drink?

    • Sarah
      February 9, 2016 at 3:00 pm #

      I’m not sure how much attention someone who regularly drinks a full bottle of wine in one go is likely to pay to a health campaign, in all honesty. That’s a lot even when you’re not pregnant! And really, recommendations like this often have the exact opposite effect they’re intended to produce. If you’re being told something patently stupid and/or problematic, you might just as easily dismiss anything coming from that source.

      • Rachele Willoughby
        February 9, 2016 at 3:28 pm #

        Like the DARE program. The warnings were so dire that kids could look around them and see that they were patently untrue and so disregarded everything the DARE program told them.

      • Valerie
        February 9, 2016 at 3:40 pm #

        Maybe I exaggerated- a “serving” of wine is only 5 oz. Somebody could easily say “I have a glass of wine with dinner” when they really sometimes have 2 8 oz glasses, or 3 servings of wine. And yeah, denial is really a thing. A lot of women with substance abuse issues don’t want to hurt their fetus, but don’t think their consumption is really that bad. That’s one of the things addiction can do to a brain.

        I don’t think the recommendation to abstain from alcohol while pregnant is stupid. We know that there are some children with FASDs with mothers that report only light drinking, so they aren’t going to say that it is safe when they know it isn’t for some children. Their paternalistic tone is all wrong and I think they should have more nuanced advice about consumption for women who chose to drink, but I can see why they do not sign off on some version of “alcohol is safe in small amounts,” or “light drinking is low-risk.”

        • Rachele Willoughby
          February 9, 2016 at 3:44 pm #

          I don’t have a huge problem with “don’t drink while pregnant”. That’s what they’ve always recommended. This new recommendation though, “don’t drink if there’s any possibility that you may conceive,” is ridiculously overblown in light of the relatively small known risk.

          • Sarah
            February 9, 2016 at 4:05 pm #

            Stupid, even.

        • Roadstergal
          February 9, 2016 at 3:45 pm #

          “alcohol is safe in small amounts”

          But that’s not the conclusion. Really, Dr T’s post above gets the nuance across pretty well, and is short and easy to read. Why not do something like that?

          Perhaps this subject is simply not amenable to an infographic. A subject that would be – “There are many diverse options for birth control. If you are not actively trying for pregnancy, have a conversation with your GYN about what’s right for you.”

          • Valerie
            February 9, 2016 at 5:31 pm #

            That’s actually pretty similar to their primary directive for what women can do to prevent FASDs- “Talk with their health care provider about their plans for pregnancy, their alcohol use, and ways to prevent pregnancy if they are not planning to get pregnant.” Maybe they should have just illustrated that.

        • Sarah
          February 9, 2016 at 4:00 pm #

          I think you did exaggerate, yes. It’s extremely important that in discussions like this we define our terms, because blurring the lines between the sort of moderate consumption that has never been shown to cause any harm at all with heavy consumption is exactly what the problem is here.

          Ultimately, there’s a large difference between saying x amount is safe, which we don’t know, and saying that there is no evidence x amount causes harm, which we do. Saying the latter when you should be saying the former is problematic, and undoubtedly causes the body making the recommendations to lose credibility in the eyes of some women. If health bodies are to tailor their message to take into account the attitudes of the intended recipients, clearly attempts should also be made to avoid this situation. Otherwise, well, stupid is sounding like a pretty accurate description of a body giving that advice about pre-pregnancy.

          Also, given that you’re aware of the reality of denial when it comes to problem drinking in pregnancy, I assume you can see the problem with assuming a woman’s assessment of her drinking is ‘moderate’ when her child has been diagnosed with FAS? Does sound a bit like you want to have it both ways, tbh.

          • Valerie
            February 9, 2016 at 4:39 pm #

            “blurring the lines between the sort of moderate consumption that has never been shown to cause any harm at all with heavy consumption is exactly what the problem is here.”

            The lines are blurry to begin with for people with substance abuse problems. That is my point. The only thing I meant to get across by my hypothetical example is that there are women who may benefit by being told by their doctors that “no amount of alcohol during pregnancy is known to be safe” because they may not have the capability to understand the magnitude of their habits, and that I think that the CDC is targeting them. You might not think that these people exist, but I assure you I have them in my family.

