Medical School Textbooks Still Say It's OK to Drink While Pregnant

Only 1-in-4 new books calls for abstinence
By Kathleen Doheny
HealthScoutNews Reporter

WEDNESDAY, July 17 (HealthScoutNews) -- Talk about being behind the times: Textbooks used in the nation's medical schools still condone drinking during pregnancy, although public health officials have promoted abstinence for two decades.

This month's American Journal of Preventive Medicine carries an article in which Virginia Commonwealth University researchers reviewed 81 obstetrics textbooks currently in use in the nation's medical schools and found that only 14 had consistent recommendations not to drink. When they narrowed the review to textbooks published since 1991, only 7 of the 29, or 24 percent, consistently recommended zero alcohol during pregnancy.

"I didn't expect so many recent textbooks to actually condone drinking," says Dr. Mary Nettleman, professor of medicine at Virginia Commonwealth University and the lead author of the study.

Many of the reviewed textbooks had mixed messages. More than half of the books contained at least one statement condoning drinking by pregnant women. Some skipped the subject alltogether.

Drinking alcohol during pregnancy can result in both physical and mental birth defects. Up to 12,000 babies born each year in the United States have fetal alcohol syndrome, a combination of physical and mental defects, according to the Institute of Medicine. Most of the mothers of these babies are alcoholics or chronic alcohol abusers.

Many women are aware that heavy drinking during their pregnancy can cause birth defects, but some are not aware that moderate or light drinking can harm the fetus, too, according to the March of Dimes.

"Alcohol goes from your system to the baby's blood stream," Nettleman says.

But do medical school professors follow the texts strictly or insert their own anti-drinking messages to students during classroom lectures?

"I can't say for sure," Nettleman says. "We did not study that."

Nettleman is puzzled as to why textbooks haven't inserted revisions. "All the major organizations, such as the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, public health organizations, all advocate zero drinking during pregnancy," she says.

"I can't prove to you that having one drink during pregnancy is bad," she says, because no one can definitely say that a single drink can damage a fetus. But since no one knows the lower limit of safety for alcohol during pregnancy, zero drinking is the only rational policy, she says.

A Los Angeles clinical geneticist says she is "not totally surprised" by the findings.

"I think there is a hesitation to put something so strong [like banning drinking during pregnancy] in the textbook," says Dr. Karen Filkins, an associate professor of obstetrics and gynecology at UCLA School of Medicine who has set up birth defects hotlines and conducts genetics counseling.

Women who have a drink and then discover they're pregnant can get very anxious, she has found over her years of counseling and administering hotlines.

"We experience [on the hotlines] numerous phone calls from women who had a drink early in pregnancy." Most are alarmed and concerned, she says. And she reassures them that most of the time one or two drinks early in pregnancy are not going to have an adverse effect, but that no one can guarantee that outcome in every case, because the limit of safety is unknown.

Ideally, how should the textbooks address drinking during pregnancy?

"I think textbooks should discuss it the way I do," Filkins says. "For those who have had inadvertent exposure, there is no reason to panic. However, there is no known lower level [of safety]. The policy and the stance should be 'no alcohol during pregnancy.' But the textbooks ought to address both the 'no alcohol' policy and the inadvertent alcohol situation."

In the case of inadvertent exposure, the textbooks ought to recommend that doctors advise the woman to call a birth defects hotline or consult with her doctor or a genetics expert so an assessment can be made of her specific risk, Filkins says. What To Do

SOURCES: Mary D. Nettleman, M.D., professor of medicine, Virginia Commonwealth University, Richmond; Karen Filkins, M.D., associate professor of obstetrics and gynecology, UCLA School of Medicine, clinical geneticist, Los Angeles; July 2002 American Journal of Preventive Medicine