Bad science on booze in pregnancy: Women infantilised with absolutist messages

I read this article in The West a little while ago, and it hit my bad-science peeve button. “Half of WA women drink throughout pregnancy“. This beat-up is certainly not alone in drawing conclusions that do not follow from the data, but it’s a particularly egregious example.

The newspaper reports on a study that looked at data from the Western Australian Midwives Notification System for 4719 births to non-indigenous women in 1995-1997. Bear with me while I pull it to pieces. [Emphasis is mine.]

Almost half of all Western Australian mothers-to-be drink alcohol throughout their pregnancy, and some even admit to bingeing in the final months before giving birth.

The women who were prepared to drink on were also more likely to smoke during their pregnancy, according to a study of 4700 mothers in the State. Doing so placed these women at the most risk of having their baby prematurely, according to the research by WA’s Telethon Institute for Child Health Research.

“Our research shows pregnant women who drink more than one to two standard drinks per occasion – and more than six standard drinks per week – increase their risk of having a premature baby,” says institute researcher Colleen O’Leary. This was the case even if the women stopped drinking before their second trimester, Ms O’Leary said.

“The risk of preterm birth is highest for pregnant women who drink heavily or at binge levels, meaning drinking more than seven standard drinks per week, or more than five drinks on any one occasion.”

The study focused on a random selection of non-indigenous women who gave birth between 1995 and 1997, and they were quizzed on their pregnancy and pre-pregnancy drinking habits.

Fewer than 20 per cent of women abstained during the pre-pregnancy period, but this increased to 57 per cent in the first two trimesters before settling to 54 per cent in the third trimester.

“Low” or “moderate” drinking came in at 44 per cent during the third trimester, while more than two per cent of women admitted to “binge” or “heavy” drinking in the final months before birth.

The study found a low birth weight was more likely to be caused by a mother’s smoking rather than drinking.

And, while there was no difference for women who abstained or drank low levels of alcohol, it said abstinence was still the safest option. […]

So, do the conclusions quoted in this newspaper report reflect the reality of the study? I tracked the full study down (Hat tip: Clive). Here are the main points from the abstract:

The effect of maternal alcohol consumption on fetal growth and preterm birth
(CM O’Leary et al, BJOG 116(3), pp 390 – 400, doi 10.1111/j.1471-0528.2008.02058.x)

Objective: To investigate the relationship between prenatal alcohol exposure and fetal growth and preterm birth and to estimate the effect of dose and timing of alcohol exposure in pregnancy. […]

Results: The percentage of SGA infants and preterm birth increased with higher levels of prenatal alcohol exposure; however, the association between alcohol intake and SGA infants was attenuated after adjustment for maternal smoking. Low levels of prenatal alcohol were not associated with preterm birth; however, binge drinking resulted in a nonsignificant increase in odds.

Preterm birth was associated with moderate and higher levels of prenatal alcohol consumption for the group of women who ceased drinking before the second trimester. This group of women was significantly more likely to deliver a preterm infant than women who abstained from alcohol (adjusted OR 1.73 [95% CI 1.01–3.14]).

Conclusions: Alcohol intake at higher levels, particularly heavy and binge drinking patterns, is associated with increased risk of preterm birth even when drinking is ceased before the second trimester. This finding, however, is based on small numbers and needs further investigation. Dose and timing of prenatal alcohol exposure appears to affect preterm delivery and should be considered in future research and health education.

There is no room for doubt here at all – the study did not, just plain did not, find that low or moderate levels of prenatal alcohol intake were associated with preterm birth. It’s as simple as that. Generalising from “high levels of alcohol intake in a certain pattern during pregnancy may cause problems” to “Women should never drink in pregnancy, not a drop; any level of alcohol is dangerous” is just plain wrong. It’s just plain bad science.

There is also a word change in the abstract conclusions and in the newspaper report that catastrophically misrepresents the data. “This was the case even if the women stopped drinking before their second trimester” was not actually what they found. Here is the money quote from the full study:

“Moderate to heavy alcohol intake resulted in an increased risk of preterm birth only in women who stopped drinking before the second trimester.”