            Furthermore, there is evidence that light consumption can cause harm. There are children with FASDs with mothers who report light drinking. That is why the CDC recommends abstinence from alcohol. Alternatives are to state the facts, eg as outlined above, with or without a recommendation. However, if they are giving ANY recommendation about alcohol during pregnancy, the only one that they can give at this point is to abstain. Does that make sense?

          • demodocus
            February 9, 2016 at 4:42 pm #

            My friend’s mother would tell people she had 1 glass of beer a day. So she would, but she’d top it off a dozen times at least. She also swore she drank the beer for the fiber.

          • Rachele Willoughby
            February 9, 2016 at 4:53 pm #

            But again, we’re not talking about simply abstaining during pregnancy. We’re talking about abstaining while *potentially* pregnant which, given the failure rates of birth control could be extrapolated all the way to *the entirety of a woman’s childbearing years*

          • Valerie
            February 9, 2016 at 5:15 pm #

            I got the impression the CDCs thing was mostly targeted to women with heavy drinking issues who are or are likely to become pregnant, and that is who my comments are about. I totally agree that the infographics are paternalistic and offensive, and I agree that it’s nonsense to tell all fertile woman that they should completely abstain from alcohol, but I don’t think that was their intent- it’s for women who are pregnant or likely to become pregnant (intentionally or otherwise), and their first recommendation is to discuss contraception with a doctor.

          • demodocus
            February 9, 2016 at 5:27 pm #

            ’cause Prohibition worked so very well.

          • Sarah
            February 10, 2016 at 11:14 am #

            We are in agreement that they shouldn’t be giving a recommendation full stop, but no the rest doesn’t make sense.

            On your ‘light evidence’ point, self-reporting from mothers of children with FASD is extremely, extremely weak. Self-reporting evidence is generally not great, as we’ve discussed on here when dissecting numerous crap breastfeeding studies. And when it’s from people who have a massive incentive either to delude themselves or deliberately lie, that’s magnified a hundredfold. Ultimately, this is not even close to being something that a health agency should be building a recommendation on. And you’re being very disingenous to assume this self-reporting about moderate drinking is accurate, but not apply the same standards to pregnant problem drinkers. If you get that the lines are often blurry with problem drinkers (although certainly not always, plenty of them know exactly how much they’re drinking and what it’s going to do to them) then why on earth would you simply take the word of mothers of children with FASD?

            Also, please don’t imagine you have anything to tell me about problem drinkers. Sadly, I am all too familiar with such, so I’m going to need you not to attribute things to me on the subject I didn’t say.

          • Valerie
            February 10, 2016 at 12:58 pm #

            I’m sorry that you also have a familiarity with problem drinkers. I’m not trying to be hostile, here- I’m just explaining why I think the CDC has an abstinence-only policy, despite the meager evidence that moderate drinking can lead to FASDs. I never meant to imply that self reporting is accurate (you are right, that would be inconsistent). My understanding is that we already know that there is considerable genetic variation in who is most easily affected by FASDs- to me, it is much more likely that moderate alcohol for a susceptible fetus at a vulnerable point in development can cause FASDs than the alternative, which is that all mothers of affected children who report only mild drinking are misremembering or lying.

            My question was if the role of a public health organization like the CDC is to dole out information and make recommendations in order to produce a certain behavior (in this case, reducing fetal exposure to alcohol by preaching abstinence-only), or if their role is to help people make informed decisions about their health. I think we agree that it should be the latter, and that this was a clumsy attempt at the former.

          • Sarah
            February 10, 2016 at 2:35 pm #

            Yes, I think we agree it should be the latter. Re FASD, it may or may not be the case that even moderate consumption could cause it. But we simply don’t have proof of a causative mechanism. There is no getting round that fact. You’re allowed to guess at one if you like, but that’s all it is.

          • Valerie
            February 10, 2016 at 4:32 pm #

            You: “There is no evidence that X causes harm.”
            Me: “Here is some evidence.”
            You: “We simply don’t have proof of a causative mechanism.”

            “Proof of a causative mechanism” is a much higher bar to clear than some evidence of harm. I gave the most obvious counterexample to your claim of “no evidence,” but there are also measurable effects in animal models of “light” or “moderate” exposure, where the mothers reach the BAC of a woman after just one drink. In any case, I don’t think a low risk of FASDs due to moderate drinking negates any of the points brought up on this blog.

