ACOG, alcohol and the infantilization of pregnant women

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Perhaps this will lay the accusation that I am a shill for ACOG to rest.

The president of the American College of Obstetrician Gynecologists (ACOG) wrote a letter in response to my recent piece in The Washington Post, Five myths about pregnancy, in which he vehemently disagreed with me. He seems to think we disagree on what the science shows; in truth, we disagree on what professional ethics demands of doctors.

I wrote:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women deserve to have the same information that doctors have and medical autonomy means that they can decide for themselves whether the risk is worth it to them. [/pullquote]

Studies on alcohol are … ambiguous. Although it is quite clear that large amounts of alcohol can cause fetal alcohol syndrome, the limit of safe consumption is unknown. There are some doctors who insist that if we don’t know the exact limit, women should avoid any alcohol. But most believe that an occasional glass of wine or beer will not cause any problems.

These sentences are undeniably true, yet in a Letter to the Editor, Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome and Haywood L. Brown, president of ACOG, vehemently disagree.

By writing that studies are “ambiguous” in “Five myths about pregnancy” [Outlook, May 14], Amy Tuteur framed the issue of a safe level of alcohol use during pregnancy as an ongoing debate between opposing sides, each with scientific validity. In fact, the science is settled: There is no amount of risk-free alcohol use during pregnancy. This is the position of every scientific and public-health institute and medical and behavioral health association in the United States …

They claim:

[No study] has found any level of prenatal alcohol consumption that is non-toxic to human development.

This is the logical fallacy known as the “argument from ignorance,” often colloquially expressed as “Absence of evidence is not evidence of absence.”

According to Wikipedia:

It asserts that a proposition is true because it has not yet been proven false (or vice versa). This represents a type of false dichotomy in that it excludes a third option, which is that there may have been an insufficient investigation, and therefore there is insufficient information to prove the proposition be either true or false.

Yes, it is true that no study has found a safe level of prenatal alcohol consumption in pregnancy, but that does NOT mean that there is no safe level of alcohol consumption, merely that we don’t know what it is.

Why don’t we know? Because the situation is far more nuanced than Mr. Donaldson or Dr. Brown acknowledge and by representing our knowledge as complete and definitive when it is incomplete and uncertain, they infantilize pregnant women.

How?

They write:

Why tempt harm when all risk can be avoided?

But it’s not their decision to make; the decision belongs to each individual pregnant woman.

What do we know about alcohol and FAS?

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.

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.

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.

Clearly the issue of alcohol in pregnancy is not straightforward.

Unfortunately, Mr. Donaldson and Dr. Brown have transmuted uncertainty into certainty. Instead of acknowledging that the safe limit of alcohol consumption in pregnancy depends on factors that we don’t yet understand, they imply that NO amount of alcohol consumption is safe in pregnancy and that is almost certainly not true for every woman. To maintain such a stance in the absence of concrete scientific evidence is to treat women like children.

I suspect that if a newly pregnant patient worried aloud about her fears of fetal harm from a glass of Chardonnay she drank before she knew she was pregnant, even Dr. Brown would reassure her that it probably caused no harm at all —because that’s what the existing scientific evidence shows. If it is appropriate to reassure women who have already had that glass of Chardonnay, it is inappropriate to tell another women who hasn’t had the Chardonnay yet that a glass of wine could very easily cause harm.

Women deserve to have the same information that doctors have and medical autonomy means that they can decide for themselves whether the risk is worth it to them.

In my view doctors are ethically obligated to be honest with women — to tell them what is true and to acknowledge what we don’t know — and let them decide for themselves. It is infantilizing to make decision for them and counsel them to do what we might prefer.

  • Why risk it? FAS is no joke.

    • True, but they don’t need to treat us like infants. Male OB/GYNs can be particularly condescending; it’s why I insist on only seeing a woman.

      • And I get that.

        But what I’m seeing here is a whole bunch of people who have never experienced what it’s like living with someone with FAS, and frankly, I’d like to direct them to talk to my baby bro, because he has FAS, and he’s all kinds of messed up mentally and physically because of it. It’s not something you want to risk, at ALL.

        (Mind, I’m proud of him for being a semi-functional adult and holding down a job. But it’s not easy for him at all.)

  • icastico

    From my view, after 3 decades working in the field of neurodevelopmental disabilities, your public posts on this topic misrepresent the degree of uncertainty we have about the harm that alcohol does – and the risk calculation that mothers make when deciding whether or not to expose their child to alcohol.

    First, on the topic of the science being ambiguous. It is not, really, ambiguous at all. You need to start first with the vast animal literature that has explicated the mechanisms of harm that cause developmental disruptions in primate fetuses exposed to alcohol. It causes damage every time at some level. The question is how much and in what form, which depends upon dosage and timing. You should also look into recent studies that control for genetic variations in humans and find clear dose response functions that implicate cognitive impacts at low levels of alcohol exposure. You can also look at clinical data and case studies indicating full FAS cases with light to moderate drinking patterns. But, really, the problem with your public stance on this topic is that it fails on a basic logical level related to how we should weigh risk in the face of uncertainty.

    Do we say “I don’t know how risky it is, so I can’t advise against it.” Or do we say “I don’t know how risky it is, so I advice against it.” In neither case are we being patronizing to the woman asking for expert advise. In both cases we are acknowledging the uncertainty.

    So, what do we know?
    1) We know that alcohol disrupts fetal development across most body systems with the nervous system (i.e., the brain) being the most vulnerable system in the body.

    2) We know that among the most common recreational drugs (alcohol, marijuana, cocaine, heroin/opiates, methamphetamine) alcohol is by far the most harmful substance to fetal development.

    3) We know that time and dosage will influence the degree of damage with heavy drinking being particularly dangerous.

    4) We know that genetics of the mother and the fetus variably impact the risk for a particular child, with some children having severe impairment in the context of light exposure and some children having little or not impairment in the context of heavier exposure. In other words, we know that some children are particularly sensitive to exposure to alcohol in the womb.

    5) We know that Fetal Alcohol Spectrum Disorders can be very disruptive to families, can limit long term success for the individual, and are very costly to society.

    Then there is what we don’t know.

    1) We don’t know if there is a level of drinking that would be universally safe, but we suspect that this level exists.

    2) We don’t have any way to predict the particular vulnerability of a particular mother/child dyad – so there is no way to give informed advice on how much drinking would be safe for an individual.

    So what is the best advice to give to a mother armed with this basic knowledge? How do we help them make the right decision for themselves based on what we know and don’t know?

    First, I would emphasize that the potential risks are large. Having a child with a significant disability is not a minor annoyance. It is a big deal.

