A Tale of Two Books for Moms To Be

It seems in the world of FASD it’s one step forward and five steps back. Just when we are making progress, and word is getting out that consuming alcohol while pregnant is not advised, someone questions the evidence and gains an audience to keep the debate raging on.

The first published literature that linked prenatal alcohol use with birth defects was in France, in 1968, by Dr. Paul Lemoine. In 1973, researchers at the University of Washington published their findings regarding a group of children who shared uncommon physical features and developmental delay. These children all had prenatal alcohol exposure. The term Fetal Alcohol Syndrome (FAS) was created to describe the patterns observed in these children.

FAS has evolved into different diagnostic terms for different countries, but prenatal alcohol exposure remains the common thread.

I want to state, this is not shaming and blaming. FASD prevention is complex and is not only a woman’s issue. People are frustrated that even when presented with current evidence, and there are no social determinants of health involved, some continue to disregard the guidelines that state there is no safe limit or time. Some think that lack of evidence means there is no evidence, so that means it’s safe. Some use their platform to share misleading information.

So what has prompted this resurgence of the debate? The recent release of an update to a book that suggests it is safe to drink alcohol during pregnancy. Below is a review a fellow advocate asked if I’d share. I have not read the book. Many in the FASD Groups I belong to have. What I did find interesting, in reading the reviews on Amazon, is that despite many noting the author does not cite enough about the scientific studies or provide much evidence, they still rate the book highly and feel safe drinking alcohol!

It appears the author came to her conclusions using statistical interpretation.

According to the Centers for Disease Control, the odds of being struck by a car in the United States is about one in 4,292. Does that mean I will never be around cars? No. But does that mean I take precautions around cars? Absolutely! Same with alcohol. Does every child who was exposed prenatally to alcohol will develop FASD? No. But in the United States 1 in 20 children born will have FASD.

So why drink a substance that is known to cause FASD. Why not pass on the alcohol for nine months?

Here, with some minor edits, is her review on the book, Expecting Better.

The fact that 792 people have given this book a rating of near 5 stars on Amazon.com is petrifying, when you consider that this non-medical-professional, economist author is advising women to drink while pregnant, even though the Centers for Disease Control clearly states that no amount of drinking during pregnancy is safe or acceptable. The idea that (this woman) could be ruining so many lives with her reckless advice is both outrageous and heartbreaking.

The author is very UNpopular on the closed Facebook page, Parenting Teens and Adults with FASD (membership 3,192) and that is because the (caregivers) on that page live with … FASD every day, and as bad as it is for them, it’s so much worse for their children (with FASD).

Most people probably don’t even understand what FASD is. It is not just a little brain damage, not just a little ADD. (Many) people with FASD can’t hold jobs as adults. Fewer than 20% will ever live independently.  Many are prone to anger outbursts, rages, addiction, jail-time and homelessness. Many have ethical problems, sometimes sexual problems. They tend to have poor working memory and low processing speed.

If you parent a child with FASD, you very likely may never even get any financial support in the form of SSI or SSDI because they tend to have strong verbal skills and present as more capable than they are (The Centers for Disease Control calls this an “invisible disability”). Knowing this, why would anyone ever risk it?

I don’t understand how someone with a background in business and economics feels that she can override advice given by the Centers for Disease Control regarding pregnancy and drinking….but (the author) clearly feels this is not an issue. If you want to take risks with your unborn child, go ahead and drink through your pregnancy. You might think your baby is fine for the first couple years…as most kids with FASD don’t receive their diagnoses until around age 11-12.

Don’t use Emily’s flawed logic as an excuse to drink during pregnancy. If you need help quitting, seek help.

A better book to read about this entire topic is one by Susan D. Rich, MD, an actual – YES, ACTUAL DOCTOR – who has researched FASD tirelessly and written an actual QUALITY book called “The Silent Epidemic: A Child Psychiatrist’s Journey Beyond Death Row”.

(Dr. Rich) will explain how consuming even a very small amount of ill-timed alcohol during pregnancy can cause FASD. But she also proposes many solutions.

One last suggestion – if you have been harmed by the advice in Emily’s book, perhaps consult a lawyer to see if you have any legal recourse.

FASD: It’s time to Stop the Debate.


There should be no more debate. It truly is time to stop. It is time for Society to address the factors that contribute to prenatal alcohol exposure. It’s time for alcohol companies to take responsibility and be legislated to label and include warnings in advertisements that alcohol is a teratogen – responsible for a lot more than FASD.

I understand people do not want to be told what to do. No one wants to be told what to do. I don’t like to be told what to do.

Using the car analogy again, do I cross the street in front of an oncoming car because I feel being told not to cross the street in front of an oncoming car is an invasion of my personal rights or freedoms?


I would not walk in front of a car because I know there is a the risk that I would be hurt or killed.

Not everyone who walks in front of a car will be hit, injured or killed. The driver might be able to stop, avoid impact, or a person may walk away with a bump or bruise. But I still wouldn’t do it just in case I was seriously injured or killed.