          • Sarah
            February 11, 2016 at 4:24 am #

            What you describe as the most obvious counter example is simply not worthwhile evidence. I mean, we eviscerate studies purporting to show X benefits of breastfeeding with the sort of ‘evidential’ basis you cite. The fact that you now mention animal models, not humans, illustrates that we don’t have any actual evidence of harm caused by moderate drinking during pregnancy. Sure, animal models can tell us things, but the research on humans drinking has yet to show harm caused by moderate drinking in pregnancy. Some mothers of children with FASD self-reporting as having drunk moderately in pregnancy is not remotely reliable. The fact that you felt you had to qualify that with thinking them telling the truth and their moderate consumption being the cause is more likely than alternatives, with nothing to back up that assertion, says everything.

            This is extremely important when FASD is being discussed. It’s not a question of ‘low’ risk either, there’s no real evidence even of that!

          • Valerie
            February 11, 2016 at 10:50 am #

            I’m arguing against your claim that there is “No Evidence” that moderate alcohol causes harm by responding with some evidence. All one needs to refute a claim like that (“no evidence exists”) is a counterexample- for “no evidence,” you have to completely reject the work in animals because it’s not people (really? no work in animals counts as evidence?) and believe that literally each and every woman with an affected child who self reports light drinking during pregnancy is lying. That’s the bar that you have to clear to keep saying “no evidence! no evidence!”. You don’t personally have to accept existing evidence as high-quality proof for it to be “real.” I’m fine with saying “the evidence is inconclusive” or “debatable,” and I’m definitely in agreement that it doesn’t justify the stigma.

            Women should be under no obligation to optimize their children by making every possible sacrifice, and I think that’s one of my big problems with the shaming of pregnant women and new moms about everything from moderate drinking to formula feeding to CIO, etc. I don’t think insisting that there is “no evidence” helps achieve this goal because it shifts the argument from one about a mom’s right to make her own decisions about risks and benefits to an argument between non-experts about the strength of the scientific evidence. The point is that the shaming is not justified, even if we knew for a fact that there was a direct causal relationship between, say, ADHD risk and moderate drinking. I think that’s where we differ- I don’t think the distinction between low-risk and no-risk is extremely important in this context.

            I get the impression that we are mostly in violent agreement- thanks for the thoughtful discussion.

          • Sarah
            February 14, 2016 at 4:16 am #

            You’d only be arguing against my claim if you’d actually provided any evidence. It’s all very well saying that I don’t have to accept the existing ‘proof’ as high quality for it to be real, but when it’s as low quality as it is then it isn’t about me accepting it- it’s not meeting the barrier to be ‘real’! You can think whatever you like about what achieves the ‘goal’, my view is that what (little) you have cited simply does not do what you claim it does. We can both uphold a woman’s right to do what she wishes with her body in pregnancy AND point out that ‘proof’ based on the recall of people talking about what they did several years ago, with massive incentives to minimise (which you clearly feel is a problem in alcoholic pregnant women) does not meet the barrier to be considered as evidence. They’re not mutually exclusive. Let’s not present them as such.

  32. star
    February 9, 2016 at 1:29 pm #

    Hmm, did the CDC ever think that many of those 3.3 million women are TRYING to get pregnant? That they are not drinking during the times they are fertile? Oh of course not, because women are stupid apparently. As soon as my period showed up after a cycle, I drank a few bottles of beer to drown my sorrow, then had a glass of wine a few nights a week until ovulation. I abstained until my period showed up. Then I stopped drinking 100% when I got those two pink lines.

  33. CharlotteB
    February 9, 2016 at 12:49 pm #

    When I saw the info graphic the CDC produced it made me wonder about how a diagnosis of FAS is made. For example, I have ADHD. I don’t think my mom drank while pregnant, but let’s say she had. Would the CDC blame my ADHD on the drinking, and therefore count it as FAS? I did drink very moderately while pregnant (1 beer/month)–if my son has ADHD, would they pin that on drinking, even though it seems like there’s a genetic predisposition to ADHD?

    The list of potential issues for baby seemed really broad.