    Then I would acknowledge the uncertainty. I would emphasize that there is NO WAY to know whether your child is one of the babies that may be particularly sensitive to alcohol exposure. There is no way to know if they will be harmed by light drinking during pregnancy, but that there is a real risk that they might be.

    It would then be advisable to talk about the possible benefits of consuming alcohol during pregnancy. Why do they want that drink? What does it do for them? Are there other ways to get those benefits that are less risky? (see the list above).

    In the end, all of this information boils down to “there is no known safe level, so the best advice is to avoid alcohol while pregnant.” I would add, BUT if you feel the need for a mild intoxicant during pregnancy, there are safer choices. Often when given the real information on risk in terms of other options, women change their view of what they are asking. Just change the words from “an occasional glass of wine” to “an occasional dose of heroin” and decide if you would have the same position on risk.

    I would also reemphasize what has already been pointed out by other responses here that “the American Paradox” is largely a myth that does not stand up to scrutiny. The epidemiological work in this field is far from stellar, but the work that has been done shows clear correlations in FAS incidence based on the drinking habits of the community under study. It worries me that it is included in your post.

  • Jules B

    I was born in 1973. My Mom talks about how her doctor would offer her a light for her cigarette when she was pregnant and in his office for check-ups. My mother ate all sorts of things while pregnant that are now on the “forbidden” list. She didn’t take prenatal vitamins (they weren’t really a thing yet, I guess). In fact her prenatal care pretty much just consisted of her going in every month to be weighed and to have her belly measured, to check to see if baby was growing (ultrasound technology was not widely or routinely used then). And she had the occasional glass of wine.

    The advice and care she received was pretty standard for the day – in other words, I think she was a pretty typical pregnant lady of her era. It would be interesting to know how many babies who were born in the 1970’s (now middle-aged adults) when lots of pregnant women drank and smoked through their pregnancies had major issues. I wonder if there are many stats on that?

    • Young CC Prof

      Well, average birth weight is up about a pound since then.

      • Kerlyssa

        i remember reading an anecdote about a woman in post ww2 america who was advised by her doctor to start smoking- she had had a giant baby already, and it ran in the family.

        • Who?

          My friend’s mum, in the 1960’s in Australia, was urged to start smoking by her GP to calm her nerves when she was stuck in a strange town, away from her family, with three young children.

          No record of how that went, but she did die of cancer in her fifties-bowel, not lung, but still.

    • The Bofa on the Sofa

      How many however didn’t survive it to talk about?

      While true, Jules, this is basically the “We didn’t use seat belts and survived” elsituation. Of course there were a lot who smoked and drank and all sorts of stuff and everything turned out fine. But there were far too many who didn’t come through unscathed.

      • Jules B

        Oh yeah, I wasn’t making the argument that all was peachy keen back then…I was just thinking that we could learn something from an era when drinking and/or smoking was more the “norm.” (If we had the data, which I doubt we do).

        • Susan Byrne

          Part of the data from the good old days would have to be gleaned from homeless, institutionalized, and imprisoned populations. When folks didn’t know what it was, they still had to deal with the consequences and the children damaged by FASD were labeled “defiant”, “bad blood”, “trouble makers”. They suffered the damage of prenatal alcohol then just as they do now.

  • Gæst

    People get all het up about a glass or two of wine during a pregnancy, but whenever I dared to move away from someone smoking, or ask that smokers standing outside the only entrance to my workplace be moved, suddenly *I* am overreacting.

  • StephanieJR
    • swbarnes2

      Right, but note how they’ve demonstrated bad outcomes in studies with very low exposure. Compare to alcohol, where many studies of very low exposure don’t show any detectable problem…but they still say “no safe level of alcohol” and ” no safe level of lead”.

      • Susan Byrne

        Those studies that don’t show any detectable damage cannot conclusively determine that there is no damage to detect. Damage at the cellular and neurological level don’t show up in brain scans, at least not with current technology and certainly not with yesterday’s. The Diagnostic and Statistical Manual (DSM) 5th edition lists the clinical symptoms doctors use to diagnose FASD. It is clinical observation of behaviors and functionality, and medical history (if mother was known to use alcohol or drugs) that provide the basis for diagnosis of FASD. Similarly for almost all common developmental disorders such as ADHD, autism etc. FASD is, like those, an “invisible” disability until the observer is trained to detect and identify it. And the population of people with FASD is conservatively estimated to be 2-3 times larger than the population with autism. More recent studies put it at up to 7 times, and in certain populations, even more.

    • Susan Byrne

      Not too far OT. All elements that cause cellular damage are categorized as “teratogens”. Lead, heroin, alcohol, and far too many more qualify.

  • StephanieJR

    Y’know, you hear about surprise pregnancies every now and again- woman doesn’t know she’s having a kid ’til she’s in labour, and suddenly there’s a baby. I Didn’t Know I Was Pregnant, read stories in magazines, that sort of thing. And usually these women have continued their lives as normal, including drinking alcohol. And those stories usually end with ‘and the baby’s completely healthy’- I don’t think I’ve ever heard of them saying the baby was sick, from genetics, FAS, or a very unexpected homebirth.

    • maidmarian555

      I used to work with a woman who didn’t know she was pregnant until she was 8 months (long before I knew her). She was a super-heavy smoker and a big drinker and was warned to expect her daughter to be seriously unwell as a result. Baby was fine. Is now an adult living a normal life with a normal job. Mind you, that’s just one very unusual case, I suspect she was just amazingly lucky.

      • StephanieJR

        Yeah, I do think it’s more luck in these cases, and some careful reporting- I never read about a disabled child, for example, or about the baby being put up for adoption. It’s almost always framed as a happy accident, with the woman always perfectly ready to be a mother, and people rallying around to help.

    • KQ Not Signed In

      I know someone who didn’t know she was pregnant until labor. She worries intensely that her child, who has some special needs, might not have them if she’d had proper (or any) prenatal care or had made lifestyle changes. She blames herself a lot.

      It doesn’t mean it’s her fault – a lot of her child’s issues are likely genetic, and others are still cause unknown. But she also doesn’t tell her story much, and I’d wager a fair number like her don’t – it’s only a great story if “everything turned out fine”

      /anecdote

    • demodocus

      i doubt they’d put it about if everything wasn’t fine.
      i do know a woman who didn’t realize she was pregnant. Her parents were down-sizing and gave Kid 1 the twin bed they’d originally bought just in case they ever had a grandchild. (THey watch Kid1 when I was having Kid2 the month before) She was helping to move this bed and dresser to our 2nd floor walk up. 3 weeks later she was a mom. The baby’s a preemie, but following her own wee arc fairly well.

