麻豆传媒

Days to go: 83听听听听听听听听听听听听听

Waist size: 91.5 centimetres (36聽inches)

I鈥檓 in the south of France this week, for a party with my French in-laws. Under normal circumstances I鈥檇 be looking forward to relishing fine wines and local cheeses. However, this would go against all the current health advice thrust upon pregnant women from the moment they conceive. Even is now apparently frowned upon.

I鈥檓 clearly not alone in feeling slightly hard done by and somewhat confused by all these messages. A about whether someone could drink a couple of glasses of wine at a wedding generated 69 responses 鈥� with vitriolic arguments from both sides.

The UK government 鈥� along with the US, France, Canada, Australia, New Zealand, Ireland, the Netherlands and Spain 鈥� currently advises pregnant women not to drink any alcohol, although it also says that if you do decide to drink, 鈥渃onsume no more than 1 to 2 units once or twice a week鈥�.

To me, this sounds like anything up to 4 units a week might be fine. But does it make any difference if I have them all in one go? At the other extreme, the US advises all women who are intending to get pregnant to avoid alcohol.

Perils of the pledge

So exactly what is a safe amount of alcohol during pregnancy? No one knows, says Patrick O鈥橞rien of the UK鈥檚 Royal College of Obstetricians and Gynaecologists (RCOG). But he adds that light drinking (1 to 2 units, once or twice a week) is extremely unlikely to be harmful to the baby.

Indeed, found that boys born to mothers who drank 1 to 2 units per week were less likely to have conduct problems and hyperactivity at the age of 3 than those born to abstainers. Girls of such mothers, meanwhile, were less likely to have emotional symptoms and peer problems.

The children of moderate drinkers (consuming 3 to 6 units a week) seemed roughly similar to those of abstainers, but there was an increased risk of behavioural difficulties in the children of women who drank more than 7 units a week ().

However, light drinkers were more likely to be better educated and from higher-income households than abstainers, which may explain the differences in the children.

How much is too much?

I鈥檝e also been scouring the literature to work out if there鈥檚 a point above which there is definite evidence of harm. , 45聽per cent of women who drank more than 2聽units a day (or a medium-sized glass of wine) during their third trimester had a . Disabilities at birth are three times more common in the infants of women who drink more than 4.5聽units a day 鈥� equivalent to three glasses of wine a night 鈥� compared with light drinkers and abstainers. Worse still, drinking more than 6聽units a day can cause miscarriage and heavier drinking carries the risk of .

So drinking even one glass of wine every night seems like a bad idea.

Vivienne Nathanson of the British Medical Association 鈥� 鈥� agrees: 鈥淒rinking every day at just within the safe limits is probably going to be harmful for the baby,鈥� she says. But binge drinking is likely to be more harmful, she adds, because the more alcohol you drink, the more alcohol you鈥檙e exposing the fetus to.

Until relatively recently, UK midwives told women that up to 8聽units a week was probably OK. When pressed, even Nathanson admitted that this was unlikely to cause problems. 鈥淚 think that would probably be the maximum, but we would always err a little bit lower than that.鈥�

Never say never?

So why advise women to abstain? For one thing, we don鈥檛 know whether very small amounts of alcohol raise the risk of problems or not, says Nathanson. 鈥淲e also know that a lot of people drink a great deal more than they think they do, because what they think is a unit is in fact several units,鈥� she adds. 鈥淎bstinence is an easy thing to measure.鈥�

Then there鈥檚 the risk that researchers will establish a link between very low amounts of alcohol and harm to the baby in the future. 鈥淚f you鈥檙e going to take the precautionary principle, saying 鈥楾ry to give up completely during pregnancy鈥� seems to be a very simple approach,鈥� says Nathanson.

However, medical ethicist of the University of Otago in Dunedin, New Zealand, says this is a dangerous attitude. 鈥淎s the list of behaviours that pregnant women are advised to avoid continues to grow, so too will the likelihood that pregnant women will end up feeling rather picked on,鈥� he says in a paper in the Journal of Medical Ethics ().

鈥淭he danger, perhaps, is that many of them will abandon reliance on medical evidence and epidemiological research altogether, and simply rely on anecdote or instinct.鈥�

The rules

Based on the conversations I鈥檝e had this week, I鈥檝e developed my own set of rules for what seems reasonable 鈥� although I鈥檇 advise other women to weigh up the risks for themselves: after all, fetal alcohol syndrome is an extremely serious condition.

• Avoid drinking during the first trimester. But if you didn鈥檛 realise you were pregnant, don鈥檛 worry too much, and just stop drinking now.
• If you don鈥檛 want to abstain during pregnancy, try and stick to 1 to 2 units once to twice a week, but if you occasionally drink a little more than this (up to about 8聽units a week), it鈥檚 probably fine.
• Find out , and remember that some wines and beers are stronger than others.
• Try to spread your drinks out as much as possible to avoid exposing your baby to high concentrations of alcohol.

Cheesy grin

As for cheese, the reason pregnant women are told to avoid soft and blue-veined varieties is because of a risk of listeriosis, a type of food poisoning that can trigger birth defects and miscarriages. But just how big is the risk?

According to the UK鈥檚 , there are around 230 recorded cases of listeriosis in the UK per year, making it pretty rare. Some of these are triggered by eating cheese, but certainly not all are. .

Pregnant women are at increased risk of developing listeriosis because their immune system is weakened, which is why they are told to avoid soft, mould-ripened and blue-veined cheese. People over the age of 60 are also at risk, says Bob Martin of the Food Standards Agency. 鈥淭here is a depression in immune system function as we get older, so older people are more likely to get it, and if they do get it they鈥檙e more liable to get a serious illness.鈥�

So it鈥檚 a small risk, but a serious one. But there is some good news: cooking these risky cheeses should kill the bacteria that cause listeriosis, meaning I can eat goat鈥檚 cheese tart. Yay!

Read previous Bumpology columns: Is my baby making me forgetful?, What does an amniotic cocktail taste like?, My fetus is smarter than an earthworm, Ultrasound reveals breastfeeding mechanics, Boxing clever with the kung-fu fetus, Can old wives鈥� tales tell me my baby鈥檚 sex?, Active fetus, boisterous child? Uh-oh, Why do I loathe lettuce?, How does stress affect my fetus?.