    • Megan
      February 9, 2016 at 12:54 pm #

      There is a specific constellation of physical and cognitive features:
      But I’m sure it would be harder to diagnose a very mild case and it could easily be misdiagnosed if, for example, only mild social or behavioral symptoms are present and no physical characteristics typical to FAS. In that case, I would think it would be more likely to be diagnosed as something besides FAS (like a psych or cognitive diagnosis) rather than attributed to FAS unless there was an obvious history of heavy alcohol consumption in pregnancy. Even then, you couldn’t be sure if that was really the cause.

      • BeatriceC
        February 9, 2016 at 1:02 pm #

        “I would think it would be more likely to be diagnosed as something besides FAS”

        Fetal Alcohol Disorder. I’ve seen foster kids slapped with this label if it was known or strongly suspected that the birth mother drank while pregnant but the child doesn’t exhibit the physical traits of FAS.

        • Megan
          February 9, 2016 at 1:17 pm #

          That’s interesting. I would bet that foster children are more likely to receive the diagnosis in the face of uncertainty than other kids. I think it would be really hard to actually know that alcohol was the cause in those instances because there are often psychosocial/environmental issues predisposing behavioral issues as well. In your experience, do those kids get treatment for their issues or is it just used as a label to blow them off?

          • BeatriceC
            February 9, 2016 at 1:24 pm #

            My experience is mostly as their teacher, but I have some friends and family members that have fostered, as well as the one child I had placed with me on an emergency basis last year*. I think it’s mostly just a label to have something put in their IEP’s to justify additional services. Schools are chronically underfunded so they will sometimes go to great lengths to get the money they need to serve the kids as best as they can.

            *My son’s girlfriend at the time called me at midnight one night freaking out and I managed to get out of her where she was, then told her to stay put and I would get her. When I got to her, she was a mess, with massive bruising around her neck. I called CPS and since I have a giant house (4300 or 4700 square feet, depending on the set of plans you believe, with 5 bedrooms and 3 full bathrooms), they left her with me until they could complete their investigation. I would have gladly kept her long term, but CPS objected to placing a teenage girl in the home of her boyfriend, along with two other teenage boys.

          • Roadstergal
            February 9, 2016 at 1:44 pm #

            “I think it’s mostly just a label to have something put in their IEP’s to justify additional services.”

            I’ve heard anecdotally from educators that some of the surges in, at varying times, autism diagnoses, ADHD, etc, are diagnoses to get support for kids that need it, so they’ll fudge or squeeze the criteria to get the kid covered?

          • BeatriceC
            February 9, 2016 at 1:49 pm #

            We’ve been known to stretch things to the breaking point in order to get kids services they need, and not just for special ed diagnoses. For example, we had a family that needed a number of things; help with transportation, after school care, paying for extra-curricular activities, and things of that nature. The mother was living with her long-time boyfriend who was not the children’s father. We declared the family “homeless” and their shelter needs met by “doubling up” (when one family lives with another for economic reasons), which then qualified the family for services under McKinney-Vento. We do this kind of thing all the time in order to help the kids.

        • ladyloki
          February 9, 2016 at 3:07 pm #

          Both of my foster to adopt kids were labeled as having FAS, even though they are both developmentally normal, the elder one skipped a grade and the younger one is at the top of her advanced class. No ADHD, no nothing except some lingering depression from being in foster care in the first place.

          I think it’s a CYA thing. They also came in as saying they might have been possibly sexually abused because the elder girl said a sexuality explicit word once. Yeah, it’s called being a kid and hearing at at school from the older kids.

    • fiftyfifty1
      February 9, 2016 at 8:17 pm #

      Yes, part of the issue is that the diagnosis of FAS has room for subjectivity and bias. The paper that Dr. Tuteur linked to gives an example of making the diagnosis in Native American children. Two of the FAS defining facial features are spooned nasal bridges and epicanthal eye folds. Both of these features can be normal variants and are found more often to begin with in NA populations. Then add to that the stereotype that “all Indians are drunks” and add the fact that living under poverty and racism is more likely to make a person have behavioral and school problems and Voila! you have made a diagnosis of FAS!

  34. Amy M
    February 9, 2016 at 12:45 pm #

    One NCB lady I met tried to tell me that OBs don’t warn their pregnant patients about what can be dangerous during pregnancy. I gave her a withering look and told her that the first thing the OB does upon confirming a pregnancy is hand out a giant packet of information, and the first part is DON’T DRINK, SMOKE OR DO DRUGS, loud and clear. Her response was: “Well, some women don’t read it!” Even she recognized that that was ridiculous.