Only“. That’s right. The study failed to find any association even of heavy or binge drinking with preterm birth, until they plucked out one particular group of women: those who drank heavily in the first trimester, then stopped.

These researchers had to work damn hard to pick out a group for which alcohol intake seemed to make any difference at all – and in that group, the confidence interval extended to 1.01. The researchers are going to have to work quite a bit harder to convince me that this association is sufficiently distinguishable from cherry-picking, a chance result of analysing and re-analysing the data in a desperate search for something “statistically significant” – especially given the complete lack of so much as a trend in the other groups. The authors claim a trend – but I can’t see it. Look for yourself.

Click through for the larger version of this table. Look down the second-to-right column, which is the fully adjusted odds ratio (OR) for preterm birth for the various alcohol categories. For those who aren’t familiar with this type of data presentation, Any OR with a confidence interval (CI) encompassing 1.0 is not statistically significant.

alcohol in pregnancy o'leary 2

On small for gestational age (SGA) babies : No association at all was found between SGA and alcohol intake, once smoking was controlled for. Not “a low birth weight was more likely to be caused by a mother’s smoking”, but there was no association at all with drinking as an independent factor. (You can see those data here).

There are a couple of methodological issues worth pointing out. The sensationalist opener “Almost half of all Western Australian mothers-to-be drink alcohol throughout their pregnancy” is based on data in which the “low” category extends right down to include women who drink one unit of alcohol less than once a month. It seems, from my reading of the full study, that one single drink per trimester would get you categorised as someone who “drank alcohol throughout her pregnancy”. Count me in to those stats!

There was also no attempt to control for nutritional status, previous late-term abortion, other past cervical procedures, or infections that may be related to preterm birth. Many other potential confounding factors were controlled for, though perhaps not always in particularly effective ways. (How many new mothers disclose every bit of illicit drug use? I sure wouldn’t have, had I been in that category.)

The “We must tell them there’s no safe dose” mentality comes from a place of infantilisation of women. It is assumed that we’re stuck in the pre-rational child phase, and that any ‘concessions’ by those who think they are in power will lead us to ‘take’ far more than we’re entitled to. (Inch, mile, etc).

It is assumed that if women are told the actual data – that there is no evidence that having a couple of standard drinks harms a fetus – that we will immediately rip off our matronly long skirts and whoop it up in nights out on the town. It is assumed that we’re just hanging back from boozing it up because we’re waiting for “permission”. It is assumed that we just couldn’t possibly understaaaaaand the reality of the dose being the poison. It is assumed that it is doctors’ and midwives’ responsibility to shield us from reality and give us “unambiguous” absolutist messages about abstinence.

It is assumed that we as women, as incubators, cannot take responsibility for ourselves and our decisions. So someone else must take it for us, and that those people need to twist and simplify the message in order for us to comprehend it with our tiny hormone-soaked inferior brains.

So don’t believe everything you read in the paper. I’m Lauredhel, and I’m sick of this shit.



Categories: culture wars, gender & feminism, health, Science

Tags: , , ,

51 replies

  1. They make it sound like almost 50% of WA women were downing a bottle of JD or vodka a day. I wonder how many of them, as a friend of mine often did, started a glass of wine, then after a couple of mouthfuls decided she didn’t feel like it any more and tipped it out. Does that count as drinking during a pregnancy?

  2. Mindy: as far as I can tell, yes, that puts you in the “low” category. I had two beers when I was four days pregnant, which means I drank “throughout” my pregnancy also. I abstained in first trimester after the positive test, then had half a standard drink twice a week in second and third trimesterse. But I’m a Bad Girl anyhow; I was also on a number of pharmaceutical drugs during my pregnancy, ranging from antihistamines to opiates, and drank wine almost every day while breastfeeding. My child is DOOMED.

  3. Well, doomed to be artistic if you posts of his drawings are anything to go by.
    Given that they got through a whole article without mentioning foetal alcohol syndrome I’m guessing that it takes a lot more drinking during pregnancy than even the ‘heavy’ category to do real damage.