But consuming alcohol while pregnant is a risk factor for so much. Why take the risk?

There is no evidence that says light drinking is safe.

How much alcohol is safe during pregnancy?

But don’t take my word for it.

Check out Proof Alliance’s Pregnancy and Alcohol Calculator.

From the article Drug Use in Pregnancy:

In general, drugs unless absolutely necessary should not be used during pregnancy because drugs taken by a pregnant woman can reach the fetus and harm it by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the growth and development of fetus.

From University of California San Francisco:

Drinking alcohol can increase the risk of miscarriage, stillbirth, newborn death and fetal alcohol syndrome (FAS). Since it is not known if there is a safe level of alcohol during pregnancy, the best advice is not to drink at all. Even one drink a day has been shown to have effects on the growing fetus. The best time to stop drinking alcohol is before you conceive. If your pregnancy is unplanned, you should stop drinking as soon as you suspect you are pregnant.

A may may not be affected. There are other factors at play. And yes, the timing and the amount of alcohol have an impact. But people should look at the latest peer reviewed research from respected scientific journals and sources. Not business economists. 

From the National Institute of Health:

Have you ever heard the term ”psychoactive drugs?”

Drugs in this category act on the central nervous system and and alter its normal, everyday activity, causing changes in mood, awareness, and behavior. Psychoactive drugs disrupt the communication between neurons (brain cells), so abusing them can have serious short- and long-term effects on the brain.

Psychoactive drugs include four groups of drugs: depressants like alcohol and sleeping pills; stimulants like nicotine and ecstasy; opioids like heroin and pain medications; and hallucinogens like LSD.

What about the warnings?

According to the CDC and the U.S. Surgeon General, “There is no known safe amount of alcohol to drink while pregnant. There is also no known safe time during pregnancy or safe type of alcohol.”

The American Academy of Pediatrics also takes a stance against drinking during pregnancy, “There is no safe amount of alcohol when a woman is pregnant. Evidence-based research has found that drinking even small amounts of alcohol while pregnant can increase the risk of miscarriage, stillbirth, prematurity, or sudden infant death syndrome.”

For more reports, check out: these studies.

From the Canadian Pediatrics Society:

If you drink (beer, wine, coolers, liquor) while you are pregnant, the alcohol will pass through your bloodstream to your baby.

Drinking while pregnant can cause fetal alcohol spectrum disorder (FASD), a serious condition that affects a child for life.

From Australia:

Associate Professor Carmela Pestell of the University of Western Australia, a researcher at the Telethon Kids Institute, said as many as 60 per cent of expectant mothers in Australia report drinking, despite expert advice that there is no known safe limit for alcohol consumption in pregnancy.

Professor Pestell said: “We know that women do not intend to harm their babies, but many unhelpful myths persist that it is okay to drink during pregnancy. We do not know how much is actually safe to drink and so medical guidelines recommend that the safest option is not drinking. Many women are unaware of this, or lack support to give up drinking even when they are trying for a baby or breastfeeding.”

Yes, we all have a right to make our own choices and decisions. But what about the unborn child? The placenta does not protect the baby from alcohol. When mom drinks, baby drinks. Fifty years of published research has shown alcohol to be a teratogen, a toxic substance to a developing baby, and can interfere with healthy development causing brain damage and other birth defects.


As a side note: In researching for this post, I came across this presentation Is it Safe? During Pregnancy and For Mom and Baby developed and produced in partnership by Healthy Child Manitoba Office and Healthy Start for Mom & Me which lists facts and myths. Their advice:

  • No amount of alcohol is safe.
  • There is no safe time to drink during pregnancy.
  • Wine, beer, coolers, hard liquor and home-made alcohol can all cause harm.
  • Stopping or cutting back on drinking alcohol during pregnancy reduces the risk of harm to your baby’s development.

Even the World Health Organization recommends abstinence during pregnancy.


This is more than a tale of two books.

It’s a comparison of the experience and knowledge of a subject.

One written Emily Oster, an American Professor of Economics, with no medical background, who studied data to arrive at conclusions about what women should or shouldn’t do during pregnancy. 

Another written by Dr. Susan D. Rich, psychiatrist and international speaker with a background in public health who for the last twenty five years has been developing programs and services for individuals with FASD. A woman who has seen first hand the results of prenatal alcohol exposure. And Dr. Rich’s book is backed up by the medical experts noted above.

Backed by the combined knowledge researchers and experts.

So, who are you going to base your decision about alcohol and pregnancy on?

For myself, I might seek out Emily’s advice on a business decision, but I’d rather go to a medical professional about pregnancy.

I think I would also speak to people with FASD and their caregivers.

In the words of my daughter, who has Fetal Alcohol Spectrum Disorder, “just saying.”

Note: If you are able, for your health and the health of your baby, go alcohol free. If you discover or think you are pregnant and have previously had alcohol, if you can, stop as soon as you suspect or know. And if you are unable to stop, I hope you can reach out for support during and after your pregnancy.