The Danish take on alcohol in pregnancy
Alcohol in pregnancy – The revised Danish National Board of Health-recommendation
Some years ago the Danish National Board of Health (NBH) commissioned Dr. Ulrik Kesmodel, Research Unit of Infant Epidemiology,Skejby Sygehus, Denmark, to perform a review of more than 300 recent studies on alcohol-related birth defects. In his 1999-report on alcohol and pregnancy (7) Dr. Kesmodel concluded: 1)The consumption of 1-2 drinks per week is withour any danger to the foetus. 2)There is some uncertaincy about the effects of 3-6 drinks per week. 3)The intake of "7 drinks per week causes a risk of abortion and reduced birth weight and birth length.
Having considered the 1999-report the Danish NBH decided to change the official recommendation and pregnant women in Demark are now given the following advice and information about drinking alcohol during pregnancy:Avoid alcohol in pregnancy if possible.
If you drink, drink no more than one drink (12 gms of alcohol) per day.
Do not drink every day.
"What is the evidence", Kesmodel asked, "that the consumption of a few drinks per month or even per week as opposed to daily intake, may be harmful in pregnancy? If there is no consistent data to suggest that an occasional drink is harmful, it is possible that a large proportion of pregnant women and health personnel will not be convinced by repeated statements that total abstinence is necessary during pregnancy. If the only official recommendation is not to drink, then these women are not told that there is a limit, nor approximately what that limit is. So we need to ask the question: Where is the limit? Reaching a consensus on this would allow us to standardize information for these women (6)."
I realize I'm being controversial here, but I see some advantages to the Danish recommendations. While there is no known safe level, anyone who counsels women who say "I had a glass of wine before I knew!" will always tell her, chances are everything will be fine.
There is some evidence, too, that the "no alcohol" message is sounding very hollow to some women who say that they drank with a previous pregnancy or know someone who drank during a previous pregnancy and the baby turned out fine. They then go on to drink as much as they please because it seems like the powers that be are lying to them or sadly mistaken. Somehow we have to acknowledge the unknown aspects and subtleties of the situation and counsel women about what we don't know in addition to what we do.
posted by Jude | 1:50 PM
6 Comments:
Actually, the reason the abstinence message fails (IMO) is because people are not willing to tell themselves "no". So we make it more palatable by giving them a number other than zero. We water down the risk in order to increase "compliance".
Heaven forbid that we should require people to be responsible for their choices.
I also would have to question his research. Oh wait, he didn't do his own research, just reviewed other studies. Well, it must be okay then, because women wouldn't LIE about their alcohol intake...
Oh, and Matt's birth weight and length and head circumference were normal. If those are all the things he's worried about then I suppose there might be a few fewer kids born with "full syndrome" (not remotely indicative of the actual effects of FASD).
"Where is the evidence"? How about: How bad do the effects have to be before we would notice them? How many kids are walking around undiagnosed but whose abilities have been hampered even slightly? The "chances are everything will be fine" line just means that we can't measure the impact of that one drink - it doesn't mean there isn't one.
When I hear about "the baby turned out fine" I have to wonder just how much potential for that kid has been lost. Seems to me like they use the same logic my mother uses to continue smoking. Fact is - she does it because she wants to and dismisses anything that tells her she shouldn't do what she wants.
The unknown aspects. We don't know where the line is, or even if there is one. Can you live with telling women it's okay when you really don't know?
Oh, and just how much do you stretch your application of guidelines? I mean, have you ever drunk milk or eaten anything past it's "best before" date? Do you really think that telling women to stop at one means they won't convince themselves that two is just going a little over so it shouldn't matter.
Just had to get that off my chest.
I appreciate your viewpoint. Mine is coming from research that says that some women say they distrust the guidelines because of what they've seen. It requires a conversation rather than a slogan. Note that the Danish official recommendation is still no alcohol. We can still recommend none, but we have to be honest with women and say we don't know. We don't know if one drink has an effect. We don't know if multiple drinks will have an effect on some babies and not others. Because there is so many unknowns, it is safest not to drink at all. But the child you know may not have been affected, or maybe we just yet don't know how s/he was affected. We have to talk to women in a way that speaks to their doubts and distrust in order for the messages about alcohol to be received.
The latest data is showing that about 14% of women drink during pregnancy. FASD incidence is estimated at about .9%. Clearly most women can get away with no effects or effects that are so slight that they cannot be seen. That's not a reason to drink, but realities that have to be explained - just because so-and-so got lucky, doesn't mean you will. It's best not to drink at all. And I'd rather a woman at least slow down her drinking than keep binging. Harm reduction is better than no change at all.
I sure understand where Cindy is coming from. It is so terribly sad to work with kids who WOULD HAVE BEEN completely ok if certain substances were not used. On the other hand if saying you may take a drink once or twice a week would stop people from TRYING not to drink at ALL and then blowing it and Binging which would cause more damage in the long run??? It may be in the best interest of the children.
FASD is difficult to diagnose. Many are misdiagnosed simply with ADHD. And, I have heard (don't know the source - got this through Doug), that there is pressure being put out NOT to diagnose because then gov't would be on the hook for more supports.
Oh, and how did they define "drink" in that study?
Can't take all stats at face value.
Seems to me that once you give people the "if you're going to" message that the recommended abstinence falls on deaf ears.
I do agree, however, that questions and concerns need to be answered honestly. We don't know, yet, because we are not fully able to measure the effects with accuracy. It's not like there's a blood test for it. And all you have to go on for "cause" is someone's word. Hardly verifiable. And one of the reasons there is so little diagnosis.
How about - We don't know if there is a safe amount. We don't know what amounts or timing (binge vs. social drinking and developmental stage of fetus) are necessary to produce these birth defects, but we do know that abstinence will prevent them. Many of the effects may not be seen for years after birth and vary greatly. It is difficult to diagnose, and there is no cure, and will never be as it is NOT a disease. Those affected will not grow out of it. It is a life sentence. Is it a risk you really want to take? We can't do anything about what's already happened, but we do recommend that you do not consume ANY more alcohol during this pregnancy. If you do slip up, please do not binge!
Bev, would endorsing the consumption reduce the damage, or would it cause more children to be affected with lower levels of damage? Hmmm... potentially increasing quality of life for some while decreasing it for others...
Cindy really what I was thinking of was human nature -- like fasting or dieting ---- when people are told "NO you can't" often that leads to THINKING MORE ABOUT IT. I was thinking if you said "a little bit" maybe some people could handle that better and not guzzle.
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