  4. Excellent post, Lauredhel. I get tired of the infantilising nonsense around pregnancy and alcohol too, and worse, I think it backfires. We get bombarded with messages saying that any alcohol during pregnancy is bad, and yet we all know people who have had a few drinks during their pregnancies, and their children seem to be just fine. So the public health message is contradicted by the available evidence, which I think just motivates people to ignore the public health message altogether.
    For the record, I didn’t drink alcohol at all during the first trimesters of my pregnancies, and only very moderately thereafter – maybe 1/2 a glass of wine maybe once a month at most. Except for the whole glass of wine I drank on my midwife’s advice, the day my waters broke but only very slowly, and nothing else was doing, so she sent me back to our friends’ house where we were having dinner, with orders to relax, and drink a glass of wine.
    Deborah’s last blog post..Living the Great New Zealand Internet Blackout

  5. One day I am going to make a scrap book of this rubbish. My children are all doomed to be drug addicts anyway, because I used gas during my deliveries.
    Another reason to love my doctor – she told me her complete understanding of the current research and said that the odd glass won’t hurt, and if it helps reduce stress, might even help.
    Ariane’s last blog post..Just when I think they’re over-reacting

  6. the “low” category extends right down to include women who drink one unit of alcohol less than once a month

    No Eucharist for you!

  7. Wow…I was a bad girl during pregnancy.
    I dyed my hair. I drank coffee and the occasional glass of wine (similar to Mindy above, one or two sips, then I didn’t want it any more). Honestly I was badgered more about the coffee (is there really any evidence that caffeine is bad for a pregnancy?).
    My Kid must be doomed!

  8. Oh, I also ate lots of fish…but no other meat…that sent the WIC nurses into fits of rage!
    OuyangDan’s last blog post..Yay!

  9. Bad science is rarely (read ‘never’) fact based but, apart from common-or-garden ignorance (or the simple innumeracy of modern/young journos.) is always a moral panic informed (sic!) by religiosity, superstition, schadenfreudelust or just plain wowsers who fear that someone, somewhere may be enjoying themselves.
    On tuther hand, alcohol is a toxin.

  10. I always enjoy pulling out the photos of my mother, pregnant with me and (later) my brother, grinning at the camera with a cigarette in her hand. Not that smoking under any circumstances is a good idea, but we were all large, healthy babies.

  11. LizBee – My 84 yr old mum could never restrain her indignation re smoking & drinking in pregnancy – I was 10lb10oz and my brother, 4 years later, was 9.5lbs, in the late 40s/early 50s on a diet of Bex, beer, cigs, white bread & steak for breakfast. She was 8 stone wringing wet.
    Nobody sez it’s a good idea, just a testament to the resilience & power of Woman.
    Wouldn’t touch the stuff meself, just saying.

  12. I jet-skied during pregnancy, up til about 7 mths, my bad.
    This is a timely post for me. This semester I have a class called “Research & the Human Services”.
    My lecturer, who is a dude, made a very specific point of informing the group that “…research is usually conducted by white males, and we live in a white male-dominated society”.
    So fucking true, and so fucking refreshing to hear a white male acknowledge it.
    So you know, take this research stuff with a big bucket of salt, sometimes.

  13. The being in hot tubs/ hot spring bath while being pregnant puts the baby at risk thing – truth or myth?

  14. I should pass this along to our TN legislators, who want to force women who have undesired pregnancy outcomes or who don’t receive “complete” prenatal care to submit to forced drug and alcohol testing.
    Oh, and I love a blog post that mentions confidence intervals and statistical significance. 😉

  15. The amount of policing during pregnancy is ridiculous. I cannot tell you how many times I told people to fuck the hell off. No one who was so concerned that they had to put me in place were going to raise my child let alone love him. Everytime I had a sip of coffee someone was there to offer their two cents. They of course wrap it up in the welfare of the child nonsense but it really is about controlling and infantilizing women.

  16. “The being in hot tubs/ hot spring bath while being pregnant puts the baby at risk thing – truth or myth?”
    I think there is truth to that one because a rise in body temperature is supposed to be harmful, unless of course the thing about body temp is also a myth.
    I used the spa at my local pool a lot for help with back ache though, and had no problems.

