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.