    Sure, some don’t read it, but the bigger issue is more likely women who don’t get prenatal care in the first place. I guess that’s what the CDC is trying to cover, but they are condescending about it.

  35. Amy M
    February 9, 2016 at 12:43 pm #

    So the current thought is that in order to end up with FAS, one has to have a certain genetic signature, AND the mother has to drink [some unknown amount of] alcohol while pregnant? Has anyone studied the genotypes? What would be awesome is if a FAS signature could be detected, along with the trisomy screens, and then women whose babies were at risk could be advised more specifically. If a genetic predisposition could be isolated, parents could be tested before they even conceive, to see if they have the signature.

    Of course,I may be misunderstanding the genetic link of FAS, in which case, forget I said anything.

    • Ceridwen
      February 9, 2016 at 1:02 pm #

      This would be ideal, but the genetics behind this are likely to be controlled by many loci of small effect rather than a single or few loci of large effect. This is also what makes it so difficult to pinpoint the genetic underpinnings of autism and a number of other disorders. It’s easy to determine that these diseases have a genetic component. But when that genetic component is being controlled by many genes acting in concert it becomes extremely difficult to state the actual risk of any individual of suffering from the condition. For example, on one genetic background a particular allele could convey a 10% increased risk of developing FAS when exposed to x amount of alcohol. But in a different genetic background that same allele could cause a much higher increased risk, be neutral with regard to FAS, or even be protective. Does that make sense?

      • Amy M
        February 9, 2016 at 4:03 pm #

        Oh it does, but that’s why I was thinking signature. Not looking for or at just one gene, but if people with FAS share differences from the general population on clusters or families of genes. MS, for example, is very heterogeneous, but researchers have found that many (if not most) patients can be put in 1 of 4 categories based on their gene signatures. And all of those signatures look different than those of people who don’t have MS.

  36. Gatita
    February 9, 2016 at 12:37 pm #

    Public health orgs are ALWAYS doing this. They pitch all recommendations to the lowest common denominator and word them too strongly because they think people won’t listen otherwise. It’s aggravating.

    • Megan
      February 9, 2016 at 12:44 pm #

      I guess it’s harder to fit a nuanced view into a soundbite or a cute graphic.

      • Gatita
        February 9, 2016 at 12:46 pm #

        It’s more a lack of trust in the ability of the general public to understand nuance–which, to be fair, isn’t unfounded. The average person’s literacy is around a 5th grade level.

        • Megan
          February 9, 2016 at 12:47 pm #

          Oh, I know. I was just being snarky. But they really ought to acknowledge that there is uncertainty in the issue. I think most people can understand that concept.

        • Ceridwen
          February 9, 2016 at 1:04 pm #

          I think we often underestimate 5th graders.

        • BeatriceC
          February 9, 2016 at 9:29 pm #

          Spend any time reading discussion forums aimed towards giving customer service workers a place to vent and I’m afraid that you’ll find that you’re right.

    • crazy grad mama
      February 9, 2016 at 2:31 pm #

      I always wonder if this approach doesn’t have the opposite effect, i.e. everybody realizes the warning are way over-the-top and thus ignores them.

  37. Megan
    February 9, 2016 at 12:36 pm #

    Attention wimmin: We know you are too feeble-minded to understand the real data, so trust us to interpret it for you and go back to doing what you were put on this Earth to do: incubate babies and be dairy cows.
    Love, the CDC

  38. Zornorph
    February 9, 2016 at 12:18 pm #

    I really feel sorry for women in this regard. A pregnant women can’t even have a sip of champagne to celebrate an event without a bystander freaking out on them.

    • Madtowngirl
      February 9, 2016 at 12:26 pm #

      When I had my first miscarriage, I hadn’t even known I was pregnant before it started happening. I had a few drinks around the time, it being the holidays and all. My doctor reassured me that the alcohol hadn’t caused the miscarriage, but a “friend” made sure to tell me that’s what caused it. This bullshit recommendation, that isn’t based in science, is only going to fuel that mentality.