  17. My Google Alert brought me to this site. I am an educator who works with children who have mothers who never thought their drinking would harm their child. When the child was born, everything looked good. All fingers and toes. What they could not see was the damage that would later show up in the form of lower reading and math skills or behaviors such as ADHD, Autism, OCD, RAD, etc. Yes, I am a white male and I have a dog in this fight. I have to budget for increasing numbers of children prenatally exposed to alcohol and needing more educational services. I also pay taxes for the increasing numbers of children born to parents who think the science is flawed. The ethanol in the alcohol damages brain cells. Any ethanol takes away potential from that fetus’ brain. Enough ethanol and the lack of potential takes the form of observable lower reading and math skills as well as social behaviors that are outside the norm.

  18. Hi Jody, and welcome. If you think anything you’ve said rebuts my post, you need to read it again, more clearly. The study only looked at preterm birth and SGA outcomes, as these are the only outcomes available on the Midwives Notification System.
    I believe strongly in offering women the available information, not in twisting it into something it’s not because you think it “should” be otherwise. I believe in trusting women to gather information and make their own decisions.
    If you have evidence for “any ethanol takes away potential from that fetus’ brain” – solid, replicated evidence – you’re welcome to present that here, briefly. Please include groups who had a single standard drink or slug of cough syrup per trimester, if you wish to support the “there is no safe dose” contention, and to support the criticism of the group criticised in this newspaper report. And please report on which confounders were included, which excluded, and how reliably. (Nutritional status? Illicit drug intake? Socioeconomic status? Smoking? Educational level? Pregnancy complications? Previous pregnancy complications? Maternal neurological status? Others?)
    What you can’t say, however, at least not with a straight face, is that the data in this study proved that any drinking at moderate or heavy levels causes preterm birth, which is what this researcher and journalist are saying.

  19. I have a child who some teachers have said has some social behaviours outside the norm, yet I didn’t touch a drop of alcohol during my pregnancy because I don’t drink alcohol. (My comment above really does refer to a friend of mine. ) So I think there may be some other variables in there JAC, and that the blame can’t be entirely laid at the feet of mothers who have a couple of drinks during pregnancy.
    I have heard that increasingly researchers are finding correlations between the father’s increasing age at time of conception and the types of behaviours you cite. Yet nowhere do I see anyone exhorting men to father children at a younger age. Funny that.

  20. If this study was asking mothers what they drank each day 10 years ago (in 1995-97 ) – I’d doubt the reliability. Hell I can’t remember what I drank last night. When were the interviews undertaken?

  21. I can’t get the full study. Is it pay only?
    I wouldn’t be blaming the newspaper until I saw the press release put out by WA’s Telethon Institute for Child Health Research.

  22. Found it- on first glance the Media release looks ok.

    Its here:
    http://www.ichr.uwa.edu.au/media/913

  23. quote seems ok:
    “…However, the results also show that low levels of alcohol consumption (less than 7 standard drinks per week and no more than two on any one occasion) appeared not to constitute a significant risk of preterm birth provided all other forms of unhealthy behaviour were avoided.”

  24. *increasing numbers of children prenatally exposed to alcohol and needing more educational services*
    I’d like to see the data on this too. Do we *honestly* think that more pregnant women are drinking now than say twenty years ago?
    And is it *really* that children ‘need more education services’ now, or that we’re more aware of childrens needs for educational services, rather than thinking the cane could solve everything?
    And do we honestly think that autism is caused by alcohol? Because to be honest I’ve NEVER heard that one before. All the experts I’ve spoken to have told me it’s genetic. Speaking as a mother of a child who has autism and ADHD (and who’s heard every rubbish theory out there) this has yet to be thrown in my face: BAD mummy, that glass of red made your kid an Aspie!!!
    fuckpoliteness’s last blog post..Is smart the new sexy and other FASCINATING questions! Fuck the Sams, and why I’m gonna be light-on with the posting

