Schrödinger's Fetus
February 5, 2016 1:35 PM   Subscribe

On February 2, 2016, the U.S. Centers for Disease Control released new guidelines advising all sexually active women to abstain from alcohol unless they are on birth control. The recommendation and related infographic were quickly criticized.

Ms. Magazine: "If you are a woman with the physiological ability to become pregnant, your role as a potential baby incubator apparently supersedes your right to make decisions regarding your own body. "

The Mary Sue: "The mention of “injuries/violence” under the “risks” section strikes me as tacit victim-blaming, and including the risks that drinking can have even for women who can’t get pregnant seems a little puritanical."

The Atlantic: Protect Your Womb From the Devil Drink

The Guardian: "We can’t tell women not to drink for fear that they might be pregnant without also telling them that it’s their right to make their own reproductive choices. I would suggest a little less fear-mongering and a little more support for women who need reproductive healthcare – including abortion care."

The reaction on Twitter.

The Onion weighed in as well.

The CDC recommendation was endorsed by the American College of Obstetricians and Gynecologists.
posted by melissasaurus (165 comments total) 29 users marked this as a favorite
 
Argh. This thing got me involved in some surprisingly heated conversations on Facebook this morning.

The substance of the recommendation seems so common sense as to be unnecessary, but then the framing of it, as: "hey ladies, your non-existent fetus is more important than your selfish desire to get turnt," was just asking for a fight.

Why not emphasize that the real risk here isn't drinking, it's having unprotected sex while not taking steps to control your fertility, with the recommendation that birth control should be easier to get and actively encouraged for women of child-bearing age who do not want to get pregnant?
posted by sparklemotion at 1:43 PM on February 5, 2016 [45 favorites]


I wouldn't find this quite so irritating if they also advised all sexually active men to abstain from alcohol unless they had a vasectomy.
posted by jeather at 1:44 PM on February 5, 2016 [110 favorites]


I really like the "for any woman" part of the infographic. Because I know a lot of women who don't even have a uterus. So drinking and getting unintendedly pregnant would be big news. And the rest of this also bunk.
posted by roomthreeseventeen at 1:45 PM on February 5, 2016 [22 favorites]


I wouldn't find this quite so irritating if they also advised all sexually active men to abstain from alcohol unless they had a vasectomy.

Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception?
posted by sparklemotion at 1:45 PM on February 5, 2016 [16 favorites]


Fuck this shit.

Trying to think of anything else at all to say about this, but nope, that about sums it up.
posted by sunset in snow country at 1:45 PM on February 5, 2016 [19 favorites]


Okay? We just had a post about how there is no "safe" level of drinking, and pro-choice discussions have pointed out that people can be pregnant for months without knowing it (hence the need for late-term abortions). If someone does want to have a baby, and wants to avoid fetal alcohol syndrome, it's good to know how to do that.

The CDC is giving medical advice, not moral judgement. It should be taken for granted that women can do their own risk/reward weighing and choose whether to have a drink weeks after having sex. If someone chooses to use these guidelines to blame women for having disabled babies, they're the one being a jackass, not the CDC.

I wouldn't find this quite so irritating if they also advised all sexually active men to abstain from alcohol unless they had a vasectomy.

As far as I know, sperm are not affected by drinking and cannot cause fetal alcohol syndrome. Again, this is not a moral rule for women to be "good, blameless mothers"—it's practical data for anyone of any gender who's trying to get pregnant.
posted by Rangi at 1:48 PM on February 5, 2016 [17 favorites]


Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception?

Drunk decision dad is not without risk.
posted by srboisvert at 1:48 PM on February 5, 2016 [21 favorites]


The CDC is giving medical advice, not moral judgement

"Drinking too much can lead to pregnancy" is not medical advice.
posted by roomthreeseventeen at 1:49 PM on February 5, 2016 [88 favorites]


Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception?

There's no fetus involved at all at the point when a risk of drinking too much would be "unintended pregnancy".
posted by XMLicious at 1:50 PM on February 5, 2016 [24 favorites]


Why not emphasize that the real risk here isn't drinking, it's having unprotected sex while not taking steps to control your fertility

Then leave off the drinking aspect entirely, and just issue guidelines about using protection for sex, and the hazards of drinking. Separately. The combination of the two smacks of patronizing women for their decisions to drink because, gasp, what if you got pregnant?
posted by Existential Dread at 1:50 PM on February 5, 2016 [28 favorites]


Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception?

Well, there's certainly a danger to a fetus when nearby men have been drinking, so maybe just say that no man with alcohol in his system is allowed within 500 yards of a pregnant woman. That seems fair.
posted by GenjiandProust at 1:51 PM on February 5, 2016 [35 favorites]


Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception

He could end up creating one in a woman who was drinking but whose birth control failed. And if she's an alcoholic, then that fetus could have fetal alcohol syndrome! And it would be HIS FAULT in exactly the same way it's hers.

Also, Just Five Alcoholic Drinks a Week Could Affect Sperm Quality.
posted by emjaybee at 1:52 PM on February 5, 2016 [23 favorites]


The being healthy when you first get pregnant is really really important may have been a better tactic for the overarching message. There is a lot of FASD research about the risks of alcohol for development and I think that has gotten lost.

Educating in greater depth about that may be more convincing than a PSA.

Related article that may be framing it better
posted by typecloud at 1:52 PM on February 5, 2016 [1 favorite]


Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception?

The recommendation is for all sexually active women. Since most of them are not pregnant, their drinking is just as risky to a nonexistent fetus as a man drinking is.
posted by maxsparber at 1:53 PM on February 5, 2016 [43 favorites]


Is there any risk to a fetus based on alcohol in the father's blood stream/semen at the time of conception?

Probably. Or even worse, habitual alcohol use probably affects sperm even if the dude isn't drunk when a child is conceived. This article mostly talks about long-term risks of alcoholism but the section on Teratogenic Effects is suggestive.

The real secret is that Fetal Alcohol Syndrome is linked to a wide variety of factors, including poverty and malnutrition, but it's much easier to lecture women on individual behaviors than to effect the kind of economic changes necessary to protect mothers and babies.

I don't agree that the CDC's recommendation is scientific. "We don't know what the safe level is, therefore no level is safe" is not a scientific recommendation. It's pseudoscience.
posted by muddgirl at 1:55 PM on February 5, 2016 [82 favorites]


I'm forty-five and have had a hysterectomy. Surely a few pints will not result in my "unintended pregnancy" no matter how much het PIV s3x0ring I have before, after, or because of the aforesaid pints.
posted by which_chick at 1:56 PM on February 5, 2016 [13 favorites]


Now, exactly WHY don't insurance companies cover birth control? Is it because they need to subsidize Viagra? Or here's novel idea-- government sponsored birth control.

Or maybe it's just more fun to control and shame women.
posted by BlueHorse at 1:56 PM on February 5, 2016 [2 favorites]


The CDC announcement is quite informative and on-message.

An estimated 3.3 million women between the ages of 15 and 44 years are at risk of exposing their developing baby to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy, according to the latest CDC Vital Signs report released today. The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol when they stop using birth control.

But the infographic? No, no no. It adds in extraneous, shaming information and muddles the message entirely. If the message is about safe pregnancies, why is the header about drinking? It doesn't make sense!
posted by samthemander at 1:57 PM on February 5, 2016 [11 favorites]


The real secret is that Fetal Alcohol Syndrome is linked to a wide variety of factors, including poverty and malnutrition, but it's much easier to lecture women on individual behaviors than to effect the kind of economic changes necessary to protect mothers and babies.

QQQQQFT. And more victim-blaming. You were malnourished and self-medicating at the time when you had an unplanned pregnancy? And the pregnancy was unplanned because you can't afford birth control and never got proper sex ed in the first place, and/or maybe you were coerced? Too bad, your fault, shouldn't have had that drink.
posted by witchen at 1:59 PM on February 5, 2016 [47 favorites]


On behalf of Muslims everywhere let me state that I welcome this small step towards Sharia Law in the USA, but I too would feel much better if there were similar guidelines for men as well.
posted by any portmanteau in a storm at 2:00 PM on February 5, 2016 [23 favorites]


In your face, straight women!

/exempt lesbian
posted by mudpuppie at 2:00 PM on February 5, 2016 [27 favorites]


Why not emphasize that the real risk here isn't drinking

Because that would be seen as advocating contraception or abortion, and we can't be having with that from a government-funded agency!

What that announcement should have said is that women should be allowed free and full access to contraception, emergency contraception, and chemical and surgical abortion on demand with no justification, so that all women may choose to get or remain pregnant on their own terms at all times, including situations where alcohol (or poisoned city water, or prescription medications known to cause birth defects, etc) was consumed while pregnant.
posted by Lyn Never at 2:02 PM on February 5, 2016 [29 favorites]


Don't forget, ladies, if you have a glass of wine and then become a victim of violence, it's totally your fault.

/exempt lesbian

[guidelines do not actually specify that sexually active =PIV sex; so watch out lesbians, you might get pregnant too]
posted by melissasaurus at 2:03 PM on February 5, 2016 [25 favorites]


"No safe level of drinking" pretty clearly means "we can't ethically study this so it's easier to tell pregnant women not to drink at all." Which sounds very nice and safe, but ends up being more finger-wagging at women, this time before they're even pregnant.

"Don't drink when you're pregnant" makes sense. "Don't drink because there's a. a tiny chance you are pregnant (and will want to stay that way) and b. your current level of drinking will damage that fetus," is a different message. And it's irritating. Like so many things people say to women. Because otherwise we'd just belly-up to the bar at six months along and get shitfaced. Because we are so dumb!

The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol when they stop using birth control.

Probably because they are trying to relax and get it on? That does not mean they are drinking like fishes in the weeks between conception and a positive test. Unless they already have a drinking problem, in which case there are other things going on.

I think what bugs about this campaign is that it's so clumsy. It seems highly unlikely that a fetus will get FAS because you had a few the night you got pregnant. So many women will ignore this completely, and others will rack themselves with guilt for having one glass of wine from the time before they know they're pregnant till the baby comes out. God forbid that baby has any problems at all; it was probably that glass of wine!

Do we really have to treat women this way? Are there not better ways to improve fetal outcomes/reach out to women with actual drinking problems?
posted by emjaybee at 2:06 PM on February 5, 2016 [38 favorites]


The infographic constitutes public health malpractice. It goes beyond the text of the study it seems to based upon. It goes out of its way to victim blame. It is incredibly tone deaf. And is some of the worst public health marketing I've seen out of CDC.
posted by mattbcoset at 2:06 PM on February 5, 2016 [20 favorites]


> In your face, straight women!

/exempt lesbian


No, see but if you have a womb and ovaries and menstruate, you have the potential to become pregnant, and therefore you must prioritize that possibility over all else!

We were talking about this at work this morning, standing around waiting for the coffee to become consumable and there was general agreement that the infographic was a hideous, condescending muddle that was probably put together by committee. But that is still no excuse for its release, because someone(s) had to have looked it over beforehand and they didn't see anything wrong with it.
posted by rtha at 2:06 PM on February 5, 2016 [11 favorites]


If this is true:
Alcohol use during pregnancy, even within the first few weeks and before a woman knows she is pregnant, can cause lasting physical, behavioral, and intellectual disabilities that can last for a child’s lifetime. These disabilities are known as fetal alcohol spectrum disorders (FASDs). There is no known safe amount of alcohol – even beer or wine – that is safe for a woman to drink at any stage of pregnancy.
Then it would be irresponsible for any medical professional (including, presumably, the CDC), not to tell people this.

