No amount of alcohol consumption is safe for pregnant women, according to the U.S. Surgeon General’s guidelines. It’s a message that has been printed on the label of every bottle of wine or whiskey in the country for the last 10 years. And since the early ’70s, alcohol consumption during pregnancy has been definitively linked to a specific group of birth defects including physical abnormalities, distinct facial features, stunted growth, memory problems, learning disabilities, even mental retardation in severe cases.

 A recent study the SLO County Health Agency publicized found more local women drink while pregnant than pregnant women elsewhere. Agency officials say the county is “one of the top problem areas in the nation for alcohol consumption during pregnancy.”

The statement is based on San Luis Obispo County rating the highest among 20 other counties surveyed in the state, as well as counties surveyed in several other states.

“We have doctors that are still saying it’s OK to have a drink once a day,” said SLO County Public Health Nurse Jan Campbell. “I think that’s very dangerous, because we just don’t know how it’s going to affect the child. It depends on so many factors … to me, it’s like playing Russian roulette.”

In a June press release, the Public Health Department said the study found 37 percent of the women surveyed drank alcohol at some time during their first 12 weeks of pregnancy before they knew they were pregnant, and that 23 percent reported drinking alcohol after they knew they were pregnant. 

But the actual data from the survey—which included 6,703 women over a five-year span—does not seem to support those statements.

The study data, provided to New Times, shows 16.6 percent of women reported consuming alcohol after they knew they were pregnant, and fewer than 30 percent drank alcohol before they knew they were pregnant. Campbell said the press release numbers may have been based on older data.

The survey suggested that it is not for lack of prenatal treatment or lack of education that women drink while pregnant. The study said most of the drinkers are well-educated, white women with good incomes and access to health care. So why are they choosing to ignore the Surgeon General’s recommendations?

 “For us, I can almost guarantee it’s the wine,” Campbell said. In other words, many people in wine country simply take a different approach to the public health efforts to stamp out all drinking during pregnancy.

The county Public Health Department doesn’t collect data on the number of fetal alcohol cases in the county and neither does the Centers for Disease Control, so there is no immediate way to know whether SLO County has an epidemic to match the study’s findings. Anecdotally, there is no indication that SLO has a high rate of fetal alcohol syndrome. Ron Yukelson, a spokesman for Sierra Vista Hospital, which has the county’s neonatal intensive care unit, said fetal alcohol syndrome is very rare locally.

Nationally, CDC studies estimate the rate of fetal alcohol syndrome ranges from 0.2 to 1.5 per 1,000 live births in different areas of the United States. The rates vary based on socioeconomic factors, regional factors, and race.

National statistics show about 20 percent of women who are known to be pregnant continue to drink during their pregnancy. The incidence of drinking during pregnancy has increased substantially in the past several years, possibly due to a media focus on the idea that light-to-moderate drinking can be healthy. National studies suggest that educated white women who have money are the most likely population to drink during pregnancy but that same demographic is not the most likely to have a child with fetal alcohol syndrome.

Moderate drinking during pregnancy reflects European sentiment. The Royal College of Obstetricians and Gynaecologists, a British organization, recommends, “If you do drink, you should not drink more than a safe amount, which is defined as not more than one or two units, not more than once or twice per week.”

Many European countries, where alcohol consumption is more prevalent among pregnant women, report lower rates of fetal alcohol syndrome than in the U.S. A peer-reviewed paper published in the Oxford University Press, described an “American Paradox” and a “French Paradox” whereby the high incidence rate of fetal alcohol syndrome in America does not correspond to the relatively low rate of alcohol consumption among pregnant women, and the high rate of consumption among French women does not seem to result in a high rate of diagnosed fetal alcohol syndrome among French children.
 
That’s not to discount the seriousness of fetal alcohol syndrome. The CDC calls it the number one most common cause of mental retardation that is completely preventable. The problem in educating women about drinking during pregnancy is there have not been any studies to determine exactly how many drinks and in what circumstances lead to fetal alcohol syndrome. Thus, the Surgeon General has taken the safest approach with the available knowledge: zero drinks during pregnancy to ensure children are born healthy.

Campbell said alcohol-related problems are more common than reported. She said it’s more accurate to consider fetal alcohol syndrome a disorder that manifests anywhere on a spectrum, so even if a child exposed to alcohol is not severely disabled, they still may suffer setbacks as a result of exposure. Campbell said symptoms can range from attention deficit disorder to general behavioral problems. The CDC estimates that as many as 4.5 children in 1,000 could be suffering from disorders as a result of alcohol exposure in the womb.  Beyond the spectrum theory, Campbell said fetal  alcohol syndrome is often misdiagnosed, or not diagnosable until a child is school-aged, when more advanced cognitive skills are needed.

“I think there’s enough research to say that drinking alcohol during pregnancy causes fetal alcohol syndrome,” Campbell said. “It’s the safest thing to say there is no safe amount.”

Kylie Mendonca can be reached at [email protected].