I’m a little too tired to read through the study you sent me. I suppose it’s possible she either got alcohol wrong or that new studies have come out since the book was published which should change the conclusions.
I would note that it’s very hard to assess the impacts of drinking in the current environment because women who adhere to health advice about not drinking are probably going to pass on genes to their children that make them less prone to the very neurodevelopmental disorders the studies purport to measure.
You could do a study where you find women who you think are at high risk of drinking during pregnancy and then perform an intervention to encourage some of them not to drink. But given that ERBs adhere to a strict Copenhagen interpretation of ethics I doubt such a study design would ever be allowed (even though conducting it would improve children’s health if alcohol does indeed have a negative impact).
It stands out to me that she contradicted guidelines by all major agencies and metareviews on this issue, specifically reassuring mothers that it is safe, when so much data points to extreme harms in large quantities, and to the fact that these harmful correlation lower, but stay significant all the way to women who have one single drink. Also that she stuck with it despite having this pointed out to her. It is possible that there is another explanation for the incurable brain damage, and more research is certainly a good idea, but that is a far cry from denying such a highly plausible risk to encourage an behaviour that is completely unnecessary. The fact that she does in this situation has me sceptical of all the rest she recommends, too.
I am also not sure whether your correlation idea holds. Many documented cases occur early in the first trimester, because the woman in question is unaware that she has gotten pregnant, and quits as soon as she learns. I doubt that a woman who believes she is not pregnant having a single glass of wine is indicative of anything else you’d expect to be highly correlated with the characteristic fetal brain damage and facial changes we then encounter. The fact that this has become so common that we no longer even recognise those facial changes indicating the brain damage as strange at all is frankly frightening.
Importantly, the negative impact of even very little alcohol on the fetus outweighs the IQ benefits you would be spending 20-100 k on.
FWIW, here’s a Cochrane review on RCTs of such encouragement designs. It’s basically a failed meta-analysis in that the data is too spotty to make any conclusions. But it shows at the very least that such studies have been done before. An encouragement design in a population with high alcohol use seems most promising for figuring out the causal effect on fetuses, as you say.
(Another recent meta-analysis on the same question finds a slight decrease in preterm birth in the alcohol education group, but this is based on just three studies and marginally significant so I’d say it’s still uncertain.)
These seem most consistent with the effect of light drinking being small or zero, though it’s hard to be certain with the sample sizes given and the difference in study designs.
I wish someone would do a large, well-designed, well-run RCT of an encouragement design so we could have a definitive answer to this question.
I’m a little too tired to read through the study you sent me. I suppose it’s possible she either got alcohol wrong or that new studies have come out since the book was published which should change the conclusions.
I would note that it’s very hard to assess the impacts of drinking in the current environment because women who adhere to health advice about not drinking are probably going to pass on genes to their children that make them less prone to the very neurodevelopmental disorders the studies purport to measure.
You could do a study where you find women who you think are at high risk of drinking during pregnancy and then perform an intervention to encourage some of them not to drink. But given that ERBs adhere to a strict Copenhagen interpretation of ethics I doubt such a study design would ever be allowed (even though conducting it would improve children’s health if alcohol does indeed have a negative impact).
It stands out to me that she contradicted guidelines by all major agencies and metareviews on this issue, specifically reassuring mothers that it is safe, when so much data points to extreme harms in large quantities, and to the fact that these harmful correlation lower, but stay significant all the way to women who have one single drink. Also that she stuck with it despite having this pointed out to her. It is possible that there is another explanation for the incurable brain damage, and more research is certainly a good idea, but that is a far cry from denying such a highly plausible risk to encourage an behaviour that is completely unnecessary. The fact that she does in this situation has me sceptical of all the rest she recommends, too.
I am also not sure whether your correlation idea holds. Many documented cases occur early in the first trimester, because the woman in question is unaware that she has gotten pregnant, and quits as soon as she learns. I doubt that a woman who believes she is not pregnant having a single glass of wine is indicative of anything else you’d expect to be highly correlated with the characteristic fetal brain damage and facial changes we then encounter. The fact that this has become so common that we no longer even recognise those facial changes indicating the brain damage as strange at all is frankly frightening.
Importantly, the negative impact of even very little alcohol on the fetus outweighs the IQ benefits you would be spending 20-100 k on.
FWIW, here’s a Cochrane review on RCTs of such encouragement designs. It’s basically a failed meta-analysis in that the data is too spotty to make any conclusions. But it shows at the very least that such studies have been done before. An encouragement design in a population with high alcohol use seems most promising for figuring out the causal effect on fetuses, as you say.
(Another recent meta-analysis on the same question finds a slight decrease in preterm birth in the alcohol education group, but this is based on just three studies and marginally significant so I’d say it’s still uncertain.)
These seem most consistent with the effect of light drinking being small or zero, though it’s hard to be certain with the sample sizes given and the difference in study designs.
I wish someone would do a large, well-designed, well-run RCT of an encouragement design so we could have a definitive answer to this question.