What specific behavior guidelines fall out of it is another question, but the CDC is probably quite correct in their assessment that right now many people may not be oriented on the risks of even modest alcohol consumption at any stage of pregnancy.

And there's at least two close situations that nobody here would blink an eye at. There are some drugs (say, accutane) that responsible doctors/pharmacists will not dispense to a woman who could conceive unless she's using one or more birth control methods because of the developmental risks. And there are other activities (driving) we already know are generally incompatible with alcohol consumption and require conscientious consideration when approaching anywhere they might meet. There's arguably some distinctions that could be made between those cases and this particular recommendation, but nothing I can see that puts it in a completely different ballpark.
posted by namespan at 2:06 PM on February 5, 2016 [5 favorites]


The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol when they stop using birth control.

Why should they? Does drinking before a fetus is implated in the uterine lining, a few days to a week after conception, affect the fetus? Do we have data to back that up? Via what mechanism? are women who are trying to get pregnant really waiting months and months and months to take a pregnancy test?
posted by muddgirl at 2:07 PM on February 5, 2016 [17 favorites]


Whenever this subject comes up, I wonder about the level of FAS in countries that do not have a binge drinking problem, but where everyone routinely has a glass of wine or beer with dinner, including pregnant moms. Also, I am old enough that through my first couple of pregnancies (4 healthy sons) nobody advised me not to drink at all nor said that moderate drinking was dangerous. Most women of my generation continued to drink very moderately during early pregnancy with no ill effects.

Nobody I knew or heard of had a child with FAS, and when I worked at a school with special education kids, the few with FAS came from seriously alcoholic mothers and were no longer with them, either in foster care or with another relative.

The idea that a mom not knowing she was pregnant needing a late-term abortion only because she has a few drinks before she knew about the pregnancy is chilling. This "warning" goes too far and insults and needlessly frightens women. It lends itself to bad jokes about not drinking unless you are on birth control not only protecting a potential fetus but also preventing sex with someone you deeply regret waking up with the next day. Sure, it is great to be cautious and not drink soon as you know you are pregnant, but this kind of warning only causes anxiety in those who already are pregnant and may not have known immediately and had a few drinks in that time span.
posted by mermayd at 2:08 PM on February 5, 2016 [28 favorites]


Drunk decision dad is not without risk.
That's what I was thinking, by their logic, men shouldn't drink ever. Where's the infographic for that?
posted by 0cm at 2:08 PM on February 5, 2016 [13 favorites]


"It should be taken for granted that women can do their own risk/reward weighing and choose whether to have a drink weeks after having sex. "

HAHAHAHAHAHAHAHAHAHAHAHAHA

You've never seen a pregnancy forbidden list, have you? Basically the only food that you're allowed to eat is BROWN RICE. Everything else is going to kill you, or your fetus, in terrible ways and you can't be trusted to make decisions about how safe your cheese storage is or how likely it is that your root vegetables harbor toxoplasmosis and LOOK YOU'RE NOT SCARED ENOUGH YET. Pregnancy is NOTHING BUT fearmongering, and the refusal to allow women to do their own risk/reward weighing -- up to and including jailing them for refusing to comply with (sometimes questionably-supported) medical advice for the good of their fetuses -- is sadly common in the United States. You can LITERALLY be arrested for inadequate nutritional choices -- which, as a woman who's had hyperemesis gravardium THREE TIMES now is particularly thrilling to me as I can keep hardly any damn food down and I eat what I think I won't vomit up while losing weight like crazy. DEFINITELY JAIL FOR CHILD NEGLECT WILL HELP.

"Again, this is not a moral rule for women to be "good, blameless mothers"—it's practical data for anyone of any gender who's trying to get pregnant."

Uh, no, it's advice that women of childbearing age should NOT DRINK AT ALL because they MIGHT POSSIBLY get pregnant without meaning to.

But then it doesn't sound like you've ever sat in an emergency room for an extra two hours waiting for a pregnancy test to come back before they'll treat you even though you told them you haven't had sex in the past year and there is literally no possible way you are pregnant AND you're on birth control besides; you just hang on to that gut wound and hope your intestines don't fall out before we decide how to treat you based on the fact that you might be miraculously pregnant with Jesus II because a) all women are liars about how slutty they are and b) your imaginary fetus matters more than your health, comfort, or long-term recovery from injury.

There is literally nothing as infantalizing as being pregnant in the US, and there is absolutely no assumption that pregnant women can make appropriate decisions about their own health or families. NONE. Once you are pregnant you are presumed to be both stupid and irresponsible and adult choices are taken away from you.
posted by Eyebrows McGee at 2:12 PM on February 5, 2016 [196 favorites]


That's what I was thinking, by their logic, men shouldn't drink ever. Where's the infographic for that?

Ocm, I agree, let's get on this!
posted by any portmanteau in a storm at 2:12 PM on February 5, 2016 [1 favorite]


I love how the CDC assumes that all women who discover they are pregnant will decide to continue the pregnancy. But then I guess they aren't allowed to talk about the scary A-word despite that being a legitimate medical procedure*.

*Depending upon where the woman lives and how much money she has, that is. A lady's MMV.
posted by smirkette at 2:13 PM on February 5, 2016 [14 favorites]


The report also found that 3 in 4 women who want to get pregnant as soon as possible do not stop drinking alcohol when they stop using birth control.

And many women who are actively trying to conceive don't drink during the "two week wait." But 99.999%(ish) of the time, if you get your period, you are not pregnant. Why should you not have a drink during the first 1-10ish days of your cycle? What evidence is there that drinking between menstruation and ovulation leads to FASD?
posted by melissasaurus at 2:15 PM on February 5, 2016 [10 favorites]


Welcome to rape culture - where women are always at risk for injuries/violence, sexually transmitted diseases, and unintended pregnancy. No alcohol necessary!
posted by galvanized unicorn at 2:15 PM on February 5, 2016 [19 favorites]


the CDC is probably quite correct in their assessment that right now many people may not be oriented on the risks of even modest alcohol consumption at any stage of pregnancy.

Really? Is there anyone in the United States (the domain of the CDC) who doesn't currently know that drinking alcohol during pregnancy is bad? I know sex ed in this country is a disgrace but this fact at least has been pretty thoroughly covered by any number of situation comedies, plus information in every liquor store I've ever entered as well as doctors' offices and whatnot. This is something people know. If you haven't learned alcohol is bad for a fetus by now, I don't think that this infographic is going to be a game changer for you.
posted by Mrs. Pterodactyl at 2:17 PM on February 5, 2016 [10 favorites]


This paper seems to claim FAS is higher in the US than in other couintries with higher alcohol consumtion.



So maybe American women shouldn't drink. Ever.
posted by Keith Talent at 2:19 PM on February 5, 2016 [4 favorites]




(but the link I posted talks about neuro development only)
posted by roomthreeseventeen at 2:20 PM on February 5, 2016


I look forward to the day the CDC advises all women of childbearing age to avoid riding in cars. Because they could be pregnant and not know it yet, and a car accident would not be healthy for the fetus.
posted by the turtle's teeth at 2:21 PM on February 5, 2016 [29 favorites]


If this is true:

It's true only in that it's considered unethical to have women drink varying amounts of liquor and then check if their babies have FAS, therefore there is "no known safe level" based on a controlled study. When studies like the linked look at retrospective data, they tend to reach conclusions like
...mothers who had children with some characteristics of FAS were older, had fewer prenatal visits, more pregnancies, more mental health problems, and more injuries (both total and alcohol-related). Although the prevalence of drinking was high in both case and control mothers, case mothers had more alcohol-related medical problems, drank heavily, in binges, and daily more often than control mothers.
posted by muddgirl at 2:23 PM on February 5, 2016 [21 favorites]


There is literally nothing as infantalizing as being pregnant in the US, and there is absolutely no assumption that pregnant women can make appropriate decisions about their own health or families. NONE. Once you are pregnant you are presumed to be both stupid and irresponsible and adult choices are taken away from you

This. I remember as a teenager reading Madeleine L'Engle's "A Swiftly Tilting Planet" and being disappointed at how my favorite cool author had the family coddling Meg because she was pregnant (You need your sleep! Go to bed right now! etc.).
posted by Melismata at 2:24 PM on February 5, 2016 [1 favorite]


"Don't drink when you're pregnant" makes sense.

Not really, no. It's just "Well, SOME level of drinking is unsafe, but we don't know what it is, though we're pretty sure it has to do with binge drinking, still, best say that even a single sip of wine is wrong." Which is a really high level of better safe than sorry concern, not actual science.

Two of my friends were pregnant in close succession, with different doctors but in the same city. One friend had a high risk pregnancy, but had a doctor who was pretty reasonable about things -- don't drink excessively, don't eat deli turkey or raw milk cheese, you've gained too much weight but you were pretty skinny at first so it's fine -- essentially "you're a smart woman, be smart while you're pregnant". The other had a normal risk pregnancy and had a doctor who was insane -- don't drink anything at all, don't eat cheese, don't have even a sip of coffee, you're one pound above this week's suggested weight gain so you need to eat less, etc etc. Guess who was more anxious?
posted by jeather at 2:30 PM on February 5, 2016 [15 favorites]


So maybe American women shouldn't drink. Ever.

Or the equally plausible alternative: American women shouldn't have babies. Ever.
posted by We put our faith in Blast Hardcheese at 2:30 PM on February 5, 2016 [18 favorites]


"Or the equally plausible alternative: American women shouldn't have babies. Ever."

Ah, there is the solution! They should have carefully monitored surrogates in third world countries have all their babies for them. It would be well worth the high price, plus American women would not lose their figures and could drink all they want all the time. Problem solved.
posted by mermayd at 2:35 PM on February 5, 2016 [1 favorite]


Or the equally plausible alternative: American women shouldn't have babies. Ever.

Nah. What it really is is American women shouldn't have sex. Ever.
posted by witchen at 2:35 PM on February 5, 2016 [9 favorites]


When the CDC puts out shit like this, it makes me question every other recommendation they make. It is so completely tone deaf, preachy, and useless, I don't know what moron in their right mind EVER thought it was a good idea.

I am tempted to file a FOIA request just to find out everyone involved, then contact each one to ask them, "Are you a complete idiot, or do you just play one on TV?"

So, so many missed opportunities here, so much damage control is now needed, and absolutely NOTHING here is going to help avoid the problem they were trying to target - which as pointed out is increasingly becoming the target of criticism itself as the zero tolerance stance the CDC is taking is just not credible.
posted by Muddler at 2:37 PM on February 5, 2016 [14 favorites]


i have this fear that these types of pre-pregnancy guidelines will eventually be used to criminalize women living normally in society.
posted by nadawi at 2:39 PM on February 5, 2016 [56 favorites]


Things That Might Also Damage The Fetus I Don't Know I Have Yet

1. Tripping and falling
2. Choking on food
3. Ever leaving my house
4. Stress from watching the news
5. Anything fun whatsoever

Obviously, all women should be put into containment units on first menstruation, fed nutritious meals, forced to get exercise, and not exposed to too much stress. No fetus will ever be at risk again! And that is surely the highest goal of our civilization.
posted by emjaybee at 2:39 PM on February 5, 2016 [38 favorites]


i have this fear that these types of pre-pregnancy guidelines will eventually be used to criminalize women living normally in society.

