Emily Oster’s Alcohol and Pregnancy Advice is Deeply Flawed and Harmful

Get the facts about light drinking during pregnancy.

Go here for a quick summary of key responses

The National Organization on Fetal Alcohol Syndrome (NOFAS) is outraged by Emily Oster’s deeply flawed and harmful advice about alcohol and pregnancy in her book, “Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-and What You Really Need to Know.  In a Wall Street Journal article promoting the book, she not only falsely claims that drinking wine during pregnancy is fine, she actively encourages pregnant women to drink alcohol, writing, “the evidence overwhelmingly shows that light drinking is fine.”  This is profoundly dangerous.

Based on her understanding of the risk and her guidance, Emily Oster is unqualified to write about alcohol use and pregnancy.  She claims to have “combed through hundreds of studies” yet she cherry picks only a few, none of which actually conclude that light drinking is risk-free.  Clearly, she is misrepresenting the data on alcohol use and pregnancy.

In her article in The Wall Street Journal, she cites from only two studies, both conducted in Australia, primarily a study published in 2010 in the British Journal of Obstetrics and Gynecology that found light drinking to not be a risk factor for child behavioral problems.  However, Oster ignores the research that found light drinking to be associated with a range of problems aside from behavior.  A study published in Alcohol Research & Health in 2011 found that drinking at low to moderate levels during pregnancy is associated with miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome (SIDS).  In 2012, another study published in International Journal of Epidemiology states, “Even low amounts of alcohol consumption during early pregnancy increased the risk of spontaneous abortion substantially.”

The bottom line: Light drinking during pregnancy cannot be considered risk free just because some studies found it to not be a risk factor in one specific area of development, given that other studies have found light drinking to be a risk factor in many other areas.

NOFAS is dedicated to helping people living with FASD, which includes Fetal Alcohol Syndrome and the subtler neurobehavioral effects of Fetal Alcohol Spectrum Disorders.  Symptoms of FASD vary widely, and can include problems with learning, socialization, IQ, impulse control, emotional self-regulation, and sensory processing.  FASD affects 1 in 100 children, nearly the same rate as autism.  FASD is under-diagnosed and often misdiagnosed as Autism or ADHD due to a lack of knowledge and the stigma of diagnosing FASD.  Maternal alcohol exposure is the leading preventable cause of fetal brain damage and birth defects in the U.S.

Of course, not every pregnant woman who drinks alcohol will have a child adversely affected, just like not every lifelong smoker will get lung cancer.  But, why take the risk?  More to the point, why would this misguided author encourage other pregnant women to take the risk with their children?  If Emily Oster wants to tolerate the risk of alcohol on her own baby, that’s her choice, but she has no right to advise pregnant women to expose their unborn baby to even a small amount of a substance that can cause brain damage.

Sadly, Oster’s statements will likely influence some pregnant women to drink alcohol, who then could tragically give birth to offspring with lifelong brain damage from the effects of prenatal exposure to alcohol, including Fetal Alcohol Syndrome.  Oster is obviously less concerned with protecting the health of newborns than she is with protecting expectant mothers from health messages she deems bothersome.

Oster says that, “recommendations from books and medical associations were vague and sometimes contradictory.” There is no contradiction among medical associations.  According to the Centers for Disease Control and Prevention (CDC), as well as the U.S. Surgeon General, “There is no known safe amount of alcohol to drink while pregnant. There is also no safe time during pregnancy to drink and no safe kind of alcohol.”  Baby Center says, “All public health officials in the United States recommend that pregnant women, as well as women who are trying to conceive, play it safe by steering clear of alcohol entirely. So do experts at the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.”

Dr. Jeanne A. Conry, President of the largest organization representing OB/GYNs, The American Congress of Obstetricians and Gynecologists, writes, “Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject.”  Despite this, Oster gives pregnant women this direct advice: “It isn’t that complicated: Drink like a European adult, not like a fraternity brother.”  If Oster actually looked at the data, she would see that the rate of Fetal Alcohol Syndrome is higher in parts of Europe than in the U.S.  An estimated 3% of children in parts of Italy are damaged by prenatal alcohol exposure, compared to an estimated 1 in 100 children in the U.S.

Three key points about alcohol and pregnancy:

1. Alcohol is a neurotoxin.  Forty years of research has shown alcohol to be a neurotoxin in utero.  That means alcohol is a toxic substance to the developing baby; just like carbon monoxide and lead are toxic substances to adults. Alcohol kills fetal brain cells.  Why would Emily Oster encourage women to expose their developing baby to any amount of a toxic substance?

2. Developing babies can’t process any amount of alcohol.  Growing babies lack the ability to process or metabolize alcohol through the liver or other organs.  Alcohol crosses the placenta, and research has shown that, “One to 2 [hours] after maternal ingestion, fetal blood alcohol concentrations (BACs) reach levels nearly equivalent to maternal levels.”

3. Alcohol is more harmful to a developing baby than heroin or cocaine. According to The Institute of Medicine, “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”  This uninformed author’s article in the Wall Street Journal implies that cocaine use is more harmful than wine, which is not based on any data whatsoever, but simply relies on the fact that cocaine is illegal and wine is legal and socially acceptable.

