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.

SGM, the FAS issue is very controversial actually, although I agree completely, the only way to be totally safe is not to drink. But the question of cost-effectiveness is tricky. If you simply tell an occasional light drinker to stop drinking, they may well do just that. But telling a heavy drinker to stop drinking isn't going to have an effect - they'll need much more support than that - and they are the ones who constitute the biggest FAS risk. If you want to decrease the incidence of FAS, you'd need to allocate your resources unevenly across the drinking population to have the maximum effect.

Anyway, thanks all, it's an interesting discussion but I must go.

Am really really going, but SM, yup, totally anecdotal, you're most welcome to disagree.

shame you couldn't share you references about pg women being hounded before you decided to go

Re: anecdotal evidence of pregnant women being judged... I have been left alone, but I'm sure I've read threads and threads on here about unwanted advice to pregnant women. No, it's not something anyone has bothered asking detailed academic questions - but the mumsnet jury must count for something (on MN if nowhere else!). Drifting off-topic rapidly, of course...

How about this for a comparison? It's been posted that as studies do come up with different results, the only safe amount would be no alcohol at all, hence it makes sense for the guidelines to stay the same and for zero alcohol to be the recommendation. Fine - this doesn't take into account the finding in this study that a small amount of alcohol was beneficial, but I can see how if doctors work by the rule 'first do no harm', then it makes sense to stick with the advice that avoids harm even if by that you are possibly forgoing some benefits.

However, this would also seem to me to make sense as a rule for driving. In other words, someone may be able to drive safely after 1/2 drinks, but it isn't certain, and there is convincing evidence that the more someone drinks, the less safe they are as a driver. So by that logic, shouldn't the drink-driving limit also be zero? And if the authorities work to the lowest common denominator, then the same logic would apply again - rather than trying to get people to understand units and judge their intake, they would be saying 'if you're driving, no alcohol whatsoever'. Yet this is not the case. In both situations, you are risking ruining a person's life in the most extreme outcome. But where the general individual is concerned, the government doesn't want to be seen to be a killjoy, a dictatorship, or telling people they can't have any of what they like. Apparently, though, where pregnant women are concerned that isn't an issue: it is For Our Own Good, and we shouldn't be given any room to be allowed to make sensible judgements of our own. Why is a pregnant woman considered less capable of rational judgement than the average driver?

yes we can all share anecdotal stories but that doesn't mean the MRC should allocate grants on that basis

Oh Gordon Bennett, ScottishMummy, did you really think I was suggesting that? (It would be something for a sociology department, anyway, not a medical one.)

very interesing, sgm

Back again for a mo

Scanning the thread, I think the majority feel that the best advice the BMA et al should give to pregnant women is not to drink at all.

I disagree - but I can see I'm in a minority.

I think this view is interesting, because this has important implications for other pregnancy advice and other alcohol advice.

Tuna and pregnancy for example. There's no guaranteed safe limit for mercury levels any more than there is for alcohol. Yet as far as I can see, where advice is given, it's generally to limit yourself to a certain weight of tuna or a certain amount of cans per week.

You would agree, then, that the advice should be changed to no tuna at all in pregnancy? Tuna is great protein etc, but so are lots of other things, so pregnant women don't need tuna, just as they don't need alcohol - it's a choice thing. If the risk is unquantifiable, presumably pregnant women shouldn't take that risk.

And then there's caffeine. Current UK advice is 300mg per day but as far as I know, there aren't clear safe levels. The potential risks of caffeine are worrying - low birth weight and even miscarriage. Logically this should mean no caffeine at all while pregnant.

Another issue is driving. As Eightieschick has pointed out, to be consistent, the advice should be not to drink at all if driving.

So changing the drinking advice for pregnant women should lead to a rethink of quite a lot of other similar types of advice. I still don't think it's a good way to go - but you can't cherry pick between approaches. Either you believe in zero-risk advice or you don't.

What I mean by cherry picking is claiming that that it's OK to allow women to risk low levels of mercury but not OK to allow them to risk low levels of alcohol.

Similarly, cherry picking would be claiming that the Great British Public can't be trusted to understand "No more than 2 units of alcohol per week", but can be trusted to understand "No more than 300mg of caffeine per week", or "Limit the amount of tuna you eat to no more than two tuna steaks a week (weighing about 140g cooked or 170g raw) or four medium-size cans of tuna a week (with a drained weight of about 140g per can)."

(from the Food Standards Agency advice website here.)