I also have this fear.
posted by melissasaurus at 2:41 PM on February 5, 2016 [7 favorites]


All I'm saying is if I have to start flashing my pill pack along with my ID at the bar, I'm gonna be pretty cranky about it.
posted by We put our faith in Blast Hardcheese at 2:42 PM on February 5, 2016 [17 favorites]


“How about we put the onus on men for a change and instruct them to knock drinks out of women’s hands?”

YOU ARE VERY BAD, ONION. NAUGHTY ONION.
posted by Hoopo at 2:43 PM on February 5, 2016 [1 favorite]


It's instructive to have this CDC infographic come out so close to the widely-covered and presumably well-thought-out CDC recommendations related to Zika virus. For the latter, the recommendation to avoid travel to places with active outbreaks was specifically directed only to pregnant women or women (actively) trying to get pregnant. But by the same logic embedded in the infographic about drinking, about half of all pregnancies in the U.S. are unplanned, so really women should shred their passports once they start menstruating, and not travel again until menopause.

I'm sure it reflects different cultures within the CDC in terms of the folks working on infectious disease versus pregnancy/maternal and child health, but it does starkly illustrate how ridiculous the "pre-pregnant women" idea is at its core. Our culture (and our public health agency, evidently) does not appear to have a reasonable attitude towards risk and cost/benefit analysis when it comes to women, sex, and pregnancy.
posted by iminurmefi at 2:44 PM on February 5, 2016 [25 favorites]


All I'm saying is if I have to start flashing my pill pack along with my ID at the bar, I'm gonna be pretty cranky about it.

Don't forget, oral contraceptives are not 100% effective. So you could be on the pill and still be pregnant. Since you're supposed to stop taking the pill when you're pregnant, all women of childbearing age should probably refrain from using oral contraceptives in case they're already pregnant.
posted by melissasaurus at 2:44 PM on February 5, 2016 [36 favorites]


The outraged here seem to be misunderstanding the context and blowing this out of proportion.

If you think there are no women in the country who would benefit from this advice, you live in a bubble. I know a woman who was in college and got impregnated while shit-faced after a party, probably didn't realize for about a month that she was pregnant, and then decided to keep the baby (she's Catholic). I wish she would have thought about the risks presented by the CDC here.

If you think it's silly, pedantic advice, then congratulations, you're probably one of the smart ones. But just because it isn't right for you doesn't mean it's THE WORST MOST INSULTING ADVICE EVER.

Take what's useful in this world and leave the rest. There's no need to complain about everything.
posted by cman at 2:44 PM on February 5, 2016 [4 favorites]


Really? Is there anyone in the United States (the domain of the CDC) who doesn't currently know that drinking alcohol during pregnancy is bad?

Well, there are a few comments throughout this thread that suggest that "in moderation" consumption doesn't harm a child. And while I'm sure almost everybody probably knows that pregnancy is one of several times to avoid boozing it up, human nature being what it is, I'd also guess that there are plenty of people who are under the belief that a little of the mild stuff is just fine.

And for all I know, maybe it is. That's a research question and I hope that continues. In the meanwhile, the CDC seems to believe that the risks are great enough that people should be conscientious about avoiding them.

I also suspect that it's common enough for people not to orient their lives around any kind of new-milestone behavior until the news of the milestone comes. That's pretty in line with human nature, and often practical to boot. There's also some scenarios where it doesn't work as well. Is it really that unreasonable to say the place where pregnancy meets alcohol might be one of them?
posted by namespan at 2:46 PM on February 5, 2016 [2 favorites]


Take what's useful in this world and leave the rest. There's no need to complain about everything.

I'll complain about what I wanna complain about. Need doesn't really enter into it.

it does starkly illustrate how ridiculous the "pre-pregnant women" idea is at its core

The doctor who informed me that I should consider myself "pre-pregnant" was not pleased when I replied that no, I was actually "pre-having-an-abortion." But he did back the fuck off.
posted by We put our faith in Blast Hardcheese at 2:48 PM on February 5, 2016 [126 favorites]


> The outraged here seem to be misunderstanding the context and blowing this out of proportion.

Not really. Every (heterosexual) reproductive-age woman I know has been subject to similar kinds condescending and inaccurate "advice" from medical providers and family and friends at least occasionally. If you were unaware of this - well, now you don't have that excuse.

> I know a woman who was in college and got impregnated while shit-faced after a party, probably didn't realize for about a month that she was pregnant, and then decided to keep the baby (she's Catholic). I wish she would have thought about the risks presented by the CDC here.

This is a problem of inadequate sexual and reproductive health education. That is not a problem to be solved by telling women to just not drink in case pregnancy.
posted by rtha at 2:51 PM on February 5, 2016 [69 favorites]


the CDC seems to believe that the risks are great enough that people should be conscientious about avoiding them

I strongly question whether the CDC places any weight on the impact of the recommendations on women's lives. It's easier to say "why risk it?" when you don't think that women's life experiences matter.

As an aside, I have to actually make sure I'm visibly drinking when I go to work events as a hey-I'm-not-pregnant-please-continue-to-promote-me signalling device.
posted by melissasaurus at 2:52 PM on February 5, 2016 [60 favorites]


I know a woman who was in college and got impregnated while shit-faced after a party, probably didn't realize for about a month that she was pregnant, and then decided to keep the baby (she's Catholic).

(Oh hey, you know my mom? Cool, cool cool. Tell her I didn't forget about her birthday, I'm workin' on it.)
posted by We put our faith in Blast Hardcheese at 2:52 PM on February 5, 2016 [21 favorites]


so, if she was "shit-faced" there's a good chance she was raped. women shouldn't drink just in case we get raped at a party?
posted by nadawi at 2:53 PM on February 5, 2016 [30 favorites]


Also, I assume that any dude who thinks this is all totes reasonable advice and we should just calm down, well, you will never have sex with a woman who was or might drink, because you would be contributing to the possibility of a child with FAS. Take responsibility!
posted by rtha at 2:53 PM on February 5, 2016 [83 favorites]


women shouldn't drink just in case we get raped at a party?

CDC guidelines, brought to you by MRA, and certified basement dweller, Roosh V.
posted by melissasaurus at 2:57 PM on February 5, 2016 [3 favorites]


The absurdity of these guidelines has already been well pointed out, but I cannot resist adding that if my wife and I manage to get pregnant together, we will all retire comfortably. (In addition to being women having sex with each other, I'm sterilized and she's on Depo for reasons).
posted by joycehealy at 3:02 PM on February 5, 2016 [2 favorites]


The thing that enrages me is that abortion is supposed to be legal, no questions asked, up to a certain time, despite all the attempts to outlaw it. And yet even the CDC cannot say: "If you have an unplanned pregnancy and have been drinking heavily, abortion may be a good choice for you. In fact, aborting an unplanned pregnancy might be your plan regardless."

No. It makes more sense and is more morally palatable to say "don't drink ever, ladies!!!" than to say "abortion is a safe and legal and valid choice, any time, especially if your unplanned fetus might be at risk for FAS."
posted by nakedmolerats at 3:04 PM on February 5, 2016 [71 favorites]


"In the meanwhile, the CDC seems to believe that the risks are great enough that people should be conscientious about avoiding them."

The CDC would also like pregnant women to avoid touching raw meat, raw eggs, or unwashed vegetables; forks or cups that have been touched by young children; hot dogs; bacon; sausage in all forms; deli meat; sushi; sashimi; seafood; ground meats; pate; all deli sandwiches or pre-prepared sandwiches from whatever source derived; soft cheeses; all cheese from Mexico; a large variety of juices; caesar salad dressing; cold chicken; homemade ice cream; eggs benedict; tiramisu; caffeine; hollandaise sauce; sprouts; custards; any steaming-hot meats whose temperature you cannot personally check with a thermometer; many raw vegetables; anything prepared by food workers because it puts you at risk for norovirus (but remember, preparing your own food puts you at risk for salmonella).

They further recommend you avoid: changing diapers of your preexisting children; your cat; physical labor; having cancer; exposure to cleaning chemicals; excessive noise; heat; shift work; night shifts; working outdoors or in a building without climate control; standing too close to microwave ovens; flying; driving; wearing your seatbelt wrong; gardening; handling pets; wild animals; other people with colds; and climbing stairs without holding a railing.

This is just at a quick glance at the CDC's pregnancy website. The packet I get from my ob/gyn of forbidden and required behavior runs to nine pages.
posted by Eyebrows McGee at 3:08 PM on February 5, 2016 [94 favorites]


This reminds me of a prescient bit of flash fiction by J. R. Blackwell, Pre-Pregnant.
posted by JDHarper at 3:09 PM on February 5, 2016 [5 favorites]


I know a woman who was in college and got impregnated while shit-faced after a party, probably didn't realize for about a month that she was pregnant

I'm assuming your implication here is that she continued getting shit-faced throughout that month? Because getting pregnant after a night of drinking is...actually not terribly uncommon for people I know, anyway. My high school buddies and their wives love them some alcohol. And they all have perfectly healthy kids.
posted by Hoopo at 3:10 PM on February 5, 2016 [4 favorites]


Is the target of these recommendations the Representatives and Senators who can prioritize increasing physical and mental health access in underserved communities at a higher risk of FAS? Is the target non-profit health resources in those communities so they can do a better job identifying women who need higher-intensity interventions? It sure doesn't seem like it.
posted by muddgirl at 3:10 PM on February 5, 2016 [8 favorites]


Take what's useful in this world and leave the rest. There's no need to complain about everything.

The advice is stupidly harmful and idiotic. It's worth speaking up about. Pointing and laughing at it as completely ridiculous and offensive.
posted by zarq at 3:11 PM on February 5, 2016 [27 favorites]


I strongly question whether the CDC places any weight on the impact of the recommendations on women's lives. It's easier to say "why risk it?" when you don't think that women's life experiences matter.

This ties into the recent-ish pushback to public health messages about breastfeeding. The actual science suggests the benefits are real but very small--yet the public health message in the U.S. pushes breastfeeding really strongly, and tracks it as one of the key measures of maternal and infant health. I breastfed my kid, I am glad I breastfed my kid, but I find the message that "breast is best" and relentless pushing of breastfeeding totally abrasive because it implicitly assumes that women's time and comfort and sleep quality is worthless or beneath consideration. I can't think of many other areas of public health other than maternal and infant health that start from the assumption that the recommended behavior change is always costless, and thus even very marginal or uncertain health gains warrant a full-blown campaign.
posted by iminurmefi at 3:12 PM on February 5, 2016 [56 favorites]


We just had a post about how there is no "safe" level of drinking, and pro-choice discussions have pointed out that people can be pregnant for months without knowing it (hence the need for late-term abortions).

