to be a bit disappointed that the British Medical Association thinks women are basically thick?

[welliemum]

Interesting study in the news here.

In a nutshell, the study suggests that light drinking (up to 2 drinks per week) during pregnancy isn't harmful to children's development.

Dr Kelly, the lead researcher, said, "Our study's findings do raise questions as to whether the current push for policy to recommend complete abstinence during pregnancy is merited and suggest that further research needs to be done."

But no, the BMA disagrees: "The BMA believes the simplest and safest advice is for women not to drink alcohol during pregnancy."

Because we're all thick, right? So thick that we can't count up to 2, apparently.

What interests me, too, about this debate is that the general population is completely at home with the idea of a safe drink-driving level - including some relatively sophisticated ideas eg that the safe level will vary quite a lot from person to person, and that keeping within the legal limit doesn't guarantee that your driving won't be affected.

So why wouldn't people be able to grasp exactly the same concept, but related to drinking in pregnancy rather than behind the wheel?

oh well pregnant women can't be treated like the general public doncha know, it's the 'ormones

Some good points here.

My interpretation for the BMA's stance was the well-documented inability for the average person to judge a unit.

For example; I was with friends the other week, and said I'd just have a glass of wine (am 6 months pg, and sticking with ligth drinking being 1-2 units and not every week, iyswim). So they poured me a big glass, right up to the top "since you can only have one glass, better make it a big one. not quite the point, guys.

Interesting point milkmade; I'd not have thought of taht

Lots of women are too thick. I saw a programme where a young pregnant woman was downing bottles of vodka when she was heavily pregnant and she said that she had no idea that she had been drinking over the recommended limits.

I think if there's a problem of people judging what a unit is (and obviously, there is) then the way forward is to educate them. A publicity campaign / midwife info etc. is probably necessary.

TBH a general publicity campaign round about christmas time is probably a good idea. It's not just pregnant women who need to know what a unit is, it's everyone who drinks alcohol.

We can't be trusted to give our children paracetemol-based medications correctly, either.

We can't read labels, apparently.

I don't trust most medics any farther than I can throw them, which is nowhere because I can't pick them up.

Yes, there are people out there who won't follow the guidelines - if they're all out knocking back vodkas they're not paying any attention to current guidelines, so why try to create a message any old thicko can understand at the expense of the truth?

This (as others have pointed out) not particularly impressive study says that the women who are drinking moderately through pregnancy are for the most part educated and well off - it would seem that the misguided thickos that the BMA has in mind are following the guidelines to the letter, but educated women are not.

That said, this one study doesn't merit a change in the guidelines in itself, for all the many reasons others have pointed out.

welliemum: I agree that it didn't show a harmful effect, but without a proper control group (i.e. a zero drinking group with similar social, educational and dietry factors) they can't actually state that it didn't cause harm as they have nothing to compare it to.

If I was the BMA I wouldn't change my advice on the basis of this poorly performed study either (however, I wouldn't have changed it to zero alcohol given the other body of evidence saying no harm with light drinking either, but that's by the by).

For what its worth, I agree with your conclusion that BMA are patronising in the extreme with their current alcohol advice. I just don't agree with your interpretation of this particular study

Mmmm, now, I'm not sure I agree that it was a poor study.

Obviously an observational study is never going to be as robust as a proper randomised controlled trial, but given that an RCT would be impossible, I think they've done a pretty good job.

They haven't used a case-control design but have controlled for a wide selection of confounders in their regression analysis, so I don't see that as a concern. It looks well thought out and the "strengths and limitations" section has a good discussion. It's a huge study - and of course big numbers won't protect against confounding and bias, but the big study size has allowed them to make a pretty robust analysis.

I'm not sure we're going to see anything much better in the forseeable future, actually.

I agree with the OP to a certain extent that it is a little patronising to think that saying we can't drink anything is the only safe thing to do as we can't count to 2 units.

Having said that, I think the advice that you can have a unit or 2 has an unfortunate effect on some less thoughtful women.

A girl I knew who was pregnant used to come into the bar I worked in and get a white wine spritzer/half pint of cider (which is fair enough) but she seemed to think that she could have 5 of them because it was "only a half pint" or "only a spritzer". Ok, she possibly wasn't the brightest spark but if the advice then had been that no level of alcohol was safe then she would perhaps have been persuaded to think differently.

But I think that goes back to what Bella was saying a bit further down - that if you drink you should understand what a unit means.

IMO, a big education campaign on "what is a unit of alcohol" would be money very well spent, and would have benefits far beyond pregnant women.

Obviously some people can't control their drinking - but for someone like that, the effect of telling them they can drink up to 2 units will be roughly the same as the effect of telling them they shouldn't drink at all - ie, no effect whatsoever.