    • Heidi

      Yeah, I think they make sure to only include the “happily ever after” stories.

    • MaineJen

      I know someone this happened to also (it is clearly more common than we think!) A tiny woman who gained about 10 pounds over the course of a year, didn’t think anything of it because she was on the pill and still got a cycle every month…continued drinking and smoking pot as usual as she was single and in her early 20s…went to the emergency room with what she thought was appendicitis, and ended up delivering a little girl. They estimated she was about 32 weeks, and her daughter had a short stay in the NICU but was fine thereafter. She considered putting her up for adoption as it was so completely unexpected and she was no longer with the father, but ultimately decided to raise her, and they were doing great last I knew.

    • Susan Byrne

      Google “FASD pregnancy” or “birth rate” and you’ll find them plentiful.

  • mostlyclueless

    “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.”

    I do not think this is accurate. From a March 2017 issue of The Lancet Global Health:

    “In some regions (most notably in the WHO European Region) a high proportion (about a quarter) of pregnant women in the general population consume alcohol during pregnancy, which is mirrored by also having the highest FAS prevalence that is 2·6 times higher than the global average (14·6 per 10 000; 95% CI 9·4–23·3)”

    You can see the prevalence by country in Figure 4, and specific numbers for each country in the appendix, table A6. They report the following prevalences of FAS per 10,000 people:

    US: 22.5
    Spain: 22.2
    France: 41.4
    Germany: 38.3
    Italy: 82.1
    Portugal: 44.0

    So of those western European countries you can see that only Spain has a low prevalence relative to the US.

    http://www.sciencedirect.com/science/article/pii/S2214109X17300219

    • mostlyclueless

      And for what it’s worth I don’t think this alters the salient point — that small amounts of alcohol are probably fine and there’s no need for “zero tolerance” level policing of women’s bodies. But I think it’s important to keep the facts air-tight when making the argument.

      • Susan Byrne

        The science is incontrovertible: no level of alcohol exposure is safe during pregnancy. The evidence is abundant: the vast majority of people in prison, children in foster care or adoptive families, and the chronically homeless have FASD.

    • AnnaPDE

      Could someone with a bit more time on their hands than I have right now have a look at the study?
      I was somewhat shocked by the German FAS prevalence so I looked at their data — it seems for Germany they have a single study of 998 kids in Berlin, none of whom had FAS, so I’m a bit confused how they come up with a 38.3 in 10,000 FAS prevalence estimate (also note the wonderful digit precision when the confidence interval is given as 0 to 105).
      Similarly, FAS prevalence in the individual studies for continental France varies between 0 and 42, with the largest sample giving around 12, but there’s also a study on La Reunion (a tiny island that technically counts as France) with 484/10,000. So again, it’s a bit weird that the “estimated prevalence” is 41.
      It’s well possible that I missed something during the cursory glance, but it’s worth a second look.

    • Susan Byrne

      Yes, and check the stats for countries where alcoholism is high… Russia, Ukraine. These are the countries that families adopt from and then years later discover their child has FASD. Also FASD is epidemic among our own Native American nations.

  • AnnaPDE

    Some women seem to love being told not to do this or that in pregnancy, and then stick to it religiously. Maybe because it gives them a feeling of keeping the baby safe by doing everything that is in her power?
    My coworker was like this — already a bit on the woo-y healthy side, she had trouble conceiving and staying pregnant, so when it finally worked out, she became obsessive about super-healthy eating, no deli, sushi, uncooked cheese, eggs that weren’t turned to carbon, etc. She actually switched OB/GYNs after her first one told her that considering her lifestyle up to now, if she doesn’t start binge-drinking while smoking, and a diet of soft cheese mixed with raw eggs that she has left out on the counter for a day, she should be fine. She decided he didn’t care enough for the health of her baby and found a doctor who made her happy by forbidding all kinds of obscure things.

    • EmbraceYourInnerCrone

      Which is fine if that’s what a person wants (though I worry about people who think that if they do everything right they can control every out come, they don’t always handle it well when life throws them a curveball…)

      However, it sometimes seems that everyone in the world thinks they have a right to comment on your parenting choices and TOTAL f’ing strangers feel entitled to tell pregnant women what to eat, drink, how much to exercise, what exercise they should do, how much they should eat.

      Also the touching. If I had a nickel for every stranger and random vague acquaintance who thought it was ok to touch my prenant belly ( I do NOT like to be touched by people I don’t know really well!!! arrgh!)
      And here’s some one who needs a swift kick in the shins:
      http://jennifermargulis.net/blog/2015/06/go-ahead-touch-my-belly-3-reasons-why-pregnant-women-should-stop-complaining-about-belly-touchers/

      • Sarah

        Oh blimey, that is impressively awful. I almost admire how annoying she is.

      • Dr Kitty

        No.
        No. No. No.

        It is NOT appropriate to touch someone without their consent.

        It doesn’t matter if the touching is non sexual, or done with the best of intentions, barring emergencies you just don’t touch people without asking.

        “I love touching people’s pregnant bellies and I’m excited for them and it makes me feel connected to the joy of creation when I touch pregnant women without their consent” is a particularly stupid and offensive argument for why pregnant people should submit to the unasked for, unwanted, physical attentions of strangers.

        ASK.
        If refusal offends you, maybe don’t ask in the first place, but certainly don’t presume consent and touch anyway.

    • TheArtistFormerlyKnownAsYoya

      In my experience these women also love to forbid other pregnant women from doing all kinds of ridiculous things. I can’t tell you how many stupid discussions about hair dye, a glass of wine, breastfeeding etc. I’ve had with these types. My son is 7 months old now and I’m still bitter and annoyed!

    • Emilie Bishop

      Infertility and loss will do a number on a woman. I was somewhat this way during pregnancy after years of infertility and a miscarriage. It is about control, but that control masks a deep fear. Good for her first doctor, because all of my medical personnel were about as anxious as I was. I’m sorry she wasn’t reassured. I wonder if I would have been or if I would have reacted the way she did. I really don’t know.

  • Lee McCain MD

    I think the word is paternalistic and condescension kind of like Dr. Brown’s (who I loathe) response to you.

    • Heidi_storage

      Dr. Brown is a nice man in person, or so I’ve always found. I’ve never considered him the sharpest tack in the drawer, though.

  • fiftyfifty1

    Carried to its logical conclusion, we must tell pregnant women (and even women of reproductive age not on birth control) that they must not eat fruit. At room temperature, fruit undergoes minute amounts of fermentation, so if there is NO safe level of alcohol, then there can be NO safe level of fruit.