Well, you know, that and the fact that
a. growth hormones from a pregnancy can promote cancerous tumor growth, eg. from undetectable to you'll probably be too far along for treatment to do more than prolong your life for a couple years if we wait until after you give birth levels;
b. some serious birth defects are not detectable or not easily detectable earlier in a pregnancy;
c. people's life circumstances as well as non-cancer or -pregnancy related health circumstances can change over a nine-month period;
etc.

Most late-term abortions are performed for medical reasons related to dangers to a woman's health, not for not knowing about the pregnancy earlier reasons, from the data I've read.
posted by eviemath at 3:14 PM on February 5, 2016 [11 favorites]



"Or the equally plausible alternative: American women shouldn't have babies. Ever."

Ah, there is the solution! They should have carefully monitored surrogates in third world countries have all their babies for them. It would be well worth the high price, plus American women would not lose their figures and could drink all they want all the time. Problem solved.


See also: Zika virus, El Salvador....
posted by eviemath at 3:15 PM on February 5, 2016


There's a lot of passion in this discussion, but I would like to point out that this infographic is geared towards healthcare providers, meant as a component of a much larger shared decision-making process. As physicians, we violate our ethical code of Beneficence by not providing information about the harms associated with drinking, but we also violate the Autonomy principle by not allowing our patients to make their own choices. If your provider isn't non-judgmentally keeping you informed and allowing you to make your own decisions, get a new provider.

As for those asserting that everyone knows drinking is bad and to just get off their backs, I've been a doctor for less than a year and have encountered several patients who have serious misconceptions about how alcohol effects pregnancy. The 2006-10 BRFSS survey found that 1.4% of pregnant women continue to engage in binge drinking:
Despite these efforts, survey data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS) 2006 to 2010 (CDC, 2012) show a past 30-day drinking rate by phone interview self-report of 7.6%, among pregnant women in the United States, with 1.4% drinking at binge levels (CDC, 2012).
Admittedly, some of those women may have had a substance use disorder and no amount of counseling would have decreased their drinkin, but this 2012 study suggests that preconception counseling is associated with a higher rate of preconception teetotaling. So yeah, 1) there's a knowledge deficit and 2) counseling may help decrease drinking before and during pregnancy.

I don't say this to undermine the very valid criticism that many women experience this counseling (and the medical system as a whole) as paternalistic and overbearing. I've worked with some real sexist assholes, but the way of the future is as I laid it out above: shared decision making and autonomy. If you're not experiencing that, fire your doc and see if you can't find someone better.
posted by The White Hat at 3:20 PM on February 5, 2016 [14 favorites]


Further, this 2012 study suggests that preconception counseling is associated with a higher rate of preconception teetotaling.

You say that like its a good thing. Why should doctors counsel fertile women in particular to abstain from drinking completely? It seems to me like this is an argument for scaring women into "good behavior" with no clear medical benefit for doing so, beyond the general benefit that abstention gives to all people, men and women.
posted by muddgirl at 3:26 PM on February 5, 2016 [18 favorites]


Research suggests that more than 1.4% of women have alcohol abuse issues, so it actually seems like a really good statistic.
posted by jeather at 3:26 PM on February 5, 2016 [5 favorites]


i don't understand any reason for doctors to counsel women that drinking might make them pregnant. if you're a doctor and that sounds right to you, please don't counsel women.
posted by nadawi at 3:28 PM on February 5, 2016 [42 favorites]


we violate our ethical code of Beneficence by not providing information about the harms associated with drinking

But at what point does the sheer volume (and breadth) of the recommendations, as outlined by Eyebrows McGee above, dilute the effectiveness of each recommendation? If you're told you can't eat cheese, and fish, and lunch meat, and and and - you start to question whether any of the pregnancy recommendations have a scientific basis. Public health isn't just about disseminating the science, it's about disseminating it in a manner that will be accepted by the society.
posted by melissasaurus at 3:29 PM on February 5, 2016 [9 favorites]


I'd believe this was well intended if they'd limited it to a warning about FAS directed to women who are or may become pregnant, but they didn't do that. What was even the purpose of adding all that stuff about violence and STDs and things, and STILL only addressing it to women?

If they really needed to issue a warning about alcohol and its effects for whatever reason, they should have framed it as a gender neutral warning.
posted by ernielundquist at 3:34 PM on February 5, 2016 [9 favorites]


The CDC would also like pregnant women to avoid touching raw meat, raw eggs, or unwashed vegetables; forks or cups that have been touched by young children; hot dogs; bacon; sausage in all forms; deli meat; sushi; sashimi; seafood; ground meats; pate; all deli sandwiches or pre-prepared sandwiches from whatever source derived; soft cheeses;

And despite the fact that I know people who would CUT ME if I suggested they give up their delicious soft cheeses, I don't recall any kind of pushback discussion about any of those guidelines, which I also assume are based in evidence.

Is alcohol qualitatively different somehow, or did I just not notice the earlier discussion?

As an aside, I have to actually make sure I'm visibly drinking when I go to work events as a hey-I'm-not-pregnant-please-continue-to-promote-me signalling device.

That's shitty, and I don't doubt that it's only one of the fronts from which you and other women face misogyny. It still doesn't sound to me like the CDC guidelines are the problem here.
posted by namespan at 3:37 PM on February 5, 2016 [1 favorite]


I don't recall any kind of pushback discussion about any of those guidelines, which I also assume are based in evidence.

Because those guidelines are aimed at women who are actually currently pregnant.
posted by skycrashesdown at 3:40 PM on February 5, 2016 [24 favorites]


if someone told me to stop eating brie because I'm a fertile female, there would be a bloodbath
posted by skycrashesdown at 3:42 PM on February 5, 2016 [34 favorites]


It still doesn't sound to me like the CDC guidelines are the problem here.

The "no known safe level of alcohol during pregnancy" guideline in itself? I don't think there's anything wrong with that either though I don't know how strong the evidence is for their position. What's wrong with the "if it is even conceivably possible that you could get pregnant" version of the guideline should be really, really obvious.
posted by atoxyl at 3:43 PM on February 5, 2016 [7 favorites]


If it's the "pre-pregnant" nature of the advice that bugs here, do you also object to the practices regarding drugs like accutane?

And let's say the CDC did believe they'd reviewed research and that evidence suggested eating soft cheeses in early stages of pregnancy (often before women might even be aware they're pregnant) was associated with an elevated risk of developmental issues.

What would you suggest they should do?
posted by namespan at 3:49 PM on February 5, 2016


If it's the "pre-pregnant" nature of the advice that bugs here, do you also object to the practices regarding drugs like accutane?

I mean, I realize you think this is a gotcha, but I do have objections to those practices. Again, they assume women can't be trusted to adequately assess the risks and make choices.

And FWIW, as an acne-ridden teen who was absolutely not sexually active, fully pro-choice, and unable to take hormonal birth control for Reasons (which later turned out to be based, surprise! not on solid science but on fear-based overcaution) I was absolutely livid about them.
posted by We put our faith in Blast Hardcheese at 3:53 PM on February 5, 2016 [30 favorites]


There also is quite a bit of pushback, if you read any pregnancy/mom sources or hang out on any pregnancy/mom web forums, because they are ABSOLUTELY IMPOSSIBLE TO FOLLOW. It is literally impossible to follow all of the CDC's dietary guidelines for pregnant women. There is no support whatsoever to help women who are pregnant avoid night shifts, or changing diapers, or working in a warehouse. It's all just part of the same "shame pregnant women and make sure they know anything wrong with their babies is their own fault for gestating improperly. PERSONAL RESPONSIBILITY." It's the same pernicious culture of personal responsibility and blaming that says "we're pro-life but we oppose funding for prenatal care" or "we're anti-abortion but against paid parental leave because it's your own damn fault you have a child." If you fail to follow all of the pregnancy guidelines -- which you cannot do -- it's your own fault when your child has a problem. That prevents it from ever becoming a societal problem or ever being something we have to deal with at a social level, up to and including teratogenic chemicals in common use that are not banned from use despite being known to cause birth defects; instead, we just tell pregnant women to stay away from them and blame them when they don't. Or we shrug about lead pipes -- should have moved and not had kids in such substandard housing!

It's also tied to the absolutely false claims that 90% of car seats are installed incorrectly -- you can't sell fucking baby products with that high a failure rate (something like six deaths total over 15 years led to the recall of drop-side cribs). That is 100% a litigation strategy by car seat manufacturers so that when your child dies in a car accident, it's harder for you to sue them for making a substandard product. You didn't do what all our commercials tell you and go see a car seat installation expert? Then it's hardly OUR fault your baby died in our car seat.

This blaming of pregnant women and insisting that "personal responsibility" and personal choices can control the outcome of pregnancy (and childrearing) is part of a society-wide shift to make parents (and especially mothers) wholly responsible for their children and to allow society to totally disclaim responsibility for safe products, safe chemicals, safe food, safe workplaces, or the care of pregnant women or their children when they're born.

After all, if you drank while you were pregnant, why should Joe Taxpayer have to pay for your kid's therapy later on? It's not HIS fault you make terrible decisions!
posted by Eyebrows McGee at 3:55 PM on February 5, 2016 [103 favorites]


I find it obnoxious that the CDC didn't issue the following statement, asking doctors to pass along the word:

WARNING MEN: Fucking women who have been drinking may lead to pregnancy. In fact, buying a woman you might want to fuck a drink may actually be encouraging a pregnant woman to drink. Think about it.

So, given there is no proof that any amount of alcohol is safe for a fetus and no proof every woman you might want to fuck is not pregnant and/or going to get pregnant from your studly ways, we recommend the following:

- Do not buy drinks for women you want to fuck
- Do not encourage women you want to fuck to drink
- Do not fuck any woman that may have been drinking

Most importantly, do not confuse this "drink = yes, then fuck = no" policy with consent issues. Even if a mildly buzzed woman approaches you for fucking, do NOT fuck her, no matter how able she is to make her own decisions. You must protect any existing and/or yet to be created fetus from alcohol at all costs.



If even one CDC doctor had considered that message, the group of decision makers would have gone out to the bar and laughed all night at the bullet they just dodged.
posted by Muddler at 3:56 PM on February 5, 2016 [19 favorites]


The difference between Accutane and this recommendation is that we KNOW that Accutane causes birth defects. We don't know at exactly what threshold excessive alcohol use causes FAS. If 40% of women who had a single drink while pregnant gave birth to children with birth defects, I think we would all agree that extreme measures should be taken to make sure that doesn't happen.
posted by betsybetsy at 4:03 PM on February 5, 2016 [10 favorites]


I don't recall any kind of pushback discussion about any of those guidelines, which I also assume are based in evidence.


Then you haven't been paying attention. There's even a whole book about it.
posted by melissasaurus at 4:05 PM on February 5, 2016 [13 favorites]


The CDC does discuss men's drinking, including how it causes injuries and violent behavior:

"Excessive alcohol consumption increases aggression and, as a result, can increase the risk of physically assaulting another person."

http://www.cdc.gov/alcohol/fact-sheets/mens-health.htm

It's just not in an infographic and has gotten no press (at least not like this).