Pregnancy vitamins are free if you are on benefits (I wasn't, I paid for mine), antenatal classes are free to every pg woman from her mw (or they were when I had mine) and relaxation doesn't cost a penny. Light exercise could be walking which again, is free unless you want to count the cost of shoes .

Still a lot cheaper than drinking 1-2 units of alcohol.

Pregnancy vitamins are free if you are on benefits (I wasn't, I paid for mine), antenatal classes are free to every pg woman from her mw (or they were when I had mine) and relaxation doesn't cost a penny. Light exercise could be walking which again, is free unless you want to count the cost of shoes .

Still a lot cheaper than drinking 1-2 units of alcohol.

I'm with you on the advice, welliemum. I think there's a historical puritan tendency in the broadly Anglo-Saxon countries that makes it culturally easier to suppress things that are fun! I am being flippant to a certain extent, but only to a certain extent. The 'no risk for fetuses' tendency is misguided because there is no such thing as a no risk environment. We each decide how much risk we are prepared to absorb. There's evidence that everyone is prepared to accept a certain level of risk - different for each individual. If we don't have that level of risk in our lives base case, we practically go looking for it: that explains base-jumpers and motocyclists! Just had a thought - might also explain some of the risk-aversion experienced by parents. We're taking on a child's risks, as well as our own, so we are prepared to accept a lower level of risk for each... Hmmm... Anyhoo. I think this basically means I am agreeing with EightiesChick.

SGM's point on FAS is interesting, though. Do we, in the UK, underdiagnose? Do the Americans overdiagnose? Or are there lots of Americans secretly tipping booze down their throats while we're not looking? Looking at the rest of the thread (because I don't really know that much about FAS) I guess FAS is only partly environmental i.e. it is triggered by alcohol consumption, but some women's bodies protect the fetus somehow. So maybe Americans are sufficiently genetically distinct from Brits that the explanation lies neither in diagnosis, nor in alcohol consumption, but in genetics? Or it could be something else - the US is a less economically equal society than the UK, so if FAS is more common in less advantaged, less educated individuals, one would expect to see more of it in the US than the UK because the US has a higher percentage of people at the ends of the economic bell-curve. The fact that there are still so many question marks here suggests that the risks will be acceptable for a percentage of the population (me, Eightieschick and welliemum!).

Robert Winston did a programme a few years ago where he followed the human life from conception to death. One of the things he did was an experiment where he and a Chinese friend sat in a pub drinking. He was able to drink a lot more than his friend (some funny out takes of him trying to do piece to the camera!) and he explained that the reason is how in the past people purified water for drinking. The Chinese did it by boiling it and adding tea leaves, we did it by adding alcohol. At some points in our history no one drank anything but alcohol because it wasn't safe not to. Subsequently those countries that used alcohol as a way of purifying water have a far better tolerance to it than countries who made tea or (like Native Americans) didn't need to purify their water.

I think there should be a recommendation not to drink at all if driving. Maybe that is what the BMA would recommend. Do we know? A BMA recommendation is verydifferent to a legal requirement.

4 cans of tuna every week is pretty heavy-duty fish-eating. How likely is it that people do that and so we need a UK medical body to advise against it?

I don't know what 300mg of caffeiine relates to in cups. I'm guessing a lot.

He is a scientist who does the human science type programmes - Child of Our Time for example. Rather zany but lovely guy.

Caffiene Name....................mls (mg) mg/100mls_
Cherry Coke.....................355 34....10
Coca-Cola Classic.............355 34.5..10
Coca-Cola Zero................355 34.5..10
Coffee (Brewed)...............237 107.5 45
Coffee (Decaf, Brewed).....237 5.6 ...2
Coffee (Decaf, Instant).....237 2.5 ...1
Coffee (Drip) ...................237 145 ..61
Coffee (Espresso)..............44 77 ..175
Coffee (Instant)................237 57 ...24
Diet Cherry Coca-Cola.......355 34 ...10
Diet Coke........................355 45 ...13
Diet Coke with Lemon........355 45 ...13
Diet Coke with Lime...........355 45 ...13
Diet Pepsi........................355 36 ...10
Pepsi..............................355 38 ...11
Tea (Brewed)...................237 47 ...20
Tea (Brewed, Imported).....237 60 ...25
Tea (Green).....................237 25 ...11
Tea (Iced).......................237 47 ...20
Tea (Instant)...................237 26 ...11
tea (white)......................237 15 ....6

(It took me ages to get it as lined up as that, I hope it makes sense, it's actually surprisingly easy to make the caffiene limit.)