    • demodocus

      air and pregnancy sparkles. Thats all we need for 9 months!

      • Charybdis

        We become hydroponic when pregnant?

        • demodocus

          Don’t trust the water, either. Might have lead!

          • Sarah

            And drinking too much water will kill you, so you shouldn’t have any just in case.

          • Azuran

            You really just shouldn’t get pregnant. After all, about 20% of pregnancy ends in miscarriage, Obviously, pregnancy is way too dangerous for the foetus!

    • Susan Byrne

      That is not a logical conclusion but rather the common error in logic known as all or nothing thinking.

      • fiftyfifty1

        Yes, exactly. I am pointing out the logic error that is All or Nothing thinking by taking it to its logical extreme. All or Nothing thinking is inherent in the No Amount is Safe assertion of extreme FAS activists.

  • lawyer jane

    What I find insidious about the paternalistic approach is that it erodes my confidence in medical advice in general. I need to rely on medical authorities to convey accurate information about risks and benefits to me and to my doctors … not scaremongering based on “no known safe level” nonsense reasoning.

    • Mattie

      Or at the very LEAST to just say it… “we don’t know at what level and in which circumstances alcohol becomes a risk, therefore we advice abstaining, but it is of course up to you to make the decision for yourself”

      • LaMont

        But also this defines “safe” as “zero risk”, which is insane. “Known to be safe” is like “he was found innocent,” just not a concept that tracks.

        • Sarah

          Indeed, and how many of the things that pregnant women do or consume have an exact and demonstrable safe level?

      • swbarnes2

        But when you have studies showing that low or moderate drinking has no detectable bad outcomes, that deserves to be mentioned too. ACOG and others probably decided that caffeine was okay because they looked at a small number of outcomes, and saw no detectable difference below that threshold in those outcomes, and started telling people that that level was okay. But with alcohol, it’s always “well, there might be problems that we can’t detect”

        A little like breastfeeding…can’t find a detectable difference? Keep insisting that there might still be one, if you looked harder.

        • Mattie

          Oh yeh, but you’d need to specify what ‘low/moderate drinking’ is because someone who barely drinks will have a very different view of that than someone who drinks a lot. Also, if you tell someone that moderate drinking is ok and then their baby has FAS it’s pretty rubbish for everyone.

          • demodocus

            since they have those for caffiene and fish, it shouldn’t be that difficult to do it for alcohol. i.e. 12 oz beer, OR 6 oz of wine OR 2 oz of liquor once a week/month, whatever.

          • Mattie

            Yeh absolutely! But if you say that you’re still presenting it as a ‘fact’ when it might not be, the only fact is that nobody really knows at what level or quantity alcohol is safe for every woman and every baby. One option is to just not say anything about alcohol, unless the person indicates at booking that they drink a lot, but then you’re still running the risk of someone suing you because their baby has FAS and you didn’t tell them.

          • demodocus

            only because no decent person is cruel enough to do the actual testing. There is also no guideline for fish for a 6 month old, I asked and my kid’s ped didn’t know. (Kid 1 loves tunafish sandwiches) They’re almost as susceptible to mercury as a fetus. Dr. A. said that he couldn’t find anything about it (after looking at the doctor search engine) but once a week was probably a good plan.
            If you don’t feel comfortable having any at all, don’t. I dislike alcohol, besides that beef bourgonion, so it’s no hardship for me. But the historian in me notes that FAS should have been far more prevalent until quite recently than it seems to be. Everyone drank watered wine or beer in a lot of cultures, even small children.

          • Mattie

            Yeh, I always wondered about that! Like Tudor people used to just drink beer haha although we googled it and the alcohol content was pretty low, maybe alcohol these days is just stronger?

          • demodocus

            Maybe. ‘Though you can still find weaker kinds of beer, they just dont sell as well because we have potable water when we’re simply thirsty.

          • Mattie

            Isn’t that just the best thing! Obviously there was a very high miscarriage rate and infant/child mortality rate in ‘the past’ and you do wonder how much of that was due to alcohol consumption, maybe more FAS babies were born but they didn’t know what it was that was wrong with them, or they just died young

          • demodocus

            Way too much in the world is trying to kill us to focus on FAS. Look at the portraits and early photographs from before 1900. Even given that a lot of them don’t include a person’s warts, if FAS were *that* common, they probably wouldn’t think twice about painting a person with the usual FAS features. The Hapsburgs were painted with their crazy chins.

          • Mattie

            Sure, there’s lots of things that can go wrong or we can die from, but it’s not really fair on the babies to just ignore that drinking while pregnant can cause brain damage, like, it’s a clear link in that it is alcohol that causes FAS, we just don’t know how much or why or if the amount is the same for everyone. Other than telling women that we don’t know, but a certain unknown level can cause it, we can’t do much else. Obviously the safest option is to tell women not to drink at all once they find out they are pregnant, but you can’t and shouldn’t ‘punish’ a person for choosing to drink/smoke/take drugs while pregnant, it is her body.

          • Sarah

            It is, and also the small ale was often safer than the water if you go back a few centuries.

          • AnnaPDE

            As Sarah already said, the alcoholic drinks today are stronger — after all, we don’t drink them as a substitute for water, or at least shouldn’t. But still, some of European history makes more sense to me when I keep in mind that some major decisions were made and countries led by illiterate teenagers who had been low-level drinking all their lives, as had their mothers during pregnancy…
            Then again, the constant alcohol exposure in not too distant European history might have had a pretty good selective effect against FAS. Does anyone here know if “small ale”-like stuff was routinely drunk in the past by populations that seem more susceptible for FAS today?

          • SporkParade

            King Henry VIII makes a lot more sense when you learn that he was a top athlete in the days before sports medicine who suffered a traumatic brain injury while only up to wife #2.

          • AnnaPDE

            Oh, interesting, I didn’t know that. *puts on reading to-do list*

          • Sarah

            Then give that fact, and tell women about all the evidence showing no issues from moderate drinking. Define what moderate drinking is if necessary, just as we do with servings of tuna, caffeine etc.

            This is not actually rocket science. Saying that we run the risk of legal action if we mislead women in one way is not an argument for failing to properly inform them in another.

      • Sarah

        Would you advise this for every foodstuff and act for which we don’t know in what circumstances it becomes a risk, though? I mean, is there research proving an exact safe level of toast for pregnant women? Chicken? Milk? Pears? After all, if you consume enough of most things they’ll be bad for you. We seem to apply different standards to alcohol, demands for absolute proof of safe levels, without doing the same for other things.