    • LaMont
      February 9, 2016 at 1:27 pm #

      I saw a visibly pregnant woman (a stranger to me) toasting with water at a wedding and my brain almost ate itself trying to hope that she just isn’t a drinker, or didn’t want to toast with champagne, as opposed to giving in to the likely truth that she was just avoiding the censure or fully in the “not one drop!!!!” camp herself. The most insidious part of being a woman is never knowing if women are doing things because they wanted to or because they (felt like they) had to. It’s constantly terrifying.

      • guest
        February 9, 2016 at 2:35 pm #

        I attended my cousin’s wedding at the beginning of my third trimester (possibly the end of the second – I don’t remember). I toasted and drank a half glass of champagne. The twins are totally fine.

        I also had one shot of vodka on New Year’s Eve, three days before they were born.

      • Sarah
        February 9, 2016 at 3:05 pm #

        She might just not have wanted it. I couldn’t bear even the smell of alcohol during one of my pregnancies. Even a sip for a toast would have been impossible. It’s quite common I think, makes sense when you consider lots of alcohol has a very strong smell.

        • LaMont
          February 9, 2016 at 10:12 pm #

          Oh I know that possibility is very much alive, it’s just disheartening to never know if it’s individual desire or societal pressure with these things. I’ve never been pregnant but if it’s the nausea-and-reflux party everyone says it is, I can totally see plenty of women considering alcohol seriously unpleasant for the duration. I have constant reflux as it is, and when it’s hitting me hard, alcohol is a bad times recipe…

          It’s just like when a coworker of mine quit her job to be stay-at-home, I straight up panicked at the thought that my very chill workplace is somehow incompatible with childrearing (if my job can’t be combined with family, no job can), then realized “this isn’t a ‘she had to’, situation, it’s a ‘she wanted to’ situation”. Still chilling for a moment. I may be slightly neurotic.

          • Sarah
            February 10, 2016 at 11:04 am #

            No, I think it’s perfectly reasonable to worry about these things.

    • indigosky
      February 9, 2016 at 1:31 pm #

      I saw an article recently about some zit faced barista at Starbucks refusing a pregnant woman a coffee. I myself was shamed by a similarly zit-faced teen at a grocery store where I was daring to buy my husband a 6 pack of beer while seven months pregnant. Idiot boy was dumb enough to judge me with his manager right behind him and he got fired on the spot.

      • Megan
        February 9, 2016 at 2:11 pm #

        I was refused a beer with dinner at a restaurant during the third trimester of my last pregnancy. I had purposefully chosen a beer low in alcohol (4.5%) and was going to split it with my husband. Is it a law to not serve pregnant women or just ignorance?

        • TheArtistFormerlyKnownAsYoya
          February 9, 2016 at 2:13 pm #


        • KeeperOfTheBooks
          February 9, 2016 at 2:20 pm #

          Ignorance, though some states have some (very badly-written) laws that either permit or even require servers to use judgment in whether or not to serve. For example, in mine, a server can be personally liable if they over-serve someone and they get into a car and drunk-drive, but on the other hand, not serving someone who shouldn’t have another drink and/or drive (“dude, you’ve just picked a fight with that incidental table for ‘looking at you funny,’ so I’m not serving you again until you hand over your keys, and I’ll gladly call a taxi”) can get the server fired by management for cheesing off the customer. Lose-lose situation.
          In short, while you probably just had an idiot for a server, there is a slight chance that the server was genuinely concerned that if you drank a beer he served and something bad happened, you’d then sue him or his establishment or both. Which also goes to show that we need better education in general about pregnancy and drinking because seriously, half a low-alcoholic beer with dinner ain’t gonna cause FAS, but there ya go.

          • Megan
            February 9, 2016 at 2:23 pm #

            I was surprised by it because we go there all the time and they know us. They also know I’m a physician and presumably know the risks. Hubby wanted a beer too, so after she refused me he just ordered one for me and then after I drank my half, he chugged the other half and ordered what he wanted. So, it didn’t really change anything anyway. I was just curious if there was a law or something preventing her from serving it to me. My state is known for its prudish alcohol laws.

