The fetal effects of so-called "binge-drinking"

The Journal of Epidemial Community Health has published an important article by Jane Henderson, Ulrik Kesmodel, and Ron Gray, entitled "Systematic review of the fetal effects of prenatal binge-drinking". This analyses the effects on babies of so-called "binge-drinking" by pregnant women, reviewing the large body of academic literature published between 1970 and 2005.

The study considered a wide range of adverse outcomes that might be attributed to "binge-drinking", including miscarriages, still births, intra-uterine growth restrictions, low birth weights, and birth defects. The conclusion of the article is, perhaps surprisingly given the moral panic about this issue, that there were no consistent significant effects on any of these, though there was a "possible" effect on neurodevelopment that would need to be confirmed by further research. Except for that possibility, the study found no convincing effects of any adverse outcomes from "binge-drinking" while pregnant.

Note: I am placing the expressions "binge" and "binge-drinking" in inverted commas throughout this post - except in the sentence at the very end where I use the word "binge" correctly. Why? Simply because these expressions are now used by medical researchers, bureaucrats, and the media in a way that is totally different from both their original meanings and their ongoing popular connotations. On occasion in the past, I've had the experience of complaining about this sneaky shift and have been told in response that, of course, concern about, say, "teenage binge-drinking" is related to serious alcohol abuse, not to levels of drinking that many of us consider moderate, reasonable, and civilised. But there's no of course about it.

In recent years, the prigs, prudes, and puritans who are determined to raise the ... ahem ... moral tone of our society have been redefining the word "binge" - and related words or expressions such as "binge-drinking" - while trying to retain the nasty, blaming associations of the old meaning.

The article by Henderson et. al. also makes mention of this tendency, though in a less blunt manner:

"The definition of a binge has changed radically over the years. In the past, it meant an extended period (usually several days) of intoxication; now it commonly refers to drinking six UK units or more on a single occasion - that is, only two or three large glasses of wine - and, in most studies of pregnant women, it has been defined as five or more drinks on a single occasion."

With that out of the way, what can we draw from the article?

An examination of the entire article does, in fact, show some associations between "binge-drinking" and various birth and post-birth problems, but the authors do not consider these to be of any established importance: the data from different studies are not consistent; any effects seem small and are often not statistically significant; the effects of "binges" as opposed to consistent "heavy drinking" are not easy to separate out, and so on.

Sensibly, Henderson et. al. do recommend discouraging "binge-drinking" during pregnancy since, irrespective of whatever else can be gleaned from the data, there's a possibility that the one-off presence of significant amounts of alcohol could harm neurodevelopment. Although there is little actual evidence of this in humans, animal studies support the possibility. I agree that that is enough to give somebody good reason not to drink significant amounts of alcohol - even amounts that would normally be considered moderate, reasonable, and civilised - while knowingly pregnant or while trying to get pregnant.

But the paper also observes that the risk seems minimal and that it is important not to introduce undue anxiety in women who have occasionally engaged in "binge- drinking", in the absence of a consistently high daily alcohol intake.

The bottom line is that women who know they are pregnant, or who are trying to get pregnant, would do well not to engage in significant social drinking, even of the moderate and reasonable amounts that get referred to, in these priggish days, as the lower levels of "binge-drinking". Women have every reason to continue leading normal lives that involve ordinary convivial use of alcoholic drinks; but if an individual woman is actually trying to become pregnant (and may already be) or knows that she is already pregnant, she has reason not to drink much on any one occasion.

In any event, panic, anxiety, and guilt are best avoided. For example, rushing off for an abortion because you had a small number of drinks on a one-off occasion, before you realised you were pregnant, would be a massive overreaction (even though I'd defend your right to overreact in that way).

Finally, next time you see a wowserish newspaper article - or hear a prude or prig whining on - about "binge-drinking", at least try to establish what definition of "binge" is being used before you accept it at face value. The enjoyment of two or three (or even five) large glasses of wine with a good meal is civilised dining; it is not going on a binge.