        • Mattie

          I mean we do recommend that pregnant women avoid certain foods, because of small risks (small potential risk of listeria, or mercury etc…) and with the mercury risk we say something like ‘no more than 4 small tins of tuna a week which is actually a lot of tuna haha AFAIK there are no risks to toast or pears assuming you eat a normal amount of them, if you’re eating nothing but pears and hundreds a day there may be problems.

          Unless you mean that we shouldn’t give any advice on diet in pregnancy, but then if someone drinks and their baby has FAS wouldn’t they have a case against their HCP for not telling them about the risk?

          • Sarah

            No, I mean we should give accurate advice about drinking in pregnancy (and indeed listeria) and not engage in the logical fallacy Dr Amy describes. There would be no legal case if accurate information were given.

            We should also acknowledge the double standards we apply to demands for evidence about alcohol consumption, because the reality is that people think they’re entitled to make demands that pregnant women abstain from alcohol until evidence of the level that’s not demanded from other food and drink is available.

          • FormerPhysicist

            Wow, I was told ONE serving of tuna per week. And nobody bothered discussing the mercury load in different types of tuna.

          • FallsAngel
          • Susan Byrne

            But the HCPs are telling you about the risk of drinking during pregnancy causing FASD. That’s what this discussion is all about. Every single medical group that has any expertise as well as those of science unanimously agree and clearly state this established fact. The argument seems to be about presentation and cultural sensitivity. The science is incontrovertible and settled.

        • demodocus

          Judging by the judgement and pseudo literature, I’d say pregnant women are not supposed to eat or drink nothing but air, sunshine, and impending baby sparkles.

          • Mattie

            There definitely seems to be more ‘regional’ variation in prenatal nutrition advice than there are regional variations in human women.

        • Valerie

          There is no “fetal chicken syndrome” known to be caused by excessive chicken. The level at which alcohol becomes toxic is much lower than the level at which these other foods are toxic- we know it’s within the range of typical human consumption. That’s why it’s treated differently from other foodstuffs, and people want to know if their level of consumption is harmless.

          • Mattie

            I think I have fetal chicken syndrome (what I’m now calling my anxiety lol)

          • No, there isn’t any “fetal chicken” syndrome. But you can get salmonella from chicken (and other foods), and E. Coli from others, and there can be resulting deleterious effects. In fact, food and drink of just about all kinds can be a minefield if improperly stored or prepared. Once again, it’s all about common sense.

          • Susan Byrne

            Yes, and the bacteria and toxins are teratogens that could cause cellular damage to a fetus, just like the teratogen alcohol.

          • Sarah

            So what’s the proven safe chicken consumption level then, and where’s the research proving this zero risk? Because this is what people demand for alcohol. And it is not as if there’s no possible risk to chicken consumption.

          • Valerie

            I’m not being disingenuous. I think many pregnant people would choose not to drink if there were even an infinitesimal chance that their fetus would have lifelong difficulties because of it. At least that’s the mindset of the pregnant women I’ve talked to- the temporary benefit of drinking is not worth any (100% preventable) risk to them. Avoiding alcohol is (for a lot of people) a pretty simple, easy thing, unlike, say, cooking everything for a long time in a pressure cooker to further reduce the risk of foodborne illness to zero (and quitting their jobs, staying inside, living in a bubble, etc). The health organizations that dole out official recommendations aren’t going to endorse a drinking regimen that will (rarely) cause harm, and they aren’t going to dose a large number of fetuses with alcohol to figure out the exact contours of the dose-risk function.

            I agree that ACOG/CDC/etc want to influence the behavior of others- this, on it’s own, isn’t a bad thing. A function of public health organizations is to educate people to change their behaviors to improve outcomes- in this case FAS. I don’t think they should use dishonesty to do it or manipulate people. I don’t think there should be judgement or shame on people who drink during pregnancy- your body, your choice. But at the end of the day, I believe that health organizations are concerned with serious impacts on fetuses, not women’s recreational behavior. There are people who believe that alcohol is immoral and use this issue, but I don’t think it’s the ACOG.

          • swbarnes2

            Can you name any behavior at all that doesn’t have an “infinitesimal” chance of causing harm?

            No one wants health organizations to endorse anything, but it’s not fair to say there is no safe limit when you have multiple studies showing no detectable bad outcomes at some levels of drinking.

          • Valerie

            Drinking is optional and recreational. Do other behaviors have risks? Absolutely. But it’s not unreasonable to choose to avoid taking tiny risks that are completely unnecessary. It’s also not unreasonable to choose to drink, especially if it’s important to your stress relief/social inclusion/relaxation/etc.

            My understanding is that studies and meta-analyses do show adverse affects for light-moderate drinking. Not all of them, of course, but enough to conclude that it’s not harmless (all of the time, for everybody).

          • Who?

            Driving is by far the most dangerous daily activity any of us undertake. And most car accidents happen close to home. Is anyone advocating pregnant women walk or take public transport to mitigate this real and measurable risk?

          • demodocus

            Having been a pedestrian, I can assure you walking on the sidewalk can be pretty damned dangerous too. Watch for long white canes, people!

          • Susan Byrne

            Faulty logic. Driving is an activity, not a teratogen.

          • TheArtistFormerlyKnownAsYoya

            That one study that used the women that were also regular users of cocaine? That’s the only one I know of that showed harm with light to moderate drinking and it is clearly, erm, flawed.

          • Susan Byrne

            If you don’t know of others, you haven’t looked. The science is settled: exposing a fetus to alcohol causes cellular damage. Which cells? How much damage? Depends on many factors of personal genetics, rate of fetal development, stage of development (week 3 is the most risk for the worst damage because that is generally when the brain is forming). Since we cannot be that precise in our assessment of the factors and the risks, it makes no sense to assume that there is no risk.

          • I think they get the point after twenty of your comments.

          • Susan Byrne

            You can bypass any of my comments, but for women who want to make informed decisions about this, talk to the families who live with the consequences, who struggle to have their children accommodated with special education, who can’t find community resources to support them or even doctors educated about it. At least double the number of families in the U.S. than those dealing with autism. Every single one of them have one thing in common: their child was exposed in vitro to alcohol, and not absurd amounts but those considered well within normal for our culture. Preaching disregard for the evidence doesn’t honor anyone’s ability to make fully informed choices.

          • Yeah, no. You’re spamming.

