Study Finds New Mothers’ Drinking Puts Infant at Risk
Drinking alcohol while breast feeding may cause “slight but significant” damage to an infant’s motor development, according to a new study that calls into question the advice given to some new mothers that they have a drink to relax and ease breast feeding.
The study, published today in The New England Journal of Medicine, found that the 1-year-old children of women who had one to four drinks a day scored slightly lower on psycho-motor tests than children whose mothers had had less than one drink a day.
The difference in the children’s agility in skills such as crawling, balancing and throwing would be discernible only to a trained observer, according to the researchers. The two groups of children scored no differently on mental tests, which gauge a child’s intelligence or IQ.
Experts were somewhat divided Wednesday on the significance of the results.
“I would advise healthy skepticism, bearing in mind that this is the first study of its kind,” said Ruth E. Little, an epidemiologist at the University of Michigan who headed the study. “However, I would say that we can no longer guarantee that drinking during breast feeding is safe for the baby.”
Dr. Robert Welch, a specialist in maternal-fetal medicine, said: “We have to begin to rethink what the effect could be of advising alcohol . . . to help in breast feeding, and instead begin to think, ‘Maybe this isn’t such a good idea.’ ”
Welch, who directs the high-risk pregnancy unit at Hutzel Hospital at Wayne State University in Detroit, called that traditional advice “one of the old midwifery-type tricks.” He said some hospitals serve beer or wine with meals for nursing mothers.
Little estimated that 10% of breast-feeding mothers drink regularly in the United States. That percentage varies by region and is likely to be relatively high among affluent women on the East and West coasts.
The study, by researchers at the University of Michigan and the University of Washington, examined 400 children of white, well-educated, middle-class women. The women were placed in five groups reflecting their alcohol consumption, ranging from zero to four drinks a day.
A drink was defined as one bottle of beer, one glass of wine or one cocktail.
When the children were tested at one year of age, those whose mothers had drunk from one to four drinks a day scored an average of five points lower on a standard test that measures so-called psycho-motor skills, such as reflexes and movement.
The infants of mothers who had consumed at least one drink had an average score of 98 on the so-called Psychomotor Development Index; the others had an average of 103. In general, scores range from 50 to 150; 100 is the average in the overall population.
“In the typical child, a small decrease in motor skills at one year is not a disaster,” Little said in a telephone interview. “The kind of decrease we saw on average is something that only a trained person could pick up.”
‘Significant Finding’
Little and others said the effect may be most worrisome at a societal level. If small amounts of harm are done to large numbers of children, the impact is significant.
“This is a significant finding not so much from the individual patient standpoint but (because) of the impact of alcohol on society,” Welch said. “It’s the multiplication of the problem, the compounding of the problem, where you begin to detect an effect.”
Nevertheless, Little said the study is cause for concern.
“The baby is taking in a substance that is toxic,” she said. “I think that’s worth worrying about, especially because the baby’s brain is growing at a very, very rapid rate and we know the brain is vulnerable to alcohol.”
In addition, she said, “These were women who really didn’t drink very much, or were social drinkers, I would say. If you’re talking about women drinking more than that and nursing, I would worry about those women and the amount that their babies are getting.”
Precisely how small amounts of alcohol could be harmful remains unclear.
‘Exquisitely Sensitive’
In the paper, the researchers theorized that the infant brain may be “exquisitely sensitive” to small quantities of pure alcohol. Or, the infant may be unable to metabolize alcohol as quickly as an adult, so it accumulates in the child’s body.
As for why mental skills would be unchanged, Little said the answer could be timing: The infant’s exposure to alcohol might have occurred at a time when the part of the brain that controls motor skills was particularly vulnerable.
Or, she said, the mental tests may be too crude to pick up subtle changes.
Little suggested caution in interpreting the results, emphasizing that they need to be confirmed in additional studies. “I have two daughters (who are nursing their own babies) and I have not warned them,” she said. “I have not even mentioned (the study). I think it’s too preliminary.”
Dr. Cheston Berlin, a professor of pediatrics at Pennsylvania State University and adviser to the American Academy of Pediatrics, said he believed that one to two drinks a week would pose no problem to breast-feeding women, but one to two a day would cause him concern.
Only Occasional Drink Advised
La Leche League International, a 30-year-old group that provides information on breast feeding, advises nursing women to drink only occasionally. “When we’re saying occasional, we’re talking about once or twice a week at most,” spokeswoman Julie Stock said.
“If I had a patient who was having significant problems with breast feeding and having difficulty with milk let-down, I still would not be reluctant to go ahead and prescribe alcohol,” said Welch of Wayne State. “However, I would certainly have to caution them that this study exists and that they certainly would not want to use alcohol on any kind of chronic basis.”
Welch said the study also illustrates the fact that “physicians and mothers are up against it. There really is nothing that seems to be safe for the newborn that the mother can take to relax her to allow for successful breast feeding. What it really means is that families have to support their breast-feeding mothers. If they have a lot of encouragement and support, they’ll do far better.”
