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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Alison Sherman, 28, of Elgin, Ill., said she drank a glass of wine every Friday night before realizing she was five months pregnant with her first child. She panicked, but her child turned out fine. When Sherman was pregnant with her second child, she said, her midwife told her it was all right to have an occasional glass of wine — after first establishing that Sherman did not have any problems with drinking before pregnancy.
Last New Year’s Eve, Sherman nursed a small rum cocktail while about five months pregnant with her second child, she said. Having read about birth defects caused by alcohol, she played it safe and drank little else, she said. Her son is now 4 months old.
“Just don’t be foolish,” said Sherman, who volunteers for La Leche League International, a Schaumburg-based group that promotes breast-feeding. She tells nursing mothers that it is OK to have an occasional drink to help them relax.
Another woman, Stephanie Jones, 29, of Hoffman Estates, Ill., is due to have her first baby in November.
She didn’t ask her doctor about alcohol because she didn’t plan to drink, but she said she would not judge someone else if they occasionally imbibed.
Still, she added, “I feel like it’s kind of selfish. I have wanted to have a beer so bad, but I think that you try to give your kid the best advantage, and knowing that alcohol is a mood-altering substance — why can’t I wait?”
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It is clear from studies that binge drinking is dangerous, Oster agreed.
Doctors who urge women to abstain from alcohol say there are too many factors at play, such as the mother’s rate of metabolism, her pattern of drinking and the genetic vulnerability of each fetus.
Alcohol that is not processed by the mother’s liver travels through the placenta into the baby’s bloodstream.
“If she is a slow metabolizer, the fetal brain is bathed in a toxin,” said Dr. Todd Ochs, a pediatrician at Ravenswood Pediatrics in Chicago. “How can that be good?”
Experts don’t know how much harm that causes, he said.
“But why would a mother do something to put her baby at risk? Is it worth a lost IQ point or two?” he asked.
Kulp, who was adopted, doesn’t know how much alcohol her mother drank during pregnancy. As a child, Kulp flew into rages and was labeled at different times as suffering from oppositional defiant disorder, attention deficit hyperactivity disorder and even autism, said her adoptive mother, Jodee Kulp.
She started documenting her daughter’s behavior and, eventually, a doctor diagnosed her with fetal alcohol syndrome.
“When we researched it, it fit,” Jodee Kulp said. “Your children will have a soup-can listing of labels. Then you get this one and it’s, ‘Oh my goodness. Of course this is what it is.’”
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Liz Kulp, who also struggled with her own alcohol addiction, said she used to throw and break objects during her rages.
“I don’t know how to deal with my anger,” she said. “Sometimes I can pull away. But sometimes when I have my rages people have their mouths on the floor. They’re like, why is she so mad? I react in some type of way, it can be scary. I can be scared for myself. But at that moment, no one can talk me out of that rage.”
Another mother, who works at the Minnesota Organization on Fetal Alcohol Syndrome, based in St. Paul, said she drank lightly with her doctor’s permission when she was pregnant in the 1980s. Today she is convinced that her son was born with brain damage because of the alcohol she consumed. She asked not to be named to protect his privacy.
“I am sure I didn’t drink more than two drinks a week,” said the mother, whose son, now 24, was originally diagnosed with oppositional defiant disorder in fourth grade. While he has a high IQ, he frequently fought with others and made poor decisions. Today he struggles with substance abuse addiction, she said.
“The doctor told me not to worry, that it was safe to use alcohol.”
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Emily Gunderson, spokeswoman for the Minnesota Organization on Fetal Alcohol Syndrome, said alcohol-related birth effects are often misdiagnosed as ADHD. She thinks more doctors should ask mothers if they drank alcohol during pregnancy.
“We don’t know exactly how much is too much,” she said. “Every woman is different. All of the medical communities have come out very strongly since 2005 that no amount of alcohol is safe. That is what frustrates us as professionals in the field.”
Oster, the daughter of two Yale University economics professors, says she doesn’t have a good answer for women who believe that their light drinking caused their child to be brain-damaged.
“A fair response would be to say it is extremely unlikely that her child’s issues were caused by alcohol,” she wrote in an email. “Caution in pregnancy is a good idea, but we have moved to a place where the assumption is that if anything goes wrong with the pregnancy or is wrong with the child it’s the fault of the mother.
“Women — and I have heard from many of them — who had a beer before they knew they were pregnant end up blaming themselves if they miscarry, or something is wrong with their child in the long run. For these women, seeing the evidence on safety of small amounts of alcohol may simply help them calm down a bit in knowing that there is no evidence to suggest they have done harm.”
©2013 Chicago Tribune
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