Medical texts lack direct messages on alcohol’s threat to pregnancy

Despite two decades of consistent warnings from public health authorities that pregnant women should not drink alcoholic beverages, the vast majority of widely used medical textbooks fail to communicate this message unequivocally, a new study reveals. Many texts, including those published recently, contradict these public health guidelines, researchers report in the August issue of the American Journal of Preventive Medicine.

“Medical texts are used for training as well as for reference,” observes senior author Mary D. Nettleman, M.D., M.S., from Virginia Commonwealth University. “In turn, training influences physician behavior. Therefore, it is concerning that many distinguished texts fail to provide clear and consistent recommendations about drinking in pregnancy.”

Previous research has shown that alcohol consumption by pregnant women is one of the leading preventable causes of birth defects and developmental disabilities, Nettleman explains. Yet when she and her colleague, Karen Q. Loop, reviewed 81 clinical obstetric texts in current use, they found that only 14 contain a consistent recommendation that pregnant women should not drink alcohol. Among the 29 texts published since 1991, only seven consistently recommend abstinence.

More than half of the 81 texts, Nettleman and Loop found, contain at least one statement condoning drinking. Although none of the 29 texts published since 1991 contains a consistent message that drinking is permissible during pregnancy, 15 carry a mixed message, recommending abstinence in one place and stating elsewhere that some level of drinking is permissible.

“Although tolerance toward drinking during pregnancy may be expected in older texts, such tolerance in recent texts was very disturbing,” Nettleman says.

Mixed messages, Nettleman added, “are not appropriate because they leave the reader with the impression that abstinence is the official line but a foolish rule made to be broken.”

Statements that condone “minimal,” “occasional” or “moderate” drinking without defining what these terms mean — found in 22 of the 81 texts — also raise concerns for the researchers. “Vague terms such as [these] are detrimental, not only because they provide no concrete guidance, but because they may have vastly different interpretations according to the social norms in the patients’ (and perhaps physicians’) environments,” Nettleman explains.

Some texts, the researchers found, skirt the issue by offering no guidance at all. Nineteen of the 81 texts discuss the topic of alcohol consumption during pregnancy without providing a recommendation, and five books don’t address the topic at all.

Nettleman and Loop suspect that the disconnect between what authorities and textbooks recommend stems, at least in part, from the fact that no safe level of drinking during pregnancy has been established. “[M]any textbooks, even recent ones, seem to have interpreted the absence of a ’safe level’ to mean that lower levels of drinking are safe and may be permitted,” Nettleman observes.