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A Losing Gamble

When a pregnant woman drinks, she plays roulette with her baby's life. Stats show that the number of imbibing moms-to-be is increasing--and researchers just don't know why.


Drinking while pregnant.

It's a horrific game of chance, but in spite of a decade's worth of public health messages proclaiming that there is no safe level of alcohol consumption in pregnancy, more pregnant women are drinking alcohol, according to new government data.

Four times as many pregnant women admitted to "frequent" drinking in the 1995 government survey compared to a similar 1991 poll. Among 1,313 pregnant women, 3.5% said they drank an average of seven or more drinks a week or had consumed five or more drinks on at least one occasion in the previous month.

Applied to the population of women pregnant at any one time, the 3.5% rate translates to 140,000 U.S. women drinking at dangerous levels during pregnancy. (An estimated 4 million women are pregnant at any given time.)

The data, drawn from a random telephone survey, was reported by the U.S. Centers for Disease Control and Prevention in the April 25 Morbidity and Mortality Weekly Report.

"These numbers are amazing," said Lance Friedsam, president of the National Organization on Fetal Alcohol Syndrome. "If these numbers represent a valid population, it's an enormous risk to unborn children."


The apparent rise in drinking during pregnancy has both disheartened and stumped health officials because alcohol consumption rates among women in general have remained steady.

The survey also found that the percentage of pregnant women who reported any drinking--one drink or more--during the previous month rose from 12.4% to 16.3%, a finding that may indicate a general softening in public attitudes about the dangers of alcohol consumption during pregnancy.

"While abstinence from alcohol during pregnancy is the official recommendation from the surgeon general and the secretary of Health and Human Services, the effectiveness of that message appears to be diminishing from these data," said Dr. Louise Floyd, chief of the Fetal Alcohol Syndrome Prevention Section at the CDC. "We need to know who is drinking at these levels and why these individuals may not be heeding this advice. That research may hold some promise of understanding this increase a little better."

For now, however, health officials appear to be at a loss to explain why more pregnant women are putting their babies at risk.

"Most of the research up to this point led us to believe that, for the most part, women have gotten the message except for the highest-risk women, and that we should target intervention to the highest risk groups. But this [new data] makes me want to say maybe we should reassess the situation," said Dr. Mary Dufour, deputy director of the National Institute on Alcohol Abuse and Alcoholism.

However, Dufour and others suggest the new CDC data may be flawed because the 1995 survey questions were changed slightly from the 1991 questions, which makes an actual comparison of the numbers impossible.

But even numbers that suggest no change in drinking patterns during pregnancy are a profound disappointment, said Janet Hankin, a professor of sociology at Wayne State University in Detroit who has studied drinking among pregnant women.

"We believe that there are about the same percentage of women drinking heavily during pregnancy. The important message is that the numbers haven't decreased in spite of warning labels and public health messages," she said.

Heavy alcohol use during pregnancy is linked to Fetal Alcohol Syndrome (FAS), a serious, irreversible birth defect that includes craniofacial abnormalities, mental retardation and growth deficiencies. But drinking during pregnancy can also cause less obvious consequences, sometimes referred to as alcohol-related birth defects, which include learning disabilities and behavior problems.


The dangers of drinking during pregnancy have been known for several decades. But it wasn't until 1989 that warning labels specific to pregnancy were affixed to alcoholic beverages under federal law. Restaurants and bars typically carry similar signs or posters.

But officials now surmise that several trends have converged to dilute the earlier prevention efforts. In particular, they cite the lack of detailed public education on FAS as well as confusion over what "moderate" drinking is and how much alcohol consumption is safe during pregnancy.

"I'm wondering if the warning label has just become part of the scenery," said Laurie Leiber, director of the Center on Alcohol Advertising, a nonprofit organization in Berkeley. "The impact kind of wears off and the behavior starts to go back. And maybe that is what has happened here."

Studies at Wayne State show that the warning labels have had "a modest effect. But only among women who weren't drinking heavily anyway," Hankin said.

Abstinence has been a difficult message to communicate, officials say, because there is no evidence that a small amount of alcohol use during pregnancy is harmful.

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