I can see how they looked at the data from various studies on outcomes associated with alcohol consumption in women, and just stuck it all into an infographic without really thinking of how to present the information in a sensitive way that helps rather than blames, and that leaves room for autonomy. So.. yeah.
posted by antinomia at 4:06 PM on February 5, 2016 [4 favorites]


That's what I was thinking, by their logic, men shouldn't drink ever. Where's the infographic for that?

They're pretty all-inclusive. Here's one just for dudes, though it's more patient-directed and not a healthcare provider-oriented infographic.

Why should doctors counsel fertile women in particular to abstain from drinking completely? It seems to me like this is an argument for scaring women into "good behavior" with no clear medical benefit for doing so, beyond the general benefit that abstention gives to all people, men and women.


Because there is purdy durn clear medical benefit. I quote from May's publication in Pediatrics: (free pdf)
The most predictive maternal risk variables [for FASD] in this community are late recognition of pregnancy, quantity of alcoholic drinks consumed 3 months before pregnancy, and quantity of [maternal] drinking reported for the index child’s father.
We can of course quibble about methodology and causation and the near-impossibility of conducting a study that would give us a maximum safe dosage. All we can do now is talk about risk and association. The association is strong enough that I feel it important to communicate that risk.

Besides, the infographic itself is pretty clear that the information pertains mostly to women who are trying to get pregnant. For women who are engaging in heterosexual intercourse, the recommendation is to discuss birth control and, moreover, "discuss the full range of methods available." If you want the CDC to do more than just imply that abortion is an option, elect a damn congress that won't gag us when the science gets in the way of their ideology.

Finally, to address the issue of warning burnout: I hear you. I have 20 minutes to see my patients, and I have thousands of evidence-based guidelines, so frequently I'm reduced to printing out information sheets and trying to focus my talk on the two or three most relevant points for my patients. This is one of the reasons it's important to have a provider you trust-- one who communicates with you in a way that doesn't overwhelm you-- one who can direct you to further reading if you want to know more.
posted by The White Hat at 4:07 PM on February 5, 2016 [8 favorites]


There's a lot of passion in this discussion, but I would like to point out that this infographic is geared towards healthcare providers, meant as a component of a much larger shared decision-making process.

I find it frustrating that the public health messages around pregnancy and caring for young infants end up being simplified and dumbed down when talking about risk factors or risky behaviors--but I can intellectually understand that this is to some extent an intentional over-simplification in the service of being accessible to all women, including those with lower literacy or who speak English as a second language. That's what keeps me from being too annoyed at recommendations like "don't eat soft cheeses during pregnancy" when it's really only a subset of unpasteurized soft cheeses that are dangerous, or the warnings that cosleeping is uniformly dangerous rather than providing information on the really high-risk behaviors (like falling asleep holding your baby in a chair or on a sofa). However, if this infographic truly is aimed at clinicians rather than the general public--and I'm curious about what makes you say that, TWH, since that's not at all obvious to me--it seems actually worse that it's taking the path of dumbing down and broadening out the message in terms of populations and risky behavior in order to be clearer and less confusing. Presumably health care providers who are counseling women on risk factors during pregnancy would be better served by more specific and actionable information? It may be true that no level of alcohol use has been proved safe in pregnancy, but we do know certain types of drinking are much more dangerous than others. I would think specific patterns of drinking associated with FASD (first versus later trimesters, binge drinking versus spreading out alcohol use) and patient characteristics (low SES is highly correlated with FASD) is more useful if you're going to use this information to actually counsel women about the risks of drinking during pregnancy.

Unless, of course, there's an underlying attitude that shrugs off considering the effect of any recommendations on women's lived experiences, so it becomes easy to say "well all women should avoid drinking just in case."
posted by iminurmefi at 4:07 PM on February 5, 2016 [14 favorites]


And yet even the CDC cannot say: "If you have an unplanned pregnancy and have been drinking heavily, abortion may be a good choice for you. In fact, aborting an unplanned pregnancy might be your plan regardless."

Hah. I can hear the cries of "eugenics!" already. (Yes, I know FASD isn't a genetic disorder. That wouldn't stop anyone.)
posted by Rangi at 4:07 PM on February 5, 2016 [1 favorite]


Besides, the infographic itself is pretty clear that the information pertains mostly to women who are trying to get pregnant.

that is not even a tiny bit clear - it in fact says "any woman" needs to fear that drinking will give them an std.
posted by nadawi at 4:13 PM on February 5, 2016 [29 favorites]


Frankly, I think it's fine if women want to drink it up and have unprotected sex. Men, too. FREEDIM!
posted by Mental Wimp at 4:18 PM on February 5, 2016 [1 favorite]


Huh, and here I thought it was about the potential risks to women of drinking too much.
posted by GhostintheMachine at 4:20 PM on February 5, 2016


that is not even a tiny bit clear - it in fact says "any woman" needs to fear that drinking will give them an std.

They also leave out the fact that many women cannot become pregnant, some trans men can, not all people who become pregnant want to stay pregnant, and not all "sex" carries the risk of pregnancy.

If the infographic were from, say, USA Today based on a poor reading of the actual guidelines, it would be one thing. But this is an official publication linked on their website and it misses critical details.
posted by melissasaurus at 4:23 PM on February 5, 2016 [15 favorites]


it also plays into existing cultural tropes that women do not have the right to consider their body their own and that rape is caused by women partying/not protecting themselves enough.
posted by nadawi at 4:26 PM on February 5, 2016 [19 favorites]


I'm genuinely confused about the medical judgments about FAS - since these conclusions and recommendations are recent, where are all the kids who have been damaged by mothers who drank moderate amounts during pregnancy?
posted by twsf at 4:29 PM on February 5, 2016 [11 favorites]


I mean, I realize you think this is a gotcha

I don't think any point I'm making here is some kind of trump card, I see it as an issue with a lot of mixed concerns. And where I think arguments have merit, I make them. Maybe it's naive to assume that other commentators here will do the same, but calling that a "gotcha" seems like a subtle way of questioning intentions and is probably better left out. And seems a lot more Sarah Palin than I'd expect from Metafilter.

but I do have objections to those practices. Again, they assume women can't be trusted to adequately assess the risks and make choices.

Humans often suck at assessing risk and acting on probable future risk. I think any professional that works in an area dealing with risks eventually has to confront that and what to do about it.

But it maybe refusing to administer accutane in that situation is in fact heavy handed and denies women due opportunity to manage the relevant risks to them and potential offspring.

So let's say that with accutane, instead of refusing to hand it out, doctors simply said "we believe there are substantially increased developmental risks for any pregnancy that begins while a woman is taking accutane. We strongly recommend that women who could conceive do not take this drug unless they're on birth control."

They could even add "because we assume women are humans that like having sex and probably aren't going to stop even if anyone thought they should, which we don't, but if you're not-even-kidding abstinent and the type of person to remember that even when in the full grip of lust, then God bless you, you're a better person than we are and that counts as birth control" if it would help.

That situation seems reasonably close to what we're talking about with alcohol here.

Is alcohol as dangerous as accutane? Maybe not. A really high relative difference in what they add in terms of risk would be a great counterargument to the use of accutane as a parallel, although it might just as much justify the strong response to accutane as a weaker response to the risks of alcohol, depending on what the absolute risks are.
posted by namespan at 4:32 PM on February 5, 2016 [1 favorite]


Accutane requires a prescription. Alcohol does not. If alcohol is so dangerous it should not be available over the counter.
posted by melissasaurus at 4:35 PM on February 5, 2016 [22 favorites]


Further, this 2012 study suggests that preconception counseling is associated with a higher rate of preconception teetotaling.

That's fine if the desired outcome is 'all fertile women stop drinking any alcohol,' but that's not what the goal is. What I'm not seeing in this paper is how such counseling actually affected pregnancy outcomes, both in terms of maternal and infant health. I did a quick PubMed search, and aside from some specific subpopulations with known health issues (eg, epilepsy, diabetes, cancer, etc), I'm not seeing much of anything on the benefits of this kind of preconception counseling on pregnancy outcomes in the general population, which strikes me as a real oversight.

Although common sense suggests that women who stop drinking and smoking prior to becoming pregnant will have healthier pregnancies than women who do not, I would like to see some actual evidence that this kind of preconception counseling actually leads to better pregnancy outcomes, rather than just reductions in self-reported exposures, if a federal government agency is going to be making recommendations.
posted by palindromic at 4:36 PM on February 5, 2016 [12 favorites]


In college there was this one obnoxious girl who while not having her shit together would also highly critique others. The embodiment of her, in our college ways of hilariousness was to smack drinks out of each others hands and shout "you're going to be a mother someday!"

I can't believe the CDC just smacked a drink out of my hand and shouted "you're going to be a mother someday!"
posted by raccoon409 at 4:37 PM on February 5, 2016 [31 favorites]


There is literally nothing as infantalizing as being pregnant in the US, and there is absolutely no assumption that pregnant women can make appropriate decisions about their own health or families. NONE. Once you are pregnant you are presumed to be both stupid and irresponsible and adult choices are taken away from you.

And the ratchet only turns one way, too, have you noticed that?

It's security theatre for zygotes.
posted by Sebmojo at 4:43 PM on February 5, 2016 [20 favorites]


If CDC wants to make women-specific guidelines about the benefits of abstaining from drinking, they can surely do that, but they do not need to wrap it up as concerns about babies. Why, excessive drinking has all kinds of negative repercussions for the woman, and most are on a more solid evidentiary foundation than saying 'any alcohol will put your baby at risk of FASD.'

If they are concerned about healthy pregnancies, then the goal should be to decrease the number of unintended pregnancies via accessible, affordable birth control, comprehensive sex education, and accessible, affordable on-demand abortion services.

These two goals do not need to be entangled, and that a women's health issue is being treated as a fetal health issue is part of the problem.
posted by palindromic at 4:55 PM on February 5, 2016 [35 favorites]


And seems a lot more Sarah Palin than I'd expect from Metafilter.

OK like, I apologize if I read more concern trolling into your comment than you intended, but this is just unacceptable. In my state those are fightin' words.
posted by We put our faith in Blast Hardcheese at 5:13 PM on February 5, 2016 [7 favorites]


I'm really weirded out by the infographic's suggestion that doctors tell women that there is no such thing as safe drinking if they are under 21. I would be fascinated to see the scientific evidence that drinking alcohol suddenly becomes safe at the stroke of midnight on one's 21st birthday. There is no such thing as legal drinking if you are under 21, but that is not an issue of health or safety. Doctors should be able to help younger women accurately assess whether their behavior puts them at risk, not lie to women because of factors unrelated to evidence-based healthcare practices.
posted by ArbitraryAndCapricious at 5:16 PM on February 5, 2016 [56 favorites]


You know what? I'm going to out myself. I was a soldier when I got pregnant, and drank normally for about a month until I found out. My kid is a sweet, somewhat snarky honors student. I regret nothing. The CDC can go fuck itself.
posted by corb at 5:17 PM on February 5, 2016 [25 favorites]


And about this:
Recommend birth control if a woman is having sex (if appropriate), not planning to get pregnant, and is drinking alcohol
I also think it would be a swell idea to talk about birth control with a woman who is having sex and doesn't want to get pregnant even if she isn't consuming any alcohol at all. If you believe that women are human beings, not just fetus-incubators, than avoiding unwanted pregnancy is a good thing even if there's no danger to the fetus at all.
posted by ArbitraryAndCapricious at 5:21 PM on February 5, 2016 [27 favorites]


[A few comments deleted. Sorry, "I don't see what's wrong with the recommendation" isn't a great way to jump into an already irritable conversation that's been describing at length what's wrong with the recommendation.]
posted by LobsterMitten (staff) at 5:40 PM on February 5, 2016 [14 favorites]


Can we make a Doomsday Clock to count down how close we are to "The Handmaid's Tale" becoming reality?
posted by trillian at 5:41 PM on February 5, 2016 [20 favorites]


has the cdc been briefed on the existence of vagina havers doing the do with other vagina havers

are they aware that spit don't make babies

i'm concerned
posted by poffin boffin at 5:50 PM on February 5, 2016 [23 favorites]


I'm reading the actual CDC report again and a huge part of the problem with this is that it says "An estimated 3.3 million women between the ages of 15 and 44 years are at risk of exposing their developing baby to alcohol ..." instead of "at risk of exposing their possibly conceived baby to alcohol." Not all of those 3.3 million women who are having unprotected sex and drinking within the same month are pregnant!

