Seek help for pregnant sister's drinking problem

Issue November 2003

Q:My sister is a respected corporate attorney, but I think she's behaving irrationally. Although three months pregnant, she has not curtailed her nightly three or four glasses of wine. As I understand it, drinking during pregnancy causes birth defects. She is something of a wine connoisseur, and when I raise the issue she reminds me that a number of women in the family, including our mother, drank a fair amount while pregnant, with no adverse consequences. Am I too worried? Is there something I can do?

A:Your concern is certainly well founded, though you may be overstating the risk and overestimating your power to influence your sister's behavior.

Virtually all reputable and governmental sources of information, including the World Health Organization, suggest that there is no known safe level of alcohol consumption during, and therefore advise abstinence as the only responsible course. While some contend that the risk of low-level drinking has been exaggerated, we are talking about how drinking increases risk, not contending that it predicts certain harm to the baby.

Nevertheless, because alcohol crosses the placenta, it can cause pregnancy problems such as bleeding, miscarriage and premature birth; Fetal Alcohol Syndrome (or the less severe Fetal Alcohol Effects), a set of lifelong abnormalities that may include low weight, slowed development, learning disabilities, abnormalities in face and body structure and faulty formation of various organs; and withdrawal symptoms just after birth if the mother is physically dependent on alcohol.

So, when your sister says that her drinking may well cause no harm, she's right; but your concern that it poses an unacceptable level of risk is also valid. Even in Ireland, where until recently many pregnant women were encouraged to get needed iron from Guinness, and up to 4 drinks a week were deemed acceptable, the guidelines now recommend abstinence. The change derives from studies showing that even such small amounts can affect fetal development. Given the preponderance of medical opinion, your sister's stance begs the question: why would drinking be so important to someone as to choose to take the risk? We might also mention that drinking during the period of breastfeeding also makes for an infant who is under the influence.

Whether you can influence your sister's choice is, of course, a whole other ball of wax. Assuming that sharing your concerns in a caring way has had no impact, it may be that you will simply have to live with your sister's choice and realize that it is hers. However, it might be reasonable to meet with her along with her husband (if there is one; you didn't mention), close friends, other siblings, or to join her in a discussion of the matter with her obstetrician, who may have more leverage. Before acting on any such plan, we would suggest you meet with us or another substance abuse specialist to review more of the specifics and develop a well-considered plan.