Jennifer O’Connell: ‘Idea we are poster children for drinking in pregnancy is horrifying’

In my experience, pregnant women can be roughly divided into two categories.

You’ll realise the first type is pregnant because she’ll be wearing maternity clothes way too big for her – and because she’ll announce it, possibly within seconds of meeting. Hang around long enough, you’ll probably get to see her 3D ultrasound photos and hear the latest guidance on alcohol consumption, peanuts and runny eggs.

The second type won’t be showing ultrasound photos to anyone, except maybe the father of the child, whom she has forgotten to tell about the appointment. Again. Her pregnancy is more difficult to detect because she’ll stay in her “normal” wardrobe – which includes maternity items leftover from last time – until she bursts out of it and she can be spotted drinking the occasional glass of wine.

I’ve been both of these types in turn; during my first pregnancy, I studiously avoided everything on the prohibited list, invested in a mini-Doppler monitor and would fall asleep to the sound of the baby’s heartbeat. By the time my third came round, I had the odd, guilt-free glass of wine and regularly mainlined great hunks of brie.

I’ve read about another type, though I’ve yet to actually meet one. This kind of mother-to-be is apparently most often found propping up a bar somewhere, roaring, “Bartender, another one, please, while I blatantly disregard the warnings about foetal alcohol syndrome, low birth-weight, premature delivery, epilepsy, vision and hearing problems, and hormonal disorders”.

According to the latest flurry of pregnancy scaremongering, Ireland is awash with this type. An international study published earlier this month claimed that the number of Irish women who drank while pregnant was six times the global average, prompting a barrage of headlines about our "terrifying" "booze shame", and the Irish women who "shockingly" "turn to the bottle" while pregnant.

The idea that we are the poster children for reckless drinking in pregnancy is horrifying – until you realise that the researchers at the Centre for Addiction and Mental Health in Canada didn't look at how much, or how frequently, the women surveyed drank. Instead, they analysed data from previous studies, and predicted rates of foetal alcohol syndrome (FAS) accordingly.

The Irish data was taken from more than 3,500 Irish maternal records from 1990 to 2011, which found that 60 per cent of women drank some alcohol while pregnant. The report doesn’t say whether “some alcohol” is a bottle a day or a glass a week. (It’s worth noting that for a good chunk of the period included in the research, many doctors were advising women that a drink or two in pregnancy was safe.)

Evidence

FAS is not to be taken lightly: it is a serious disorder, affecting an estimated 119,000 children globally and responsible for a range of neurodevelopmental impairments. But all the evidence suggests that the risk of FAS and associated foetal alcohol spectrum disorders (FASD) depends on the quantity, frequency and timing of alcohol consumption during pregnancy. Several other studies – including from Yale and Brown University, the University of Copenhagen and the University of Bristol – have failed to find any evidence of harm from low to moderate alcohol consumption.

Many experts argue that, because there is no scientifically-proven “safe” level, all alcohol should be avoided. But by shaming those who choose to enjoy a single glass of wine on a night out, we’re missing an opportunity to help those who really need it.

During my three pregnancies, which were spread over almost a decade, I managed to accumulate an encyclopaedia’s worth of confusing and contradictory advice, eventually coming to the conclusion that much of what we’re told when pregnant is based on dubious science, and the belief that mothers-to-be need to be infantilised, harassed and manipulated into doing the right thing.

First time, peanuts were out. On my second, they were in but in small doses. On my third, I was supposed to be hoovering them up like a bulimic elephant. Now, I see that fish is in again, unless it's sushi, in which case it's out, unless you're in Japan, in which case it's in. Runny eggs, out for years, are back in again in Britain.

In the US, the policing of pregnant women is no longer just a cultural phenomenon: in states such as Alabama, women are being criminalised for "endangerment of a child" for taking even small amounts of drugs during pregnancy. In one recent case, a woman lost custody of her son after she took two halves of a Valium tablet on separate occasions while pregnant.

Here’s a really intriguing theory, one that it might be in science’s interest to investigate further: other than the small number of women suffering from an addiction, the vast majority really do just want the best for their babies.

Maybe if we stop castigating them and policing their behaviour, arm them with some scientifically robust data, and then let them get on with it, they’d prove themselves to be intelligent beings, capable of making the right choices.

joconnell@irishtimes.com