CHICAGO — University of Chicago economist Emily Oster approached her pregnancy much like she does her job, challenging assumptions and evaluating data on what she could safely eat and drink during the nine-month gestational period.
Now she’s put her findings in a new book — and provoked outrage among doctors and patients who vehemently disagree with her conclusion that it is harmless to drink a limited amount of alcohol during pregnancy.
Oster, 33, encourages women to decide what is best for themselves, but her “bottom line” recommendation allows for one to two alcoholic drinks per week during the first trimester, and one drink daily during the rest of pregnancy.
“Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong — and What You Really Need to Know” contradicts the U.S. surgeon general’s position that no amount of alcohol is safe during pregnancy. The book has also angered families affected by fetal alcohol spectrum disorders or FASD, an umbrella term for birth defects caused by a mother’s alcohol consumption during pregnancy, such as brain damage.
The book “has caused quite a firestorm,” said Dr. Ira Chasnoff, a Chicago pediatrician who specializes in children prenatally exposed to alcohol and other drugs. “The difficulty you have is someone who has no clinical understanding, who is relying on studies and statistics without understanding what lies behind the statistics.”
Oster covered other topics in the book, weighing the pros and cons of pregnancy-related advice by reviewing hundreds of academic studies published in recent decades. She analyzed subjects that ranged from drinking caffeine (she’s for it) to bed rest (she finds no evidence that it prevents preterm labor) to smoking (absolutely not).
But her position that most doctors are overly cautious regarding alcohol use has caused the uproar.
“I am not knocking her, but it would be nice if she would meet some people living with FASD … instead of reading a piece of paper, a book or a file,” said Liz Kulp, 27, who said she was diagnosed with fetal alcohol syndrome at age 12. Kulp, who lives in Minnesota, has written several books about the effect her birth mother’s alcohol use had on her, including uncontrollable rages.
Research has shown that neurological damage caused by alcohol’s impact on a fetus can result in devastating physical, mental, behavioral and learning disabilities. The question that doctors cannot answer is: How much alcohol is too much?
“In fact, there is virtually no evidence that drinking a glass of wine a day has negative impacts on pregnancy or child outcomes,” Oster wrote in the book, released in August. “Of course, this is a little sensitive to timing — 7 drinks a week does not mean 7 shots of vodka in an hour on a Saturday night.”
She drank an occasional glass of wine during her pregnancy and has a healthy 2-year-old daughter today, she said in a phone interview. Oster, frustrated with the confusing array of information concerning pregnancy, wanted data to support the decisions she made.
She said her doctor approved a few drinks during pregnancy, and, anecdotally, other women have said that they, too, received the green light. Trying to find an OB-GYN to admit it publicly, though, is not easy.
“In the face of so many restrictions and choices and things to think about, for many women, having a framework of trying to work through them is valuable,” Oster said.
Where the data are contradictory, she said, “women can make the choices themselves.”
She has the support of Ernest Abel, professor of obstetrics and gynecology and psychology at Wayne State University in Detroit, who came to a similar conclusion in a 1998 book.
“Nobody really knows what the threshold is, but there is evidence that one drink a day or one drink a week is not harmful,” said Abel, who, like Oster, is not a medical doctor but has a doctorate.
In the abstract for his book, he wrote: “Rather than exaggerating the dangers of ‘moderate’ drinking, clinicians and researchers who work in this area should recognize that any harm to an unborn child from alcohol exposure is related to acute binge or chronic abusive drinking.”
FASD researchers strongly disagree with Oster and Abel’s conclusions, and they cite a University of Pittsburgh study released in July that found that a single alcoholic beverage a day during pregnancy increases psychiatric symptoms in a child more than 20 years later, as an adult.
In a letter released Monday, researchers with the Fetal Alcohol Spectrum Disorders Study Group likened alcohol to thalidomide, a drug that caused miscarriages and missing limbs in babies in the 1950s and 1960s before it was taken off the market.
“Although there may very well be a dosage below which thalidomide does not cause missing limbs, would it be reasonable to classify it as ‘safe’ during pregnancy at low levels?” they asked.
The FASD community tries to boost awareness of the dangers of alcohol on unborn children on the ninth day of the ninth month, which was Monday.
Dr. Kristin Scott, a family physician who lives in Chicago, decided to abstain from alcohol and caffeine after becoming pregnant through fertility treatment. Scott said that, at age 42, she didn’t want to take any chances.
Her daughter, now 7 weeks old, was born with a serious congenital abnormality involving the intestine. The problem was corrected through surgery two days after birth and does not carry any lifelong implications, she said.
Still, Scott said, “If I had had any alcohol at all, I would have had thoughts, like, ‘My gosh, did I do anything to cause this?’”
While drinking is not directly linked to the abnormality, “I certainly didn’t need alcohol in the picture to be second-guessing myself,” Scott said. “Anything I could control, I controlled, because there is so much you can’t.”
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