Also for any woman who had any alcohol in the past month, she was considered to be at risk regardless of whether the alcohol was consumed after the potential date of conception- just if she had had a drink within the past 30 days.

I know it seems a bit nitpicky. It is very easy to say (as the CDC rep did) "why take the risk?" but it's the CDC's job to tell us what the actual risk is.

Until you're pregnant (or trying to conceive and paying attention), it's hard to understand how much your individual wants/desires/needs are expected to be subsumed for the theoretical health of the baby.
posted by betsybetsy at 5:53 PM on February 5, 2016 [12 favorites]


iminurmefi: "But by the same logic embedded in the infographic about drinking, about half of all pregnancies in the U.S. are unplanned, so really women should shred their passports once they start menstruating, and not travel again until menopause. "

They can still come to Canada; currently and projected to be Zika free for the foreseeable future.

rtha: "you will never have sex with a woman who was or might drink, because you would be contributing to the possibility of a child with FAS. Take responsibility!"

Already do. I don't have sex with women who have been drinking strictly for consent reasons.

melissasaurus: "Accutane requires a prescription. Alcohol does not. If alcohol is so dangerous it should not be available over the counter."

We tried that already and the risk mitigation was worse than the risks.
posted by Mitheral at 6:17 PM on February 5, 2016


if someone told me to stop eating brie because I'm a fertile female, there would be a bloodbath

But there are serious health risks associated with bathing in other people's blood!

the risks are more severe for the other people though
posted by aubilenon at 6:19 PM on February 5, 2016 [7 favorites]


I'm a trans dude, so yay, I can drink as much as I want!
posted by desjardins at 6:24 PM on February 5, 2016 [10 favorites]


As a currently pregnant woman: fuck you, CDC. Fuck you.
posted by lydhre at 6:37 PM on February 5, 2016 [11 favorites]


> rtha: "you will never have sex with a woman who was or might drink, because you would be contributing to the possibility of a child with FAS. Take responsibility!"

Already do. I don't have sex with women who have been drinking strictly for consent reasons.


That's great! But if she's had a drink in the last 30 days...well, the risk of conceiving a child with FAS is still present, says the CDC, so.... Yeah. Have you considered getting snipped, just in case? And always wearing a condom as well. After all, can't be too careful.
posted by rtha at 6:39 PM on February 5, 2016 [11 favorites]


i'm thinking of my twitter friend who was bullied out of her gym a couple days ago because other people were "concerned" that she was there and visibly pregnant. one day us uterus havers will be seen as more than our ability to incubate the next generation and i can't fuckin wait.
posted by nadawi at 6:40 PM on February 5, 2016 [26 favorites]


Yet again, my tax dollars are spent stupidly.

Lucky's List of Tax Wants

1. baseline healthcare for everyone- this includes pre-natal care and abortion if it is desired. No one needs a f&(_*(*(__* reason not to have a dependent.

2. Can we stop making million dollar toys that do nothing ? Our military could be half the size it is with a few less toys and it would still be sufficient to defend the country/fund baseline healthcare.

3. All "government issued studies" need an outside auditor to be a second set of eyes before they see the light of day. No self respecting private sector firm would allow the clumsiness of this message to get through.

4. A case of the finest champagne delivered to Lucky's house, along with a state of the art hot tub (I am a woman, and plan on both drinking, and having hot tub sex)
posted by LuckyMonkey21 at 6:45 PM on February 5, 2016 [2 favorites]


I've been in a state of rage since I read this the other day. I just had a baby. I had no clue I was pregnant for about 6-7 weeks. My son was a young toddler at the time, so naturally I drank a glass of wine many nights after he went to bed. There were also several times I had beers at a bar, and there was one night I got fairly drunk. I stopped drinking once I found out. I'm certain that no one is even a little surprised that my daughter is perfectly healthy.

The CDC's recommendations are complete bullshit. Why? Oh, did I forget to mention that my daughter was unplanned? How unplanned? I WAS ON HORMONAL BIRTH CONTROL WHEN SHE WAS CONCEIVED. Even on birth control, clearly there is a non-zero risk that women can get pregnant. So, sorry ladies, but based on the CDC's 'logic' and refusal to recognize the actual likelihood of risks, clearly women should just never drink alcohol no matter what.
posted by gatorae at 7:02 PM on February 5, 2016 [26 favorites]


nadawi: "i'm thinking of my twitter friend who was bullied out of her gym a couple days ago because other people were "concerned" that she was there and visibly pregnant."

One time, I guess going on five years ago now given the age of my spawn, someone on Ask Metafilter asked for crockpot recipes, and I gave the recipe I always give, an excellent cassoulet that makes 12 servings and uses 1 cup of red wine in the sauce and then cooks for 10 hours. I posted this recipe with just the comment that it was super-delicious, and another poster comes in and says, "Eyebrows, you said in a thread a couple days ago that you're pregnant! It's not really safe for you to be drinking wine!"

I mean 2700 other posters jumped in to be like "uh I think 1 cup of red wine split 12 ways and cooked for 10 hours is probably fine EVEN IF she weren't just posting a recipe that maybe she makes when unpregnant" but SERIOUSLY what is wrong with people, sighting a pregnant woman makes OTHER PEOPLE get hysterical. It's like my uterus has special telepathy to project hysteria.
posted by Eyebrows McGee at 7:05 PM on February 5, 2016 [47 favorites]


How many of us Mefi's would not have been conceived if it wasn't for a little drinking??
posted by Muncle at 7:11 PM on February 5, 2016 [1 favorite]


CDC Basically Informs Women That They Are Incompetent:

"What we do know is that we have a problem and it’s clear to all of us at the CDC that you – women – are to blame. When we say that 1 in 20 children are on the fetal alcohol spectrum, we are not basing this on clear cut criteria, but rather behaviours like hyperactivity and attention problems that might be linked to FASD, so we’ve decided to link them conclusively. We don’t want to talk about the fact that these behaviours are incredibly normal in childhood[9][10] but we have a school system and society that doesn’t support them. We don’t want to talk about the fact that our expectations for children have shifted so much that we no longer expect children to be children, but rather to be mini-adults, and when they can’t meet this expectation because it’s not biologically normal, we instead will look to you – mom – as the cause of these problems. We want to ignore that if we just shifted the way we think about childhood and how we treat children, we might not have $5.5 billion in costs each year from the various mental and associated physical disorders we’re linking to FAS instead of a society that piles anxiety upon kids starting in preschool."
posted by gingerbeer at 7:16 PM on February 5, 2016 [37 favorites]


Emily Oster's summary of the actual research.
posted by gingerbeer at 7:19 PM on February 5, 2016 [3 favorites]


> It's like my uterus has special telepathy to project hysteria.

Wouldn't it be great if they really had superpowers - like good ones? Besides growing a human being, I mean.

And now I'm gonna go look through your posting history for your cassoulet recipe!
posted by rtha at 7:21 PM on February 5, 2016 [2 favorites]


I'm sitting here drinking a delicious cocktail even though I know I messed up taking my birth control earlier this week because based on lots of experience I know I can resist having unprotected intercourse. (Probably cause it hurts like hell.) The idea that fear of FAS is going to motivate women to get on the pill because unplanned pregnancy itself isn't enough of a motivation seems not clear to me.
posted by carolr at 7:25 PM on February 5, 2016 [4 favorites]


Also for any woman who had any alcohol in the past month, she was considered to be at risk regardless of whether the alcohol was consumed after the potential date of conception- just if she had had a drink within the past 30 days.


The fact that they base it on 30 days and not each particular woman's cycle length is ridiculous. I have a 25 day cycle. Over the course of 30 days, I will have two periods. But nope. That glass of wine I had two periods ago puts my nonexistent fetus at risk.
posted by melissasaurus at 7:40 PM on February 5, 2016 [5 favorites]


Before I knew I was pregnant, I bought a bottle of Veuve Clicquot to celebrate something. Drank it with my dinner (which was, oh noes! sushi) and quickly threw up. That was my first inkling that I might be pregnant. Upon confirmation, I was more upset that I wasted a bottle of expansive champagne than anything else. I didn't have another drop of alcohol until two weeks before my daughter was born, when I had a glass of champagne. At my wedding. I also smoked a couple of cigarettes three months prior, on 9/11, when my in-laws were on a cross country flight out of Newark and we couldn't get in touch with them for a very long while. So, I'm clearly an unfit mother, if you ignore the happy, healthy teenager putting together Lego in the other room right now.
posted by Ruki at 7:56 PM on February 5, 2016 [12 favorites]


This post should contain a 'Previous' link, because the CDC is just repeating a thing they did in 2006. At least they learned not call women 'pre-pregnant' this time.
posted by palindromic at 7:56 PM on February 5, 2016 [5 favorites]


A post-patriarchy CDC would have strict guidelines regarding the use of "pre-pregnancy" whether explicit or implicit.
posted by yesster at 8:32 PM on February 5, 2016


"Pre-pregnant" has meaning in livestock management. Women aren't livestock.
posted by yesster at 8:41 PM on February 5, 2016 [10 favorites]


I heard a guy from the CDC interviewed on CBC Radio this week. He said that they were worried about men travelling from countries with Zika infections and returning to have sex with their wives. He was advising that married men use condoms with their wives until they were out of the infection incubation period.

I was glad the CBC interviewer was asking him some tough questions. But I was wondering if he thinks only married men and women have sex. I wondered if he knew single men had sex. Maybe even with men. And that women also travel. And might not be married.

I thought I was listening to a 1950s broadcast until I heard the CBC interviewer and realized this was a current story. So then I switched to a station that was discussing Ghomeshi and the CDC guidelines on drinking and knew it was probably still 1970.
posted by Chaussette and the Pussy Cats at 8:54 PM on February 5, 2016 [26 favorites]


I would be fascinated to see the scientific evidence that drinking alcohol suddenly becomes safe at the stroke of midnight on one's 21st birthday.