  25. My reply was not a comment on the research, but rather, a comment on the comments, including the one that targets white males. I have done seminal research on the connection between school shooters in the U.S. and prenatal exposure to alcohol. None of the shooters’ mothers knew they were damaging their child’s brains. Will I be able to find the research that one drink damages the brain? Not until the brain imaging strategies reach the level of finding the minute damage. Do I work with children whose mothers are in denial that their drinking has had an impact on their child’s learning. You bet. Maybe someday I will be able to answer your question as to one drink when new technology such as the a new magnetic resonance imaging (MRI) technique called Diffusion Tensor Imaging (DTI) provides researchers a more detailed look at the damage to the brain. There is much more to be learned, and in the meantime, the people who don’t want to change their habits will continue to bring brain damaged children into the world.
    I wish the poster would hold yourself to the same standard of research of the blogger when you make comments about the father of the child. Show me the research that shows the DNA that transfers causes the damage I cited and I will show you research that either ignored asking if the child was prenatally exposed to alcohol or used the unreliable method of self reporting by the mother instead of scientific testing of the female for alcohol consumption. I would submit the cited research in this blog has the same highly unreliable statistics from self reporting mothers. As for the fathers, I strongly believe they are equally responsible for the health of their child and I strongly believe, as well as have anecdotal data that the drinking fathers ply their child’s mother with alcohol to get sex and to justify their drinking. Thank you for letting me comment.

  26. The study’s paywalled, which is why I included the two key data tables in the post for people to see. As you can see from the “only” to “even” switch in the abstract conclusions, however, the researchers themselves are also mispresenting their own data.
    Thanks for tracking down the press release. I’m having a hard time matching up the data in it with statistically significant data in the paper. To give you an idea of numbers, that “9.5%”, for example, is six babies, and the “13.6%” is three babies. (Table.) And as you can see, the confidence interval for the “2.3 fold” odds increase they report in that press release (adjusted odds ratio for preterm birth for heavy drinkers who stopped after the first trimester) encompasses one – it’s not statistically significant.
    In other words, this paragraph:

    Institute researcher Colleen O’Leary said “Our research shows pregnant women who drink more than one to two standard drinks per occasion and more than six standard drinks per week increase their risk of having a premature baby, even if they stop drinking before the second trimester.

    Is not supported by the data. That is not what their research showed. Assuming that you actually buy into notions of statistical significance being important, which is kinda the cornerstone of modern medical science.
    Nor does this: ” the safest choice is not to drink alcohol during pregnancy. ” follow from their data, either.
    Nor does this: ”It is very telling how the combination of smoking and heavy drinking can mean double trouble for pregnant mothers and their babies.” follow, that I can see.
    Before other readers get too confused, I’m not advocating heavy drinking and smoking during pregnancy. Nor am I advocating abstinence. I’m advocating accurate, evidence-based information being offered to women in midwives’ and doctors’ consultations and in the public sphere.

  27. JAC, at the minute level, an awful lot of stuff causes damage. One of things that annoys me about all the OMGALCOHOL stuff is that so much less attention is paid to things that are not easy to blame on the mother.
    Stress which raises blood pressure can also damage a foetus (I seem to recall, at least I remember being told that when I was pregnant). Noisy environments, particularly at night, have been shown to induce quite significant levels of stress, even in people who report no sleep disturbance. Yet I haven’t seen a headline that says “Council admits to allowing 50% of pregnant women to experience harmful levels of noise”.
    I’m not saying this is real science. I’m saying that the choice of what to investigate heavily reflects things which can be blamed on the “female”, as you word it. It could turn out to be real science if anybody looked for stuff like that.
    The other thing I find misleading is the strict causality implied in what you are saying and in much reporting. There may be a correlation, but other things clearly come into play. Alcohol consumption is not enough to make a school shooter. I know you didn’t say it is, but if alcohol is the only factor anyone mentions, it is too easy to reach that conclusion.
    I have no doubt I did things every day in each of my pregnancies that damaged my babies’ brains. I put petrol in the car. I went out on polluted days. I experienced stress. I ate food with trace amounts of Bad Things. Occasionally I drank alcohol (after 1st trimester, there can be nothing more repulsive to me than alcohol during morning sickness). I am not in denial, I am simply dealing with reality and managing risk. Tell me what else goes into turning a child who was exposed to alcohol into a child with clinically significant symptoms. Then we can manage the risk with more knowledge.
    Ariane’s last blog post..Just when I think they’re over-reacting

