Headline-writers cause IRETA’s Director of Research to facepalm

A few years ago, I attended my husband’s family reunion. It was a festive occasion since we were recently married and we had just announced we were expecting a baby. I was chatting out in the sun with some folks when someone offered me a beer. I politely declined and simply said I wasn’t drinking since I learned I was pregnant. Then someone piped up and said, “I just read that it’s not a problem to have a few drinks when you’re pregnant.” Someone else agreed and said they had read the same thing. I just smiled and said I was fine.

Later that weekend, I did a little digging on Google and it didn’t take long to locate the article they were talking about. Back in June 2013, a large British study found moderate alcohol consumption during pregnancy was associated with better scores on a measure of balance in the children when they were 10.

Now, let’s take a closer look. The dependent variable of balance is only one of literally thousands of effects that drinking alcohol during pregnancy has been shown to have on offspring. Even worse, the independent variable of alcohol consumption was based on retrospective self-report, one of the least reliable measures. So while this study did have an impressive sample size (7,000), at best it can be regarded as just one small piece of the puzzle.

Wait until you see what the headlines did to this finding. Here is a sampling of the stories I found in response:

“Moderate drinking during pregnancy ‘does not harm baby’s development’”

“Study: A drink per day during pregnancy seems safe”

And even, “One glass of wine a day is A-OK for pregnant women: Study”

Wait, what? The study that found that self-reported drinking during pregnancy did not negatively affect one measure of balance in 10-year-old children equates to calling alcohol consumption during pregnancy safe and A-OK? Yes, these headlines all refer to the study described above.

This incident reminded me of a few things. One, the body of research on the effects of alcohol during pregnancy is large and the results are mixed. Two, many health professionals are still reluctant to directly address drinking during pregnancy with women, leading moms-to-be to rely on their own devices to educate themselves. Three, irresponsible journalism confuses pregnant women, their support systems, and even the clinicians who care for them.

A Clear Statement From the American Academy of Pediatrics

Let’s fast forward to last month, when the American Academy of Pediatrics released yet another clear statement about drinking alcohol during pregnancy: you should not do it. You can read the full report here. It is a very thorough and well-illustrated summary of the effects of alcohol on the developing fetus. The report states that during pregnancy:

  • No amount of alcohol intake should be considered safe
  • There is no safe trimester to drink alcohol
  • All forms of alcohol, such as beer, wine, and liquor, pose similar risk, and
  • Binge drinking poses dose-related risk to the developing fetus.

Seems straightforward, right? This AAP report echoes myriad other health organizations in the conclusion that while the research is mixed, there has been no consistent demonstration of a safe level of alcohol consumption during pregnancy, therefore the best bet is to just not drink at all. As unequivocal as this statement is, I was especially discouraged to see the headlines in response to this one:

“Is drinking during pregnancy really so bad?”

“Why do people get so bent out of shape about drinking while pregnant?”

“Light drinking while pregnant is probably safe. So why are women being told otherwise?”

Interestingly, despite their headlines, some of the news articles conclude with support for the AAP statement. The Boston Globe article (“Is drinking during pregnancy really so bad?”) ends with “Since we really don’t know what constitutes a safe level of alcohol consumption, the only way to avoid the risk is to avoid the alcohol entirely” which makes the headline that much more misleading.

Lately, I am ever more perplexed by the role that the media plays in disseminating research information to the public. To be fair, while many of the headlines supported and reinforced the AAP statement, others (such as those above) seemed to use the report as a platform to highlight only the studies that have not found adverse effects of alcohol on outcomes, and therefore introduce additional confusion to the issue.

Researching Alcohol Use During Pregnancy is Difficult

It is worth noting the unique limitations of research on the effects of drinking during pregnancy. These issues are summarized in this Scientific American article that is excellent and highly recommended. In a few words, it is unethical/impossible to conduct a controlled study on this topic. To do that, pregnant women would have to be randomly assigned to drink various levels of alcohol. Then, months and years later, their offspring would be studied at several time points into childhood. And that doesn’t even consider the other variables we’d want to control for that potentially impact development, such as smoking, nutrition, poverty, and the list goes on. Since this obviously cannot be done, the research we have is based strictly on correlation and is prone to confounds.

Besides that, alcohol consumption is most often measured via retrospective self-report (like the BMJ article above) which is prone to intentional and/or unintentional bias. Finally, as the AAP report suggested, some of the effects of alcohol on the developing fetus can be extremely subtle and we might not yet have the measurement tools to evaluate them.

Why Take the Risk?

In a way, the AAP statement reads like: “We know what we don’t know: if any safe level of alcohol consumption during pregnancy exists (and that is a big IF), we don’t know what it is.” On the other hand, we do know that Fetal Alcohol Spectrum Disorders are 100% preventable if a woman does not drink alcohol while pregnant or while trying to get pregnant.

There are so many things that can happen to our kids over which we have little control. Yet, this is one area where we very much do have control.

So for me, the CDC’s simple advice rings very true: “Why take the risk?”

 

DSC_0389Dr. Dawn Lindsay is the Director of Research and Evaluation Services at IRETA. In this capacity, she is the evaluator of the National SBIRT ATTC and oversees other research and evaluation activities at IRETA. Prior to joining IRETA, she conducted research on adolescent substance use disorders in the Department of Psychiatry at the University of Pittsburgh. She is a member of the American Psychological Association and American Evaluation Association. Recently, she has blogged about researching SBIRT and talking about marijuana with teens.

Resources

Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study (BMJ, 2013)

AAP Says No Amount of Alcohol Should be Considered Safe During Pregnancy (AAP, 2015)

How Much Alcohol Is Safe for Expectant Mothers? (Scientific American, 2013)

Alcohol Use in Pregnancy (CDC, 2014)

Alcohol Exposure Affects Fetal Brain Development (IRETA, 2014)