          • Sarah

            You’re being disingenuous, because you talked about women wanting to know if their consumption is safe and it’s very, very obvious that there are people involved in the discussion, even as far up as legislators, who aren’t motivated by that

            As for ACOG, of course it’s not a bad thing for them to want to influence the behaviour of others, but let us not delude ourselves that they do it in a social and cultural vacuum. They have chosen to apply different standards to alcohol evidence than they have for other things.

            And nobody is saying that foetuses should be dosed with alcohol to figure out the exact risk, literally nobody. That’s also disingenuous, incredibly so. The point being made here isn’t that we shoud perform those kinds of trials. It’s that because we can’t, we should explain the limitations of the evidence we have. I cannot believe that isn’t very obvious. That’s the same approach as lactivists who, when it’s pointed out that the evidence is weak, lacking in RCT etc, painstakingly explain why it would be unethical to perform certain studies, rather than modify their advice in the light of the evidential weakness instead.

          • Valerie

            You are reading things into what I type that aren’t there, and then claiming I’m disingenuous. I’m sincere. I believe that health officials are motivated by FAS prevention, not reigning in the behavior of women, and I believe that many pregnant women avoid alcohol because of risks they know to be tiny- that they don’t want to do a recreational activity that has a small chance of lifelong harm.

            I never said that anybody said that fetuses should be dosed with alcohol- I meant that it’s basically what would need to happen to determine a safe limit to endorse. And it’s not going to happen, so they endorse abstinence- I think we all agree here that that should come without the paternalistic BS and with an explanation of uncertainty.

          • swbarnes2

            ACOG wants to prevent the birth of low birthweight babies. But they don’t say “there is no safe level of caffeine, so avoid it entirely”. They say “Since we see no harm at this level, stay below that.”

            There are big studies that show no harm drinking below a certain level. Women should be told that.

          • Susan Byrne

            Can you point to the studies that show no harm to the fetus from drinking below a certain level, please? There are complex factors that can lead to anecdotal cases of a woman drinking alcohol while pregnant and still having a perfectly healthy baby. But unless you know your own tolerance (which itself depends on a complex set of factors), the stage of development and health of the fetus, the tolerance of the fetus (which itself is dependent on complex factors), the percentage of alcohol in the fancy fun cocktail you ordered on special at the bar, your genetic issues, the father’s genetic issues, etc etc etc, the only informed decision you can make is to avoid intentional exposure of your fetus to the number one teratogen condoned and heavily marketed: alcohol.

          • swbarnes2

            This took 5 seconds to find

            https://www.ncbi.nlm.nih.gov/pubmed/23322857

            “the overall lack of any adverse effects of light drinking is similar to findings from other recent cohort studies. Light drinking in pregnancy does not appear to be associated with clinically important adverse effects for mental health and academic outcomes at the age of 11 years.”

            https://www.ncbi.nlm.nih.gov/pubmed/23590126
            “The findings suggest that light drinking during pregnancy is not linked to developmental problems in mid-childhood”

            https://www.ncbi.nlm.nih.gov/pubmed/20924051
            “At age 5 years cohort members born to mothers who drank up to 1-2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of mothers in the not-in-pregnancy group.”

            https://www.ncbi.nlm.nih.gov/pubmed/18974425
            “Children born to mothers who drank up to 1-2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of abstinent mothers. Heavy drinking during pregnancy appears to be associated with behavioural problems and cognitive deficits in offspring at age 3 years whereas light drinking does not.”

          • Susan Byrne

            Importantly, these studies were prior to the current criteria for identifying FASD.

            There is conflicting data regarding the effects of alcohol exposure in utero when there is no evidence for FASD. Several studies from the Danish National Birth Cohort did not identify any effect on general intelligence, attention or executive function in 5 year old children whose mothers reported low-consumption, moderate-consumption, or binge drinking compared with children whose mothers reported no alcohol use in pregnancy [24, 25]. However, there are weaknesses to these studies, as they did not include any diagnostic evaluation for FASD in their cohort, and 5 years of age may be too young to make a true assessment on any neuropsychological effects of alcohol, as the brain is still developing at this age [26].

          • I don’t like spam.

            https://youtu.be/g8huXkSaL7o

          • demodocus

            I assume you must cook all your food to well done, even salads, because there’s no reason to eat anything raw or medium-rare on the off chance of listeria

          • Sarah

            Even further, it should come with an accurate assessment of the existing research and without descending into the fallacious, inconsistent approach Dr Amy criticises here. It is not a binary choice between giving a safe limit and endorsing abstinence.

            As for the rest, again it must be pretty obvious that not all people in this discussion who aren’t women wanting to know about their own consumption are health officials. I’ve specifically mentioned legislators, for one.

            And even if they were, it’s not enough simply to be motivated by a desire to avoid FAS. You also need to be motivated by a desire to promote the autonomy of pregnant women and to see them properly appraised of all the relevant facts we have. Otherwise you will find yourself taking the approach Dr Amy criticises, and there simply isn’t any place or excuse for that. Ever.

          • Susan Byrne

            Then let’s discuss others who want to influence behaviors: drug dealers, the $24.7 billion dollar alcohol industry, and those wonderful legislators motivated by the money and their own careers. There are no different standards applied to alcohol evidence than other drugs. But there’s a reason to focus on alcohol use in pregnancy: it’s the number one cause of the silent epidemic of FASD. And alcohol consumption, and binge drinking, are greatly increased among people of fertile age, men as well as women, but significantly more so among women.

          • Sarah

            None of which addresses the point I was making. Go and crowbar your pet phrases in elsewhere.

          • Susan Byrne

            The point you are attempting to make seems perfectly valid and is clearly stated as your opinion. Your supporting observations are illogical and have not been supported with anything more than random associations. Your incivility isn’t a good look.

          • Sarah

            You need to not tone police. We don’t take kindly to that here. You’re also not one to talk about random associations after that stream of crowbarred consciousness.

          • Azuran

            Chicken is, however, a huge source of food poisoning, which can be harmful for pregnant women. And since no matter how careful you are, there is never a 0 risk of getting sick while manipulating chicken, pregnant women simply shouldn’t be eating or touching chicken meat.

    • Susan Byrne

      Ladies, please, let’s not compare apples to oranges or food to teratogens. You can see how silly this argument is by substituting any other known teratogens for the alcohol. Try “lead”, “cocaine”, “viral infection”, or “malnutrition” and you’ll see the point.