Oster says, “It’s fine to have the occasional glass of wine – even one every day – in the second and third trimesters.”  This is simply not true without some risk. Dr. Michael Charness of Harvard Medical School gives just one example: “We’ve been able to show very striking effects of alcohol on the L1 cell adhesion molecule, a critical molecule for development, at concentrations of alcohol that a woman would have in her blood after just one drink.”

NOFAS reached out to Dr. Edward P. Riley, Former Chair of the U.S. National Task Force on Fetal Alcohol Syndrome and Professor of Psychology at San Diego State University.  Dr. Riley reviewed Oster’s statements and concluded, “I find it amazing that Dr. Oster wants to take on the responsibility of assuring so many women that it is OK to have ‘A glass of wine or so a day’ while pregnant.  She readily acknowledges that ‘all drinking isn’t created equal,’ but fails to recognize that all women are not created equal.  Individual genetics, drinking habits, and other contributing factors limit the ability of science to make the sweeping assurances that Dr. Oster appears willing to endorse.”

Kathy Mitchell is the National Spokesperson of NOFAS and founde­r of the Circle of Hope, which provides support for women that have used alcohol while pregnant.  Mitchell has talked to countless women that drank moderate amounts of wine while pregnant, and years later have a child with learning or health issues, such as autism or ADHD. “Even if these problems have nothing to do with the alcohol use, some women will still blame themselves and live with the guilt that just maybe, possibly their child’s suffering was due to their drinking while pregnant. Emily Oster thinks that the way to relieve women of this worry and guilt is to tell them: Don’t worry, it’s fine. Enjoy a glass of wine.  In fact, the best way to relieve women of this worry is to encourage pregnant women to avoid alcohol, including wine, and therefore have no reason to worry whatsoever.”

This misinformed author claims that her relaxed attitude towards drinking wine during pregnancy is in the interest of liberating pregnant women to have more freedom, to “take back your pregnancy,” as her article was titled in The Wall Street Journal.  NOFAS supports efforts to liberate women.  However, liberation doesn’t come from drinking wine while pregnant.  Liberation comes from never having to worry that you might have done something to harm your child by drinking alcohol.

Oster writes of her wine-exposed pregnancy, “This approach to pregnancy—getting the best information and making my own decisions with it—worked for me. And I’m happy to report that my daughter, Penelope, now 2, is healthy and thriving.” However, according to Dr. Susan Astley and Dr. Therese Grant, “Children exposed to and damaged by prenatal alcohol exposure look deceptively good in the preschool years. The full impact of their alcohol exposure will not be evident until their adolescent years.”

Oster states, “I like my role as anti-pregnancy police.”  What this self-proclaimed medical expert calls the pregnancy police are in fact almost always public health officials, doctors, OB/GYNs, and researchers, dedicated to improving health outcomes of women and their children, with no intent to control or alarm women in some oppressive or paternalistic fashion.  On the contrary, NOFAS, and the overwhelming majority of people actively promoting the message that no amount of alcohol is safe during pregnancy, purposely avoid scare tactics so as not to alarm women who may have had a drink before they knew they were pregnant.

Oster seems to enjoy making people angry, as she tweeted: “If you like today’s @WSJ excerpt (or if it makes you mad!) there is more in the book.”  Well, this author makes NOFAS sad when we consider the children and families who may be harmed by her words.  NOFAS calls on all those who care about the wellbeing of children and families to denounce Emily Oster’s dangerous encouragement of drinking during pregnancy.

Get the facts about light drinking during pregnancy here.

For media inquiries, please contact NOFAS President Tom Donaldson.

- National Organization on Fetal Alcohol Syndrome

 

Key Responses:

  1. Emily Oster has no medical training or expertise and is unqualified to write a book which provides advice and guidance about alcohol use and pregnancy.
  2. She cherry picks studies and ignores the research showing light drinking to be associated with miscarriage, stillbirth, preterm delivery, spontaneous abortion, and sudden infant death syndrome (SIDS).
  3. If Emily Oster wants to tolerate the risk of alcohol on her own baby, that’s her choice, but she has no right to advise pregnant women to expose their unborn baby to even a small amount of a substance that can cause brain damage.
  4. She is clearly less concerned with protecting the health of newborns than she is with protecting expectant mothers from health messages she deems bothersome.
  5. Sadly, Oster’s statements will likely influence some pregnant women to drink alcohol, who then could tragically give birth to offspring with lifelong brain damage from the effects of prenatal exposure to alcohol, including Fetal Alcohol Syndrome.
  6. Emily Oster thinks that the way to relieve women of the worry and guilt from having a few drinks during pregnancy is to tell them: Don’t worry, it’s fine. Enjoy a glass of wine.  In fact, the best way to relieve women of this worry is to encourage pregnant women to avoid alcohol, including wine, and therefore have no reason to worry whatsoever.
  7. Liberation for expectant mothers doesn’t come from drinking wine while pregnant.  Liberation comes from never having to worry that you might have done something to harm your child by drinking alcohol.
  8. Emily Oster claims that her 2-year old daughter is perfectly healthy, yet the full impact of the alcohol exposure on her child will not be evident until the adolescent years.
  9. What Oster calls the “pregnancy police” are in fact public health professionals, doctors, OB-GYNs, and researchers, dedicated to improving the health outcomes of women and their children.  NOFAS, and the overwhelming majority of people actively promoting the message that no amount of alcohol is safe during pregnancy, purposely avoid scare tactics so as not to alarm women who may have had a drink before they knew they were pregnant.