This is totally unrelated to the rest of the thread, but when I was like 20 years and 9 months old, I got a minor in possession of alcohol citation. When I went for my court date, the judge gave me a lecture about how it just wasn't safe to drink before 21. I believe I rolled my eyes and said something like 'That doesn't sound completely made up at all!'

And that is how you turn a fine into 6 months reporting probation.
posted by palindromic at 9:19 PM on February 5, 2016 [23 favorites]


A better guideline would be to recommend aborting any unplanned pregnancies.
posted by Jacqueline at 9:24 PM on February 5, 2016 [7 favorites]


I for one think this is excellent advice. Actually I think it doesn't go nearly far enough in that I think the scope is far too limited. As you all may know the number one killer of men in the United States is cardiovascular disease. I'd like men from the ages of 18-99 to take the following precautions for their heart attacks:

1.) Please take 300mg of aspirin every day. This is a typical loading dose of aspirin for someone who is infarcting. It is much higher than a regular dose, but since you may or may not be infarcting at any given moment this seems like a sensible precautionary measure. But please be aware that by taking this dose of aspirin every day you are putting yourself at greater risk of bleeding and bruising, and also it is inappropriate if you are not currently having a heart attack but who knows maybe you are?

2.) Please refrain from eating immediately prior to your heart attack. If you cardiac arrest you are likely to vomit which will cause aspiration pneumonia and drastically lower your chances of survival. Given that there is no known safe time to eat prior to a heart attack that you may or may not be having I recommend refraining from eating altogether. Also please ensure that everyone around you knows how to administer CPR and use an AED and that you are never alone not even while you pee because your heart attack could strike at any time unless it doesn't.

3.) Please keep your wrists and groin areas shaved at all times and scrubbed with chlorhexidine so that when you do or don't have your heart attack the cath lab staff will be able to access an artery quickly and remain sterile. This step is very important. Please stop crying.

4.) Please have intravenous access in place at all times. In the event that you do or don't have your heart attack this will save precious moments for the ambulance staff who can administer life saving medications. Also please be proficient in inserting an IV line despite probably having no training. Hey buddy I know it's inconvenient to have to insert a cannula every 3 days per best practice to prevent phlebitis. I guess you don't care about your health?

5.) Please exercise in a way that thickens and strengthens your heart muscle. This will ensure that when you either have or do not have your infarct your heart muscle will recover more quickly. But please refrain from exercising if too strenuously, especially if you are at risk of an arrhythmia! You don't want to have a cardiac arrest remember? Geez this guy.

6.) Please immediately call an ambulance or present to an emergency department at the first sign of your heart attack that may or may not be happening even now as I type this. As they say time is muscle and the longer you wait the more damage you'll do to your heart, which you obviously don't care about that much or you would have had an ambulance pre-booked for just this emergency. But please also don't waste our fucking time and show up unless you're actually having a heart attack or else you're just using up medical resources and also you're being a big baby. But how can you tell whether you're having a heart attack until you ring an ambulance or show up in ED you ask? Ho ho ho my lad.

7.) Please inform your family that you may or may not be in hospital at any given time with a heart attack that could happen right now but probably won't unless you're a bad person and ate the wrong foods and didn't exercise except also that there is a strong genetic component so maybe your parents are just bad people? Please tell them that when you are letting them know that the heart attack that lurks in the shadows may or may not have swooped upon you like Batman just going to town on a bad guy.

8.) Most importantly please do not have a heart attack in the first place! If you do have one it's probably either because you're irresponsible and untrustworthy, or because you don't look after your health particularly well, or because of genetics, or some other reason but whatever you still suck and it's your fault. If this makes you feel bewildered and like the advice is contradictory and difficult to follow and a little bit victim blamey all I can say is that you're obviously not serious about your heart health. My medical advice is to drink a glass of concrete and harden the fuck up.
posted by supercrayon at 9:32 PM on February 5, 2016 [69 favorites]


When this hit the NY Times the other day, I found the article hard to read because I was rolling my eyes so hard.
posted by Dip Flash at 10:10 PM on February 5, 2016


Chaussette and the Pussy Cats: "I was glad the CBC interviewer was asking him some tough questions. But I was wondering if he thinks only married men and women have sex. I wondered if he knew single men had sex. Maybe even with men. And that women also travel. And might not be married. "

Might just be that the CDC default is condoms in any non-monogamous relationships already so the Zika warnings are on top of that. And the risk that people are freaking out about is a risk to the fetus so a woman who traveled giving Zika to a man she is married to isn't seen as a problem at least as far as Zika effecting fetuses goes.
posted by Mitheral at 1:03 AM on February 6, 2016


The thing that enrages me is that abortion is supposed to be legal, no questions asked, up to a certain time, despite all the attempts to outlaw it. And yet even the CDC cannot say: "If you have an unplanned pregnancy and have been drinking heavily, abortion may be a good choice for you. In fact, aborting an unplanned pregnancy might be your plan regardless."

This is the most insane part to me. This is not an elected office. Is it career, or somehow political suicide to say that? Was there someone for whom it was gatekeeping this report and pushing it in this direction? Was this somehow lobbied?

I understand that isn't a marketable opinion or information to present, but i want to know why they care and who exactly was involved in them basically rolling over in to absurdity rather than saying that.

When did abortion become "off the table" to discuss for the CDC? Has something along the lines of the restrictions on gun violence research happened? That seems like it would be pretty fucking important information if so.
posted by emptythought at 1:50 AM on February 6, 2016 [7 favorites]


Please keep your wrists and groin areas shaved at all times

You can have my 4-inch thicket of wrist fur when you shave it from my cold dead hands
posted by Greg Nog at 5:55 AM on February 6, 2016 [8 favorites]




Women Who Have a Baby:
Don't drink while breast feeding for 18 months. Check. (Or pump beforehand)
Don't drink while gestating a fetus for 9 months. Check.
Don't drink while actively trying to get pregnant. 12 months (if you're in that 85% range).Check. (Although as someone said upthread, you can actually figure out when you ovulate in your cycle...)

That adds up to three years of not drinking, which many people sign on for when they have a baby. I see the points upthread that some people may not be aware that you're not supposed to drink when pregnant, but then I also see the point that these recommendations are aimed at doctors who surely do know and are telling their patients about the above.

Start your period at age 13, peers start drinking at 16, if you are heterosexual and aim to give birth to a baby, you might plan on doing that at 24. And birth control access is varied and if it looks like usage is spotty anyway. So these recommendations add on another 8 to 11 years where they're saying women shouldn't drink.

So, that's 11 to 14 years of not drinking. I mean, I guess we could say if women aren't willing to commit to that, they shouldn't be thinking of giving birth to a baby, but...surely not, right?
posted by CMcG at 7:22 AM on February 6, 2016 [2 favorites]


I have a family member with Fetal Alcohol Syndrome. His life is very difficult, and he didn't deserve to have this happen to him. There is no safe amount of alcohol during pregnancy. It's important for people to know this.

That freaking graphic. Hey, CDC, have you noticed that there are issues that affect men with regard to alcohol? Injuries/violence, heart disease, cancer, STDs, fertility problems, unintended pregnancy. The message is incredibly disrespectful to women.

FAS, Zika, and just plain old choice are terrific reasons why women must have reproductive control and reproductive choice. That means education, excuse me, respectful education, birth control and abortion.
posted by theora55 at 8:03 AM on February 6, 2016 [2 favorites]


At probably a seder, but possibly a different holiday, my cousin's cousin was there, and quite visibly pregnant. As you all should know, Manischewitz wine is a crime against grapes, wine, the colour purple and any glass it is in. So when she asked me to pass her the Manischewitz, I raised my eyebrows and went "Really?"

Every single person at that end of the table froze. "No! I am judging you for drinking that wine, not for drinking a glass of wine while pregnant! Drink better wine!" Awkward.
posted by jeather at 8:17 AM on February 6, 2016 [6 favorites]


There is no safe amount of alcohol during pregnancy.

There is no KNOWN safe amount of alcohol during pregnancy.
posted by agregoli at 9:26 AM on February 6, 2016 [13 favorites]


Nursing Clio:

Here is what is missing from the warnings and warning labels: any distinction between alcohol use and abuse and any mention of the link between alcohol and violent crimes. Alcohol abuse is linked to homicide, rape, assault, and child and partner abuse. Intimate partner violence towards pregnant women is responsible for fetal demise, fetal injury, and low birth weight and for the deaths and injuries of thousands of women. Should we be warning women not to have intimate partners?

Let’s get real. Talking about how women ought to behave and about fetuses is a way of not talking about and acting upon the real issue: the lack of treatment for women (for everyone really) with alcohol abuse disorders. Credit the robust alcoholic beverage industry lobby and the politicians who won’t stand up to them with keeping us focused on all the wrong things. According to the National Institute on Alcohol Abuse and Alcoholism, approximately 26,000 women die each year from alcohol-related causes. Alcohol abuse is the third leading preventable cause of death in the United States.

posted by bunderful at 9:32 AM on February 6, 2016 [7 favorites]


The reason that there's no known safe amount of alcohol during pregnancy is that there's no ethical way to do experiments that would determine what the safe amount of alcohol is during pregnancy. Available evidence seems to suggest that it's safe to drink moderately while you're pregnant, but there's no way to prove that without potentially endangering fetuses. An added complication is that drinking in early pregnancy is associated with greater risk than drinking later on, which is what these guidelines in their inept way were attempting to address.

In another thread, I cited a representative from the UK Royal College of Obstetricians and Gynaecologists, whose take on this I really liked:
"There is no proven safe amount of alcohol a woman can drink during pregnancy. We know that heavy drinking can cause fetal alcohol spectrum disorders and has also been linked with an increased risk of miscarriage. Although the available evidence on low-level drinking has not yet been found to be harmful to women or their babies after 12 weeks of pregnancy, we cannot rule out the risks altogether.

“It is our responsibility as healthcare professionals to be open and honest with women, explaining both the potential risks of consuming alcohol during pregnancy and the limitations of the science, and supporting them in coming to a decision for themselves. We all deal with uncertainty in our lives on a daily basis; pregnant women are no less capable of doing so.”
I think the solution to this has to be to give women the information we need to make informed choices and respect our ability to make those choices intelligently. I realize that's a really difficult, scary thing to do, and some women will inevitably make regrettable choices. But some women will make regrettable choices even if you do treat us all as permanently pre-pregnant, so there is no way around the challenges presented by women's autonomy.
posted by ArbitraryAndCapricious at 9:35 AM on February 6, 2016 [7 favorites]


Should we be warning women not to have intimate partners?

In fact, the number one cause of death for pregnant women in the US is homicide.
posted by melissasaurus at 9:40 AM on February 6, 2016 [16 favorites]


Lest we forget how the CDC was a pillar of humane enlightenment during the Tuskegee study and the AIDS crisis. I'll be over here taking this latest recommendation with a martini and an upraised middle finger.
posted by Orange Dinosaur Slide at 10:55 AM on February 6, 2016 [7 favorites]


Wow, there's quite a difference between the comments on the CDC guideline post from 2006 and this one.

(Apart from the overall tone and flow of conversation, there are no favorited comments—favorites were added to MetaFilter only 9 days before the post.)
posted by Rangi at 1:09 PM on February 6, 2016


Wait, is there evidence that drinking before one knows she's pregnant —weeks 4-5, say—can cause FASD?
posted by purpleclover at 2:40 PM on February 6, 2016


Wait, is there evidence that drinking before one knows she's pregnant —weeks 4-5, say—can cause FASD?