  • Mattie

    I was talking about this with my friend the other day (she’s a final year med student) and I was thinking back to the advice we gave to women, and it was common for one midwife I worked with to give…different advice, depending on the client. So she would often tell fairly well off/middle class women that the odd glass of wine would be ok, while she told young/poor women that they shouldn’t be drinking at all. It was just one midwife, but it really pissed me off, it seemed so prejudicial

    • AnnaPDE

      Definite prejudice right there.
      Though individualised advice is certainly not a bad idea. When someone has told you that their pattern alcohol use is mainly “let’s get shitfaced on Saturday night and pass out somewhere”, then you probably want to give them different messages than someone who maybe has half a glass of wine with a fancy dinner every few weeks.

  • LaMont

    I mean, doesn’t this “why take the risk” logic hold true for literally anything? Don’t drive, don’t have a stressful job, don’t do *anything*…

    • Valerie

      Unlike driving or holding a job, alcohol is viewed as having no benefits. Obviously it does, or nobody would drink, ever.

  • EmbraceYourInnerCrone

    Add to this that humans are very poor at judging risk. The same person who might be HORRIFIED that one would have the occasional glass of wine while pregnant, might think delivering at home is very low risk. If you exist in the world you are exposed to potential risks, unless you are going to stay home and live in a bubble you have to figure out how high a risk of harm is probable from anything.
    Example: eating fish from the top of the food chain (shark, swordfish, some tunas) exposes you to ingesting more methyl mercury the more fish you eat

    https://www.epa.gov/choose-fish-and-shellfish-wisely/what-you-need-know-about-mercury-fish-and-shellfish.

    Also possibly things to avoid: soft cheeses, caffeine, deli meat, sushi, raw milk, raw eggs, uncooked shellfish. smoked seafood(lox, herring, etc)

    But it’s not up to me to tell a grown woman what she is and isn’t allowed to eat. Chances are(with the exception of raw dairy and shellfish) most of the things there are not going to cause a problem.

    And things you can’t do anything about very well may. If you live in the city or near a major highway or coal fired power plant you are going to be exposed to more pollutants (me, on both counts I can hear the I95 from my backyard and see the power plant stacks too). If your city infrastructure is out dated and has old water pipes you may be ingesting more lead than you know.

    Some one having a drink now and then should be their decision, not their spouses, not their doctors, not the local grocery store clerk.

    • demodocus

      Mom had major cravings for deli roast beef and baloney when she was expecting my little brother. Being 30 years ago, I’m not sure any one but her amused middle school daughter commented on it.

      • EmbraceYourInnerCrone

        When I think back to what my aunts and mother(my mother is one of 7 children) ate, drank and how much they smoked when they were pregnant (it was the 50’s/60’s) I am sometimes astounded my cousins and I are all mostly unscathed (mostly…)

        • StephanieJR

          My mum smoked with my brother and I. Our weirdness is probably genetic, though.

          • EmbraceYourInnerCrone

            Mine too! Although who knows? My Dad was in the merchant marine when they still used lead paint (“red lead”) and he used to talk about accidental gas releases from the factories in north New Jersey of who knows what when he as a boy(He was born in the late 1920’s)

            http://www.nytimes.com/1991/01/01/science/research-on-birth-defects-shifts-to-flaws-in-sperm.html?pagewanted=all

            “Animal studies have identified more than 100 chemicals that produce spontaneous abortion or birth defects in offspring fathered by exposed males, said Dr. Mattison. Among them are alcohol, opiates like heroin and methadone, gases used in hospital operating rooms, lead, solvents, pesticides and a variety of industrial chemicals”

            People often forget that what the father is exposed to affects future children too..

          • EmbraceYourInnerCrone

            From the same article:
            “Wives of men exposed to vinyl chloride and waste water treatment chemicals have more miscarriages. Welders who breathe toxic metal fumes develop abnormal sperm, even after exposure stops for three weeks. Firemen who are exposed to toxic smoke have an increased risk of producing children with heart defects. Several studies have found that fathers who take two or more alcoholic drinks a day have smaller than average infants”

      • MI Dawn

        I had mad cravings for those well-known peanut butter and chocolate cups, to the extent of checking out EVERY vending machine in the hospital trying to get some, and ending up sending ex-spouse to the 24 hour 7-11 (we worked in the same hospital) to buy me some!

        • demodocus

          We went to a certain eponymous town in Pennsylvania last October and I went on such a binge of those for a week after we got home. (My nephew goes to school there)

    • Roadstergal

      “The same person who might be HORRIFIED that one would have the occasional glass of wine while pregnant, might think delivering at home is very low risk”

      Isn’t it funny that a lot of the contrarian ‘I know better than the doctors’ goes away where alcohol in pregnancy is concerned? I definitely don’t get that one. It’s very different from marijuana, which is manna for the woo set.

  • Heidi_storage

    Thank you. I refuse to believe that the half ounce of wine I drank every Sunday morning put my embryos/fetuses at risk. Moreover, the notion that women should avoid alcohol if they’re not on birth control is infantilizing, as well.

    Since we don’t know our individual risk for FAS, of course it’s a good idea to cut down on alcohol (or cut it out). But terrifying millions of responsible women is not a good public health measure–especially since women who are likely to drink to excess are also unlikely to pay attention to ACOG, CDC, etc recommendations.

  • Sarah

    It’s interesting to read an American framed discussion on this. I understand from what I’ve seen online that the idea of consuming alcohol is much more controversial there. Although we have seen some of this attitude in the UK, eg when pregnant women were told to avoid alcohol on the grounds that we’re too thick to understand what 1-2 units looks like. I routinely hear people demanding evidential standards for moderate alcohol consumption that they’d never apply to anything else. It pisses me off and I don’t even like the smell of alcohol when pregnant, let alone the taste.

    • demodocus

      We also had Prohibition. The US has an odd relationship with alcohol. I don’t care for it much, so it’s fairly moot to me, but when everybody is freaking out over a single glass, it makes me think twice about that beef bourgonion (sp?) I get a craving for once or twice every winter. It takes 3 hours to burn off, and my recipe is for 1/2 an hour cooking. Doesn’t seem to have harmed my terrifyingly verbal 3 year old or his little sister, but really, do I need this much anxiety over 8 oz of alchohol spread split 2 or 3 ways?

      • Heidi_storage

        No.

      • Sarah

        Well, if you’re going to worry more than you’re going to enjoy it then it makes total sense not to bother. Rather unfortunate that you’ve been put in that position, though.

        • demodocus

          The PPD helped there, mine started early. 🙁

          • Sarah

            I can imagine.

      • Valerie

        https://www.oasas.ny.gov/admed/fyi/fyi-cooking.cfm

        According to this, ~35% is left after half an hour of cooking. FWIW, most of the alcohol is gone after just 15 min.

