Alcohol consumption during pregnancy and beyond
Back to the topic of "obvious things to avoid during pregnancy" (read my post about caffeine here), let's talk about alcohol. It's a controversial topic, so here's a disclaimer: My intention isn't to point a finger at anyone. I believe that there is a lot of misinformation and taboo regarding the subject, and all I'm trying to do is pass on evidence-based information so that people can make informed decisions, for which they can hold themselves accountable. When in doubt? Reach out to a health care professional (or, you know, feel free to get in touch with me).
Like so many other substances, alcohol is vetted during pregnancy because we just can't test for a safe limit on a pregnant woman. Since there hasn't been enough conclusive research done, the current go-to recommendation is therefore to avoid it altogether. But the reality is a bit more complicated than that, since surveys have found that 20%-30% or pregnant women drank at some point in their pregnancy.
I watched a Ted Talk once about how alcohol consumption during pregnancy was "forbidden" because doctors don't trust that women will be able to stop at one small glass. It sounded like a tempting idea - drink wine and fight the patriarchy! - but still not tempting enough, to me, to put my babies at any potential risk. Note that I said "to me". I am not at all throwing shade at anyone who opted for the occasional glass of wine while pregnant. The amount of alcohol ingested, the length of period using alcohol, and the developmental stage of the embryo/fetus at exposure are the main contributors to assessing the level of risk - which basically means that having one small glass on your 38th week won't have the same effect as having a few glasses during the first trimester (read: While the former can be tolerated, don't do the latter).
The thing with alcohol consumption during pregnancy is that it's also highly subjective and culturally biased. I live in Europe, so it doesn't come as such a shock to me to hear from women who've had "a glass of wine here and there" while pregnant. When I was about to give birth to my first in Brazil, my OBGYN told me that I could, indeed, have a glass of wine at that point if I was really craving it (I still didn't, because I didn't feel comfortable with the idea). In America, many women would gasp at the thought of it.
I do not condone alcohol consumption while pregnant. But I don't condone a harsh judgment of those who have opted to do it occasionally and moderately and with guidance either. What I do strongly recommend is making informed decisions.
So here's what we know: Guideline development groups in the UK, for instance, used to tolerate a low-to-moderate consumption of alcohol (32g, or 1-2 units, once or twice a week) during the second and third trimesters. Alcohol consumption while trying to conceive and during the 1st trimester were always, and are still, a no-go. What do I mean by units?
A pint of low-strength lager = 2 units of alcohol
175ml glass of wine = 2.1 units
125 glass of 12% wine = 1.5 units
Hard liquor = A firm no.
However, these same groups are now recommending total abstinence during the entire pregnancy, because studies are mixed on low-to-moderate alcohol consumption. They all agree that there's a correlation between consumption and a number of negative impacts on the baby - they're just unclear on what the threshold is. By negative impacts, I mean intellectual impairment, growth impairment, low birth weight, premature birth... To name a few. I don't want to scare anyone, just pointing out that the risks are many, and they're real.
At the end of the day, it truly is the mother's (or parents', or whoever's involved in the baby's development) decision to assess the situation and decide whether the risk is worth it (my honest opinion? It isn't). I keep bringing up this topic because I think it's an important one to be discussed. Some women live with a shadow of guilt for having had one small glass of wine at 38 weeks. Others drink definitely more than they should because the cutout line is so blurred. Yet we avoid discussing this and throw everyone under very distinct black-or-white categories (total abstinence? You're doing great. Had one glass of beer in your whole pregnancy? You're already a terrible mother). If we don't discuss topics such as this and give them evidence-based reasons to help them make decisions, how are people going to know any better?
I'd also like to point out that a lot is discussed about drinking alcohol while pregnant, but what about consuming it while breastfeeding? The common narrative goes something like "now that baby's out mama needs a glass of wine or two!" - but we need to backtrack a little.
A bit of the alcohol consumed is indeed transmitted to the baby through breast milk, so there are some precautions to keep in mind. Alcohol peaks in the milk at about 30-60 minutes after drinking it - so definitely avoid breastfeeding during that time window if you've had alcohol. The good news? Alcohol doesn't accumulate in breast milk, but rather leaves it as it leaves the blood. In other words, when your blood alcohol levels are back down, then your milk alcohol levels are down too. I like the way Erica Chidi Cohen puts it in her book "Nurture" (one of my all-time favorite books): "If you're too drunk to drive, you're too drunk to breastfeed". It's something that should maybe go without saying, but in case you didn't know, now you do.
One last piece of advice: Newborns have very immature livers, so any amount of alcohol can tax their systems up until about 3 months of age. If you can wait that long postpartum to drink, then it's advised to do so (especially if you're feeding on demand, since you never know when the demand will come). Otherwise try to have that small glass of wine between feeds, keeping in mind the time when alcohol will peak in your bloodstream and breast milk.
Again, these are just a few guidelines to safely drink postpartum. Follow them and have your wine (or beer, whatever), with some peace of mind - after all, you deserve it.