There is some evidence that drinking earlier in pregnancy is worse than drinking later in pregnancy. But no evidence of what the troublesome threshold of alcohol intake is (because they can't do a proper study under current ethical standards), and FASD has a bunch of other correlated factors like poverty and malnutrition. Many of the studies fail to distinguish alcohol use from alcohol abuse.

Also, it's important to remember that gestational age ("4 weeks") is measured from the last menstrual period. So, when you miss a period and take a test, you're already "4 weeks pregnant" even though conception occurred about 2 weeks prior and implantation about 5 days prior. So, you may be "4 weeks pregnant" but you had an implanted embryo for only about 5 days. This has also been an issue for abortion restrictions based on gestational age (e.g., a ban after 20 wks).
posted by melissasaurus at 2:59 PM on February 6, 2016 [1 favorite]


Yep, I am aware that drinking in the first trimester is worse than drinking in the third. Thanks, melissasaurus.

I am specifically asking about evidence that drinking in weeks 4 or 5 (even 6)—knowing that it means 14, 21, 28 days post-conception—results in FASD. Does that exist?
posted by purpleclover at 3:06 PM on February 6, 2016


I don't think it exists. (sorry for the forthcoming wall of text, not all of which pertains to your question specifically)

In Journal of Obstetrics and Gynaecology Canada, the current Alcohol Use and Pregnancy Consensus Clinical Guidelines [pdf] state:
It is not uncommon for women to have had low-level exposure to alcohol in early pregnancy, particularly because many pregnancies are not planned. Such women may be concerned about possible harm to their fetuses and some may seek pregnancy termination for that sole indication. The available evidence about the effects of low-level consumption does not warrant acceding to such a request.
They also provide sample scenarios and how to advise:
Scenario 1: Janine is 26 years old and comes to your office to discuss her concerns. She discovered two weeks ago that she was pregnant. This is her first pregnancy and it was unplanned. An ultrasound done today confirms a gestational age of 8 weeks. A few weeks ago she was at an anniversary celebration for friends and had three glasses of wine. The day before she discovered she was pregnant she went with some co-workers to a bar after work and had two drinks. She has consulted several sources on the Internet and has now come requesting a termination of pregnancy.

Assist and Advise: There is a low level of risk with this level of alcohol use. It is likely that this level of alcohol will not affect the fetus. The options for unplanned pregnancy may be reviewed.

Assist: Support Janine’s choices. Give her information about alcohol in pregnancy as well as factual information to share with her friends.

Scenario 2: Josee is a 20-year-old university student. She parties regularly on the weekends, when she will often consume 6 to 8 beers at a time. She found out yesterday she was pregnant at 9 weeks, gestation. She wants to continue the pregnancy and plans to stop drinking. She is concerned about the well-being of the fetus.

Assess: This pattern is consistent with binge drinking. A range of methods may be used to assess her drinking: a standardized tool, a timeline follow-back, or discussion about her patterns of drinking. Review goals. Acknowledge that it may be difficult for Josee to change her alcohol consumption patterns as they are so connected to her social lifestyle.

Advise: It is prudent not to drink at all in pregnancy. The pattern of Josee’s drinking is of concern. Repetitive drinking of more than 4 or 5 servings of alcohol at one time may cause fetal damage. There is risk to the fetus with continuous binge drinking. We cannot predict if there has been harm. There is a risk that there may already have been adverse effects on the fetus, but the nature and extent of those effects cannot be quantified. There is no way to make a prenatal diagnosis to include or exclude a fetal effect. Support Josee in her choice to continue her pregnancy.
In contrast to the CDC, they also state the following:
While recording of maternal alcohol use may have longterm benefits for the diagnosis and support of children, the implications for mothers are often less positive. Pregnant women and new mothers report experiencing discrimination and lack of support from health care providers and others in a position to assist them with alcohol problems. In addition, women fear losing custody of their children if their alcohol use is made known to child welfare authorities. (Substance use in pregnancy is almost unique as a health problem that can result in the loss of child custody.) For women, these fears of prejudicial treatment and removal of children create serious barriers to open discussion of their alcohol use, to providing consent to laboratory testing, and to seeking support or treatment. It is therefore critical that physicians and other health care providers make extraordinary efforts to sensitively discuss alcohol use with women, to seek to understand their fears, and to actively assist women to access treatment and support as necessary.
and:
Fundamental to a harm-reduction approach is a shift away from stigma, guilt, confrontation and shame, towards an empowering and strengths-based approach. A respectful, non-judgmental approach by the health care provider accommodates goals of reduced use rather than immediate abstinence.
posted by melissasaurus at 3:52 PM on February 6, 2016 [16 favorites]


Also, the infographic recommends screening all adult patients, and if they drink too much (by pretty conservative measures) to then spend 6 - 15 minutes (!) counselling them. Which seems like an incredible waste of time in almost all situations. And will just increase the likelihood that people lie or avoid going to the doctor.
posted by kjs4 at 6:47 PM on February 6, 2016 [5 favorites]


The Emily Oster article I linked up thread has a good summary of some of the research:

"It is possible to unearth research that points to light drinking as a problem, but this work is deeply flawed. One frequently cited study from the journal Pediatrics, published in 2001, interviewed women about their drinking while they were pregnant and then contacted them for a child behavior assessment when their children were about 6. The researchers found some evidence that lighter drinking had an impact on behavior and concluded that even one drink a day could cause behavior problems.

So what's wrong with this finding?

In the study, 18% of the women who didn't drink at all and 45% of the women who had one drink a day reported using cocaine during pregnancy. Presumably your first thought is, really? Cocaine? Perhaps the problem is that cocaine, not the occasional glass of Chardonnay, makes your child more likely to have behavior problems.

The evidence overwhelmingly shows that light drinking is fine. Of course, this is sensitive to timing. Both the data and the science suggest that the speed of drinking, and whether you are eating at the same time, matters. It isn't that complicated: Drink like a European adult, not like a fraternity brother."
posted by gingerbeer at 8:45 PM on February 6, 2016 [3 favorites]


> You've never seen a pregnancy forbidden list, have you? Basically the only food that you're allowed to eat is BROWN RICE. Everything else is going to kill you.

Breaking news: brown rice has "80 percent more inorganic arsenic on average than white rice of the same type" and will kill you.
posted by anthill at 10:39 AM on February 7, 2016 [1 favorite]




Wow, there's quite a difference between the comments on the [previous Metafilter] CDC guideline post from 2006 and this one.

There's less of the dismissive "I think women are overreacting" commentary in this thread, which is a good thing.
posted by hurdy gurdy girl at 4:41 PM on February 8, 2016 [5 favorites]


"1. Assess a man's drinking. Advise him not to drink at all if he is violent or might be violent." The CDC’s new alcohol guidelines for women, updated for men
posted by Orange Dinosaur Slide at 3:28 PM on February 10, 2016 [2 favorites]


Rebecca Solnit's analysis of the language used.
"I wish all this telling women alcohol is dangerous was a manifestation of a country that loves babies so much it’s all over lead contamination from New Orleans to Baltimore to Flint and the lousy nitrate-contaminated water of Iowa and carcinogenic pesticides and the links between sugary junk food and a host of health conditions and the need for universal access to healthcare and daycare and good and adequate food. You know it’s not. It’s just about hating on women. Hating on women requires narratives that make men vanish and make women magicians producing babies out of thin air and dissolute habits. "
posted by gingerbeer at 5:02 PM on February 11, 2016 [8 favorites]


Tara Haelle: Backlash Over CDC Paternalism Overshadows Real Risks Of Drinking In Pregnancy:
Alcohol starts affecting a developing embryo by the third week after fertilization. From then on, alcohol crosses the placenta. Every. Single. Time. What it does once it gets there depends on what’s going on at that precise moment. But the idea that it does nothing is a misconception not supported by the evidence base.

I read dozens and dozens of studies in full for the alcohol and pregnancy section of the book I coauthored with Emily Willingham. I began that research thinking a glass here or there was no big deal. I had even had a few glasses of wine or beer sparingly in my second pregnancy and stood by my decision. Heck, I had a half a shot of whisky at the start of my son’s second trimester—it was a free sample and I wanted a taste. I was therefore stunned when I really dug deep into the research: Several dozens of hours reading epidemiological studies, basic science studies, animal studies, in vitro studies, ultrasound studies, developmental studies and various commentaries and editorials on the relative merits and limitations of all these.

To my own surprise, I changed my mind. Once I had a better understanding about what alcohol is at a chemical level, how it works, how it differs from many other substances, how it interacts with cells, how it circulates and how underreported fetal alcohol spectrum disorders—separate from the more serious fetal alcohol syndrome—are, and how poorly these conditions are screened for, detected, diagnosed and managed, I did a complete 180 on this question.

There is no doubt that even one drink—even a half drink—circulates throughout the entire body and reaches the embryo (or, later, fetus). There is no doubt that alcohol damages developing cells. So the question isn’t about exposure but about damage. The more relevant questions are: “Which cells?” and “How bad is the damage?” And there is no way for current technology to answer that at any given moment.
posted by purpleclover at 1:33 PM on February 20, 2016


Rebecca Solnit on the CDC's use of passive voice to erase male responsibility:
Meanwhile, the mechanisms of pregnancy are assiduously avoided in this mystification of reproduction story. First there is what we could call the mystery of the missing man: it absents guys from reproduction and absolves fathers from what is called fatherlessness, as though their absence from the life of a child was somehow something that had nothing to do with them. [...] Seriously, we know why men are absented from these narratives: it absolves them from responsibility for pregnancies, including the unfortunate and accidental variety, and then it absolves them from producing that thing for which so many poor women have been excoriated for so long: fatherless children. The fathers of the fatherless are legion. [...]

I wish all this telling women alcohol is dangerous was a manifestation of a country that loves babies so much it’s all over lead contamination from New Orleans to Baltimore to Flint and the lousy nitrate-contaminated water of Iowa and carcinogenic pesticides and the links between sugary junk food and a host of health conditions and the need for universal access to healthcare and daycare and good and adequate food. You know it’s not. It’s just about hating on women. Hating on women requires narratives that make men vanish and make women magicians producing babies out of thin air and dissolute habits. [...]

Rape is a willful act, the actor is a rapist. And yet you’d think that young women on campuses in particular were raping themselves, so absent have young men on campuses been from the mystificational narratives. Men are abstracted into a sort of weather, an ambient natural force, an inevitability that cannot be governed or held accountable. Individual men disappear in this narrative and rape, assault, pregnancy just become weather conditions to which women have to adapt. If those things happen to them, the failure is theirs.
posted by Eyebrows McGee at 9:10 AM on February 27, 2016 [1 favorite]


Exactly.
posted by gingerbeer at 10:13 AM on February 27, 2016


Meanwhile, extrapolating from one study, perhaps the CDC should be telling all men who might potentially become fathers not to drink at all ever due to the risk of fetal alcohol spectrum disorders from the father's pre-conception drinking.
posted by eviemath at 1:40 PM on February 27, 2016


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