  28. FXH: “When were the interviews undertaken?”
    It’s a good question, and one I should have addressed in the post, thanks. A random sample of women with unrelinquished livebirths were sent an invitation letter and postal questionnaire 12 weeks postpartum to participate in the study of health-related behaviours in pregnancy and infancy, known as the RASCALS* study (OH ho ho ho). The response rate was 81% (n=4861), and only one of those responses was unable to be linked with birth information on the statutory WA Midwives’ Notification System. Multiple births and Indigenous women were excluded from the analysis.
    * Randomly Ascertained Sample of Children in Australia’s Largest State

  29. Thanks, Ariane. Jody? Please don’t do this here:

    instead of scientific testing of the female for alcohol consumption

    You need to lurk a little more.

  30. You know what Jody? I’m pregnant and I have a dog in this fight too. Because the more panicked and obsessive people get about what I should be allowed to do while pregnant, the less autonomy and trust I am given as the woman carrying said child and feeling her move. And with that comes unneccessary and often harmful interventions. Not to mention the sheer stress caused by well-meaning but totally ignorant people ‘advising’ you. Constantly. About everything.
    I’m one of those women who will be on some PSA poster if my child ends up with any sort of disorder whatsoever (because it isn’t just FAS you’re talking about is it? It’s anything and everything) because between my last period and the missed one, I had two weddings. One in the Barossa and with some really really wonderful wine. So that alcohol intake can be blamed by some self-important teacher because my kid is developmentally delayed – because proving the correlation is just too hard. It’s much easier to blame women for everything.
    I’ve had my brother in law telling me how I’m fucking up my baby’s genes by eating chocolate (because of the study that mentioned changes in genes when certain foods were eaten) (he hadn’t read the study itself, just one of these news reports). I’ve had people recommend against eating mussels steamed with beer, or red wine infused stews, because ‘one drop can cause untold problems’. I’ve had any number of insanity inducing stories about ‘oh I ate heaps of takeout with my first and she is so hyper and unmanageable!’ – all of which come free with a sneer at whatever horrible miscarriage and damaged child inducing thing I’m doing or eating.
    Condemnation and judgement is the constant theme of interactions while pregnant. I’m lucky enough that my ob. isn’t an idiot, and my partner isn’t an idiot either, and I am smart enough (and well connected enough) to be able to research things myself. But if I didn’t have DSL? Had a controlling ob/partner? Didn’t have a shitload of training and experience in research? I’d be at the mercy of every fool who had read something/seen somewhere/had the feeling and felt they needed to rescue me from myself.
    But excuse me now, I have a cold and can’t take a damn thing except panadol, strepsils and vix. So I’m curling up and trying to ignore the little voice in my head saying “SUFFER BECAUSE EVERYTHING IS GOING TO HARM THE FETUS”

  31. http://www.theage.com.au/news/world/autism-risk-linked-to-older-fathers–study/2006/09/05/1157222077908.html
    If you put autism into the search box, you will find Tigtog’s post on this on the second page of results.
    BTW, my name is Mindy, it’s right there above my comment.

  32. Will I be able to find the research that one drink damages the brain? Not until the brain imaging strategies reach the level of finding the minute damage.
    In other words, yes, you ebil wimminz, I will keep on looking at more and more minute detail until I can PROVE that you are the source of all fetal malformation!!! The evidence MUST be there because I say it is. And one day, one day, I will find it!
    /end sarcasm
    Gah!

  33. Concern troll is concerned.
    [I’ve taken the liberty of adding the appropriate macro. ~L]

  34. ” (is there really any evidence that caffeine is bad for a pregnancy?).”
    Yeah, there is – for fetal growth, for example, and also for the fetus’s developing cardiovascular system, but there does not seem to be any good evidence that it increases the risk of miscarriage.
    The hot spa thing is also a genuine risk. See here.
    Now watch the spaminator eat my post because of too many links.