          • KeeperOfTheBooks
            February 9, 2016 at 2:26 pm #

            Weird, especially since they knew you. If your state is like that, then, my guess is that the server might well have been worried about liability, or was perhaps badly educated. Utterly idiotic, of course. Just means that you needed to go home and enjoy an entire beer instead. 😉 (Says the woman who follows UK guidelines on drinking while pregnant, so after the first trimester I usually have either a glass of wine or a beer or two over the course of a week, but of course YMMV, use your prudential judgment, et all.)

          • Megan
            February 9, 2016 at 2:31 pm #

            That’s what I’ve just done this pregnancy is just have one at home. A beer is a wonderful thing for helping BH contractions! Again, choosing a low alcohol one, having it with food and waiting until third trimester (though truthfully I likely would’ve had one after 20 weeks if I had wanted one). It’s just ironic to me because when I don’t look pregnant and could easily order a beer at a restaurant is when I’m more likely to do damage to my baby, but by third trimester, any damage from one beer with dinner is very unlikely, but that’s when I got refused!

          • Zornorph
            February 9, 2016 at 3:18 pm #

            I always thought the bartender rule was that, as long as the customer is reasonably sober, to serve what they requested be it piss or poison.

          • An Actual Attorney
            February 9, 2016 at 5:13 pm #

            I heard this from a friend of a friend, so take with salt. When my city had a lead in the water, but theoretically had cleaned it up, a pregnant woman went to her weekly glass of wine with friends. The restaurant always served her. But when she asked for a glass of tap water, they said they weren’t comfortable serving it to a pregnant woman.

          • Rachele Willoughby
            February 9, 2016 at 5:15 pm #

            Did they offer her a free bottle of water? If so, I’m going to dub that superior customer service.

          • An Actual Attorney
            February 9, 2016 at 7:42 pm #

            Not sure. But that would have been the classy move.

        • An Actual Attorney
          February 9, 2016 at 5:07 pm #

          In the US, at least, probably against the law not to serve. But friends of mine who have waited have said they often put alcohol in coffee mugs for pregnant women to protect them from other customers.

          • demodocus
            February 9, 2016 at 5:11 pm #

            But caffeine!!
            there are one or two benefits of being fat enough that nobody’s sure if you’re pregnant or fat.

      • TheArtistFormerlyKnownAsYoya
        February 9, 2016 at 2:15 pm #

        Where I live they have posters plastered all over the (government-owned) liquor stores stating “alcohol and pregnancy don’t mix”. No wonder employees feel they have the right to do things like this. It’s absolute hysteria.

      • Inmara
        February 9, 2016 at 3:15 pm #

        Somewhere I read about this hilarious exchange in Starbucks:
        Random lady to a pregnant woman (who had decaf chai latte, btw): “You are pregnant, you shouldn’t drink coffee!”
        Pregnant woman: “You are fat, you shouldn’t eat that cake!”

    • Carolina
      February 9, 2016 at 1:34 pm #

      I got a lecture from the cheese counter worker at Whole Foods when I asked if the goat cheese was pasteurized. She told me I couldn’t have it even if it was. I glared at her and ate a huge piece of the sample.

      • guest
        February 9, 2016 at 2:32 pm #

        You rock.

      • Elisabetta Aurora
        February 9, 2016 at 3:31 pm #

        Wait, why couldn’t you have goat cheese?

        • Rachele Willoughby
          February 9, 2016 at 3:33 pm #

          Just another thing us pure, perfect vessels of life are supposed to abstain from if we’re pregnant (or, according to the CDC, might ever conceive).

          • Elisabetta Aurora
            February 9, 2016 at 3:47 pm #

            Please. This is insane. I just ate an entire round of it with my dinner tonight. Goat cheese and Paprika Omelet. 20 weeks along.

          • Megan
            February 9, 2016 at 3:49 pm #

            Man, a whole wheel of goat cheese sounds really good (especially with a beer!). Now I’m going to have to send hubby to the store on his way home… (32 weeks and change)

          • Elisabetta Aurora
            February 9, 2016 at 3:54 pm #

            Yeah, I just read today on one of those “Your baby is now the size of a cantaloup” websites, “You’ve probably gained about 10 pounds now.”


          • Megan
            February 9, 2016 at 3:57 pm #

            They meant the non-cheese weight only. Cheese weight doesn’t count. 😉

          • Rachele Willoughby
            February 9, 2016 at 4:01 pm #

            Or ice cream. Everyone knows that pregnancy requires a certain amount of weight gained purely from ice cream.

