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Should women abstain from alcohol throughout pregnancy?

BMJ 2015; 351 doi: (Published 06 October 2015) Cite this as: BMJ 2015;351:h5232

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Use common-sense, not just evidence, to advise on alcohol in pregnancy. Re: Should women abstain from alcohol throughout pregnancy?

Mather and Wiles are to be commended on their article "Should women abstain from alcohol throughout pregnancy?" written with Patrick O'Brien. By striking a note of caution, Mather and Wiles underscore the Hippocratic principle "Primum Non Nocere" (First, do no harm) as a guiding principle for healthcare professionals.

Pregnancy is not a disease; it is a transitory physiologic state created by growth and development of a foetus within its mother's body. It is flawed thinking then, to examine the risk of alcohol consumption as one would document adverse reactions in drug trials. The preciousness of developing life in pregnancy permits only correlation by observational studies; it simply can never be ethically possible to design a randomized controlled trial to test the effect of alcohol in pregnancy in a human model.

Powerful computing power may permit complex simulations in the future on a computer model to determine a "safe dose" of alcohol in pregnancy. Ethics prevent us from conducting randomized controlled trials to examine the effect of alcohol in pregnancy. Until then, causation is difficult to prove; at best science can safely look for correlation. Would Patrick O'Brien refrain from discouraging a pregnant partner to drink alcohol simply because "the evidence against alcohol is lacking"? O''Brien's conclusion that women can be explained the meaning of a unit of alcohol and then be expected to make an informed choice in pregnancy ignores known complications such as Fetal Alcohol Syndrome. In stating so, he clearly overlooks the social and health fallout of binge-drinking that has reached epidemic proportions among British youth. Or has the thalidomide tragedy faded from our collective consciousness? Discussing alcohol consumption with a pregnant patient is not the time for ambiguity. Isn't it better to err on the side of safety for the sake of future generations?

In poor and developing nations such as India, societies traditionally give pregnant women the best of nutrition and care. This protective approach may stem from poor primary health care services. In the West, it is intriguing that pregnant, educated mothers would wilfully consider imbibing alcohol with a fetus growing within them. Is this an arrogance bred by ready access to free and quality healthcare services, one wonders.

To conclude, a would-be mother would do well to heed Mather. And if the evidence is low, is there no role for common sense? Perhaps one should step back and, for once, look beyond Science toward The Humanities. The study of Medicine is to address disease. Perhaps this is why birth and death in developing nations often happen at home rather than hospital. Pregnancy, the fetus, birth and health are about Life itself. This is best appreciated by a verse from a poem by Kahlil Gibran:

Your children are not your children.
They are the sons and daughters of Life's longing for itself.
They come through you but not from you,
And though they are with you yet they belong not to you.

Competing interests: No competing interests

12 October 2015
Deep Shikha
B.D.S., Manipal University
Nakul Uppal
(M.Sc., Applied Psychology, Walden University)
Mangalore, India