    • EmbraceYourInnerCrone
      • EmbraceYourInnerCrone

        This woman also said she got lectured at a restaurant for ordering sushi:
        https://www.reddit.com/r/BabyBumps/comments/46biu8/denied_service_at_sushi_restaurant/?st=j3bu1u6b&sh=053f942a

      • Sarah

        Yeah I know it’s not just the US, I mentioned there being touches of it in the UK too. Hadn’t heard of NZ though.

      • maidmarian555

        I’ve occasionally had a ‘proper’ coffee during this pregnancy. I really, really miss them (way more than alcohol or even the cigarettes I’ve managed to quit) and a decaf doesn’t always quite hit the spot. I’d be mortified if some spotty barista told me I wasn’t ‘allowed’ one. Urgh.

        • Azuran

          But coffee isn’t even bad. My government’s health department says that 1 to 2 cups per day is safe (depending on what you consider a ‘cup’). The only reason I’ve stopped while pregnant was because it was making me nauseous.
          And now that I have a baby that gets up at 5am, I’d punch anyone who tried to get between me and my ‘not even morning yet’ coffee

          • maidmarian555

            Yeah I like a really decent strong coffee. So I try not to overdo them. I don’t really worry about these things too much, I look at the general guidelines and attempt to stay within them. Which is what the vast majority of pregnant women do and why we don’t need baristas or waiters to tell us what we should or shouldn’t be consuming! I’m pretty astonished that this goes on tbh.

          • Dr Kitty

            I went to decaf when I was pregnant with #1.
            My co-workers bought me a mug that says “Do I look like a morning person?” and suggested, with increasing levels of desperation, that perhaps one coffee a day would be better for me and the baby than the cortisol and blood pressure spikes that going without clearly led to.
            My caffeine-free life lasted all of two weeks.

            I am apparently unbearable to be around without coffee.

            I drink one cup a day, but clearly I don’t function as a human without it.

          • demodocus

            If this were facebook, i’d put the laughing icon on this 😀

        • swbarnes2

          ACOG says that < 200 mg of caffeine a day is okay. That's quite a bit. For comparison, a can of soda has 35 mg. So even if your coffee has 3x as much, one or two a day would be fine

          http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Moderate-Caffeine-Consumption-During-Pregnancy

          • Sarah

            NHS says the same.

          • The Bofa on the Sofa

            For comparison, a can of soda has 35 mg.

            Not the sodas I’m drinking…. 🙂

        • BeatriceC

          A few recently pregnant friends have complained about being shamed for their coffee drinks by baristas, gas station clerks, and others.

          • maidmarian555

            Wow. Why on earth do people think they have the right to police women’s bodies in this way? It’s outrageous.

          • demodocus

            I got the stinkeye a couple times when I’d have a cup of (decaf!) tea. Most people didn’t realize I was pregnant, though, so it wasn’t too bad for me.

        • MaineJen

          That was me…I missed coffee more than alcohol.

        • Merrie

          I had a pharmacy clerk ask me if I was sure I wanted to buy Robitussin DM because it’s not recommended in pregnancy… I was in my last year of pharmacy school at the time.

      • AnnaPDE

        Let’s not forget second-hand sugar. Because that’s the worst thing to do to your fetus.
        I wonder if at some point some idiot nutritionist is going to notice our unhealthy addiction to water.

    • maidmarian555

      I was in Waitrose buying zero-alcohol beer the other day. At 22 wks my bump is now very obvious. One of the guys stacking shelves ran over to make sure I knew I was picking up the alcohol-free beer and that I hadn’t grabbed it by accident. I think you’re right that it’s not seen as being such a Terrible Thing here as it is in other places.

      • Dr Kitty

        I was heavily pregnant and bought all the supplies for a big family party I was catering.
        Which meant deli meats, soft cheese, seafood, wine, beer, ready made salads etc.

        Whether or not I was going to actually consume any of it myself or not is none of the cashier’s business.

        By all means, bar staff should stop serving obviously drunk customers, pregnant or not. Beyond that… nope.

      • Roadstergal

        OT, I was at a Warriors game a few weeks ago getting overpriced concessions, and the fellows behind me were laughing at the fact that alcohol-free beer was cheaper than water (O’Doul’s, $6, bottled water, $6.50).

        • Mattie

          $6.50 for a bottle of water??? That’s shocking

          • Roadstergal

            Concessions at sports stadiums are a ripoff, concessions at sports stadiums in the Bay Area even more so, concessions at sports stadiums in the Bay Area for one of the most popular teams nation-wide during the playoffs is utterly insane.
            We drank from the fountain for free and blew our food budget on garlic fries.

          • Mattie

            Worth it! A couple of years ago I was in Italy on holiday with my dad and we went to this town that was like SO expensive (it was on the emerald coast in sardinia and all designer shops and yachts and expensive cars) the bar was selling 500ml bottles of evian water for €20

          • Roadstergal

            Whoa!
            I admit, we’re a little spoiled here (well, there – I’m in Switzerland until August). Bay Area tap water is delicious – I’m reminded of that whenever I go anywhere else and wonder what that weird taste is…

          • Poogles

            “Bay Area tap water is delicious – I’m reminded of that whenever I go anywhere else and wonder what that weird taste is…”

            I’m jealous – we have well water at home, and while it has tested as safe to drink, it tastes and smells *terrible*, so we have a bottled water machine for drinking and cooking water :-/

          • demodocus

            Very true. Just don’t blame the staff; we don’t set those insane prices. We might even be volunteers working a booth where our team/school group/charity gets 10% of the profits.

          • The Bofa on the Sofa

            Concessions at sports stadiums are a ripoff,

            It’s capitalism, that’s all. If everyone refused to buy it, prices would go down. But they don’t, so they won’t.

            Bay Area for one of the most popular teams nation-wide during the playoffs is utterly insane.

            You just explained it all in one sentence. It’s about popularity.

            OTOH, I can tell you from experience that you ARE allowed to bring food into SF Giants games. I bought my peanuts outside. Then again, given the food inside (get a Cha-Cha bowl at Orlando Cepeda’s place), there is reason to eat inside.

        • maidmarian555

          This is why I never go out. I get 6 Becks Blue (OH drinks them mostly as he’s an Air Traffic Controller so can’t have alcohol during the week) for about £3.50. Mind you, at least most places stock it now. If I do venture to the pub, I’d much rather have a fake beer than some sort of icky sweet drink. I object to having to pay for bottled water on principle, especially when our water here from the tap is subject to better testing than anything you can buy in a bottle. That said I don’t even think it was that expensive for water the last time I was at Wembley Stadium (I saw the 49ers there a few years ago). Could be wrong though, I was definitely drinking proper beer that day!