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Advising pregnant women to avoid alcohol

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To the Editor: I thank Cameron and colleagues for their timely report,1 particularly in the context of publicity for a new self-help book by economist Emily Oster, which questions advice about avoiding alcohol during pregnancy.2,3 I note with interest that Cameron et al’s study reports that proportionally more of the women who consumed alcohol beyond the first trimester were older and more highly educated.

Oster has commented in the media on the lack of randomised controlled trials and poor evidence of causality, even where there is a proven association.2,3 While unsurprising that someone without a health background can misunderstand how evidence is used clinically, it is concerning that responsible health advice is being questioned on this basis. The concept of a clinical trial of a recreational substance (such as alcohol or caffeine) to see if it causes any harm in pregnancy is plainly ridiculous.

Alcohol is a known neurotoxin that crosses the placenta.4 Studies of the effects of alcohol have consistently shown that even intermittent moderate to heavy (binge) drinking…