  35. Concern troll busters might also note that this one also bears some similarity to a spammy grepper. He’s an educator who has just starting selling a book contending that 80% of school shootings can be blamed on the mothers’ drinking.
    Rebekka: The caffeine and miscarriage/stillbirth debates are rather fascinating, and are also a good example of needing to read the data very closely. I’ll reproduce here a comment I made on Feministe a while back about the widely-misused Wisborg study. There’s a lot of other good stuff in the Feministe thread.
    Wisborg’s study “Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life: prospective study” also demonstrated the toxic media spin around drugs in pregnancy. This was widely reported in the media as “COFFEE CAUSES STILLBIRTH!!1!”
    If you look at the actual results, what it shows it that intake of more than EIGHT cups of coffee a day at 16 weeks of pregnancy may be correlated with stillbirth (about triple the risk). Table 2 is the relevant table in the paper.
    However, the confidence interval included 1.0, meaning that the result was only of bare and borderline statistical signifiance. Smoking, alcohol, and some demographic characteristics were controlled for, but there are some very notable omissions: drug intake and nutrition, including eating disorders and intake of Listeria-risk foods. It is entirely reasonable to postulate that there may be an association between drinking more than eight cups of coffee a day in early pregnancy (seriously, eight cups?!), and disordered eating, intake of amphetamines/cocaine, and possible various other factors that are associated with poorer pregnancy outcomes – but they didn’t even ask. The authors later replied saying that they didn’t consider drug abuse an issue because the incidence of drug abuse is a “minor problem” in Denmark.
    That is without including consideration of the possibility that women with non-viable pregnancies don’t get as nauseous and lose their taste for coffee compared to
    But most importantly: if you drill down to the actual data instead of just the abstract – something the MSM never bother with – drinking no cups of coffee a day was also associated with a trend to increased risk of stillbirth compared to drinking 1-3 cups a day, and the increase was around 67% (though barely outside the range of statistical significance). Between 4 and 7 cups a day there was a trend to increased risk (again, not statistically significant wth the tests they used). So from this study, it would seem, if you were the gullible type, that the optimal intake is 1-3 cups a day, and that caffeine abstinence is contraindicated.

  36. Looking at Rebekkah’s links – abstracts only, not looking at the full data – it’s also clear that the first study (growth-restriction) found no effect at levels below 200 mg per day, and the confidence interval for the OR extended down to 1.1 for levels 200-300 mg.day and down to 1.0 for levels >300 mg/day. Those are some pretty borderline results, and it’s the trend more than the individual results that is suggestive (not conclusive) that there may be a causal link. The abstract says that they only adjusted for alcohol and smoking, leaving other possible confounders uncontrolled for (nutrition, socioeconomic status, and race spring to mind).
    The second was a study in mouse embryos.

  37. Yes, absolutely.
    I didn’t find any decent studies that suggested a link between caffeine (or coffee) intake and miscarriage. The studies I linked to weren’t suggesting a correlation between miscarriage and caffeine intake, just in case anyone was confused!

  38. But they don’t suggest real problems with growth either. Not when you consider ‘normal’ caffeine intake. Christ, even my most caffeine addicted friend doesn’t consume that much in a day (mostly). The only reason I cut down on caffeine was to minimise issues between that and vitamin intake – since I was throwing up between one and two thirds of what i ate, I wanted anything that stayed down to be useful. But hey, I wasn’t feeling bad enough already – I needed someone who hadn’t read the studies to come up and tell me my choice of beverage was not only going to probably kill my baby, but if it didn’t, it was going to developmentally delay them. Because I’m obviously not smart enough to have read the studies myself. Or decide for myself.
    In other words, next time you approach a pregnant woman and tell her not to drink caffeine, you’re practising some bad science and some shitty judgement. Because the statistics aren’t there, the abstracts aren’t telling the whole truth and it’s just another way to judge women.

  39. geekanachronism: Word.
    For me, the caffeine consumption side of things took care of itself in first trimester, as did the alcohol intake side of things. I developed major aversions to both, preferring a stay-down-please diet of canned peaches, strawberries, sharp cheddar, and fruit toast. (No, not ginger or crackers. Brrr.)
    Despite the purported physiological impossibility (and I’m agnostic on this one), the alcohol aversion kicked in when I was about four days pregnant. I didn’t finish the second beer, and I wanted to go to sleep at ten o’clock. My friends were quite concerned that I was ill, and I had no idea what on earth was going on. Little did any of us know!