Very few people are unaware of the dangers of smoking in pregnancy. Lots of them still smoke.

There was a big education campaign (TV adverts, huge billboards with drinks and a number on the glass to show the units etc) over the summer... I guess a few people still missed it.

It is next to impossible to prove beyond doubt that there is a set limit of alcohol that will have no effect on the baby. The best designed study possible could still not show this. Although I hate the BMA with an intense fury (I am a medic, I'm allowed to ;) ) and don't think they are the best people to give this advice I can't fault the logic that the only 100% safe amount of alcohol is none. (in the same way that the only 100% safe contraceptive is no sex). That doesn't mean that people are not entitled to read the evidence and make their own decisions.

I think it is good - they give us advice to make us feel guilty, what better preparation for motherhood is there?

Not ignoring the discussion from here on by the way - it's late down here in NZ and I need my zzzzz...

"If the govt wants a simple message that everyone can understand, it could be something like ?don?t drink more than 2 units of alcohol per week when pregnant?. "

The problem is this is not a simple message,as a lot of people have pointed out on here not everyone knows what a unit is. It's safer for the BMA just to say no alcohol, the BMA are not out to get you.

I don't think you should be allowed to drink and drive at all either because, back to the recurring theme, not many people know how much a unit is.

Hmm, sorry but I think most people, educated or not, act thick when it comes to alcohol. Many people drink over the recommended limits for non-pregnant adults - and people do lie to doctors about how much alcohol they consume, particularly by omitting those fairly regular "one off" days when calculating their average drinking.

Of course people can to come to their own decision, but we should also admit that most people are very capable of deceiving themselves about their own "bad behaviour". Are we really expecting the average person to read all the current research and make an educated decision themselves? Advice can be ignored, but the aim is to filter the information and give a rule of thumb guidline. If you have the time and inclination to delve deeper and work it out for yourself, great, but most of us dont.

I agree with the comment above though, that money would be better spent explaining what a unit of alcohol is. Alcohol is stronger, glass sizes bigger, and being drunk more socially acceptable than ever before.

For example, many pub "standard" glasses of wine contain around 3 units. What percentage of people would think "moderate drinking in pregnancy" was less that 1 glass of wine a week?

I think there is an irony in the OP saying the BMA think we are stupid, then misunderstanding the study. Light drinking was defined as 1-2 UNITS a week, not 1-2 DRINKS. Totally different. 250mls of wine - a pub glassful - is usually more than 3 units.
I did have the odd drink in pregnancy - probably nearer 3 units a week quite often, and have never believed that a couple of small glasses of wine (125-150mls) would do any harm. But I think the medical profession is becoming worried about the effects of drinking in pregnancy on babies.

Its far easier for people to follow "No" rather than "Some" - that automatically introduces greay areas.

I know that 2 units is 1 of my wine glasses of normal wine.

Its really not worth having 1 glass of wine a week - its not as if thats a great revelation or freedom which you suddenly can have.

As there is a % of the population that don't get "not smoking or drinking in pregnancy" at all, then I think the recommendation that you shouldn't drink at all stantds up.

I think it's fair to say that the BMA thinks that most people, male and female, are a bit thick. Because they are.

Internet forums like this are not a typical cross section of society - we're self selecting and of course people like us are going to be a bit more clued up on health matters then the average punter.

The best selling newspaper in this country is The Sun. Sadly, we are a nation of thickos.

And anyway, it's not the people following BMA guidelines we need to worry about. It's people who don't know the BMA exists or would care anyway.

some cow from the BMA on the BBC tonight, re-iterating that women underestimate the units they drink, thereby backing up most posters' points on here - that many medics think we're all lying about the amount of alcohol we consume or are too stupid or can't be trusted around it.

Surely encouraging regular but light exercise, a good diet, taking pregnancy vitamins, attending ante-natal/parenting classes and relaxation would be better than saying woman can drink lightly during. It's very open to interpretation and as someone else said it's empty calories.

FWIW, my Mum and Nan were recommended to drink Mackesons stout when they were pg to build up their iron levels (mind my Nan had 3 babies with the privations of wartime/rationing to contend with) but now we'd think a doctor who recommended stout to drink was off their rocker . I was furious when my doctor told me to eat more red meat - who did she think was going to pay for it?

'I was furious when my doctor told me to eat more red meat - who did she think was going to pay for it? '

the same person who pays for prenatal vitamins, antenatal classes and 'relaxation' and opportunities for light exercise.

On my PCT peer support course we're told to tell mothers no alcohol when breastfeeding because (I quote my instructor) "most people don't know what a unit is".

I ticked on my notes that I do drink but left how many units blank, as I explained to the MW, sometimes I have a drink once in a week, mostly I don't drink. Even if they double that, I don't much.

They don't think people are thick. They want to promote the safest possible practice