          • Elisabetta Aurora
            February 9, 2016 at 4:06 pm #

            Actually, it totally makes sense that we would crave foods that are high in calcium. Didn’t they used to say that you lose a tooth with every baby? Or something like that.

          • Rachele Willoughby
            February 9, 2016 at 4:11 pm #

            I absolutely did. So did my mother. We both needed dentures in our late twenties. Medical literature says it’s an old wives tale but i have not found that to be the case.

          • demodocus
            February 9, 2016 at 5:03 pm #

            I think that’s the entirety of my weight gain 😉

        • demodocus
          February 9, 2016 at 5:02 pm #

          Some soft cheeses are not pasturized and i guess can pick up nasties more readily than hard cheese. *shrugs* My ob said pasturized feta was fine, so long as i didn’t go completely nuts with it.

      • Megan
        February 9, 2016 at 3:51 pm #

        Just another reason to avoid Whole Foods. I’m sure the folks at Giant Eagle wouldn’t give a crap what cheese I eat! 🙂

        • guest
          February 9, 2016 at 3:55 pm #

          Oh Giant Eagle. I miss it.

    • Elisabetta Aurora
      February 9, 2016 at 3:06 pm #

      I was in the third trimester when I crammed my enormous ass into an itty bitty economy class seat and flew for 14 hours to visit my in-laws. When I arrived, sweaty, exhausted, and jet lagged, my father-in-law graciously opened a very fine bottle of real French champagne that he had been saving for many years. The toast was to their first grandchild, everyone including my husband, brother-in-law, and his wife were given a glass. And for me? The beautiful breeding cow who had come all this way to spend Christmas with them? I was given a glass of orange juice – not even fresh squeezed for that matter (I mean they knew I was coming and were planning on opening that fucking bottle in front of me).

      Later in the evening when I was alone with my father-in-law, I tried very politely but firmly to tell him that what had happened was not okay. I tried to be diplomatic and understanding of his fears, while at the same time explaining that it was rude and patronizing not to offer me a glass as well. He seemed to take the criticism with aplomb and I thought that was the end of it.

      Fast forward to my second pregnancy. We are out to dinner with my in-laws and the waiter pours everyone at the table a glass. I am busy with my toddler and don’t notice. I hadn’t planned on drinking that night (it wasn’t a special occasion and I didn’t have any desire for it) see my glass and hand it to my husband. My mother-in-law reaches across the table to pat my hand.

      “I’m just so happy to see that you’re choosing not to drink during this pregnancy. We’ve been really worried.” I think I see a tear in her eye.

      • AirPlant
        February 9, 2016 at 3:10 pm #

        You know that reaction gif of Krysten Ritter rolling her eyes forever?
        I would totally post that at your MIL if I could.

      • Megan
        February 9, 2016 at 3:17 pm #

        Oh, please… *rolls eyes*

      • demodocus
        February 9, 2016 at 4:58 pm #

        Gag me. Makes me want to take a swig of that open bottle of merlot that’s been hanging out in our fridge for long enough to make any wine connesiur (sp?) shudder. (i do like beef burgundy and we have no palate to speak of.)

    • LovleAnjel
      February 9, 2016 at 3:21 pm #

      When I was about 7 1/2 months along we went to a wine bar with some friends. It had automatic dispensers that would give you an ounce, a half glass or a full glass. I would just get an ounce at a time, and because of pregnant taste buds mostly pawned them off on my husband. I did get the pleasure of waddling around with what appeared to be a mostly-drunk goblet of wine and watching the looks on people’s faces.

  39. Madtowngirl
    February 9, 2016 at 12:17 pm #

    It disappoints me that the CDC is joining other organizations in being reactionary, rather than honest, about the scientific data we have.

    • Megan
      February 9, 2016 at 12:34 pm #

      Oh but the real data is just so complicated. Wouldn’t want the little women to have to use their brains to try to understand it. /sarcasm

  40. Ennis Demeter
    February 9, 2016 at 12:01 pm #

    They are only women, so who cares? Better safe than sorry!

    • Roadstergal
      February 9, 2016 at 12:10 pm #

      Women don’t need pleasure.

      • Zornorph
        February 9, 2016 at 12:17 pm #

        Unless it’s an orgasmic birth, you mean.

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