  40. Lauredhel – walking past ABC TV news tonight I caught the tail end of something about grog causing cancer etc in women. My bullshit detector went off, (correlation doesn’t = causation etc) but I don’t have any detail.

  41. Goodness, I didn’t know that noise was supposed to be a factor. I played in bands while both of mine were in utero.
    I do notice they have good pitch and rhythm.
    *Pause while I go straight to hell*

  42. For some time I have been sceptical about all these messages as well. I think that too many women stop breastfeeding because they want to have a couple of drinks even daily and so they decide to bottle feed.
    My observations come from a friend of mine who had to be considered a daily very heavy drinker when she became pregnant at about 35 years old. As she did not find out she was pregnant until quite late she was drinking all through the first trimester and we (all her friends) were quite worried about her and the baby’s health when we found out she was pregnant. She stopped drinking for the remainder of the pregnancy but of course the ‘damage’ was already done.
    As it turned out her child was born without complication and is the most gifted athlete and nicest now 16 year old boy you could want to meet. (She was a beer drinker so it may be that this is what saved the little tacker)
    Anyway this outcome made me question these messages about the levels of drinking associated with potential for fetal alcohol syndrome, (and breastfeeding) so I am not surprised to see this study challenged on this basis. Lauredhel is right on the money when she says it’s about infantilising and moralising about women to try and keep us in our place. I don’t drink alcohol much but smoked dope on occasion throughout the pregnancy and while breastfeeding so I guess I’ll see you all in hell. This is about ZERO TOLERANCE policy and women are being used to push a drug free life. Never forget cleanliness is next to Godliness.

  43. I got a raw meat aversion, had no problem with booze. I haven’t had a drink since I started the morning sickness, because, well, throwing up is awful.
    And as far as noise goes, the thing I read recently (in a mothering mag, one of the ones telling me I shouldn’t have been feeling her kick yet and I should have gained a lot more weight…) mentioned that the babies of women who lived in high noise areas (next to Tokyo airport was the example) had babies who didn’t LIKE silence. So became agitated in the quiet of the hospital and calmed once at home. Which, given all the ‘soothe your baby with womb sounds/movements’ makes sense. And wouldn’t it be easy to blame the bad mothers for not moving because the baby is agitated by silence? Much easier than studying when they’re agitated and when they aren’t.

  44. Just to clarify, I was making up the noise thing. Just a random speculation based on possible stress related effects on an unborn baby. The noise itself, other than the conditioning effect noted by geekanachronism, has no effect that I am aware of.

    The conditioning effect has been noted in all sorts of ways. No doubt baby is listening and paying attention in there! 🙂

  45. I put that ‘drug use’ in perspective, as ever since I was 13 (and exhorted to never have children due to Epilepsy) I’ve been taking various anti-convulsant/anti-depressant /painrelief ‘cocktails’ for various medical issues which were all phased out after I found I was pregnant – but that was well towards the end of the first trimester. (Replaced by anti-hypertensives/anti-diabetic and steroids whilst pregnant or breastfeeding)
    We had all the very detailed scans that could tell if there were cranio-facial abnormailities, or heart valve defects etc. – it blew me away that the scans can pick up the various chambers in the heart etc..
    Pretty much all the way through pregnancy and breastfeeding I have had to balance the need for using something that is not proven safe in pregnancy or breastfeeding in order to protect my own health, so it brings the choice to use or not so-called recreational and occasional use drugs into perspective.

  46. Well, in the Middle Ages the beer was safer to drink than the water.
    Pregnancy is such an upsetter of categories. It blurs the line between the public and the private. The thing you did in private, ie. the “baby dance” (jeez I hate that coy shit) now has a very public visibility, ie. your ginormous baby belly. Even though it’s still your body, it seems to have become public property somehow: people want to touch it, they want to tell you not to drink (a waiter didn’t offer me wine while I was pregnant; I drank 2 glasses to teach him a lesson: my kid seems okay so far…), they want to “manage” you for daring to make them think of private things in a public space.
    This is what I believe, hand on heart.

Trackbacks

  1. links for 2009-02-24 « Embololalia
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  4. Bad Statistics, Bad Science
  5. Alcohol and Breastfeeding: NHMRC buys into abstinence-only messaging — Hoyden About Town
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