More than 3.3 million women are at risk for alcohol-exposed pregnancies, which can result in birth defects, developmental disabilities, miscarriage and fetal alcohol syndrome, according to a U.S. Centers for Disease Control and Prevention report published Tuesday.
What's more, three out of four women who reported wanting to get pregnant "as soon as possible" continued drinking alcohol.
News agencies and social media, however, focused on a secondary part of the report, which warned women who aren't trying to get pregnant that alcohol exposure could harm unborn babies if they accidentally did get pregnant. News agencies interpreted the report as a mandate that all women of childbearing age who aren't on birth control shouldn't drink. At all. Ever.
"CDC to Women: Protect Your Womb From the Devil Drink," sneered The Atlantic. Slate wondered: "CDC Says Women Shouldn't Drink Unless They're On Birth Control. Is It Drunk?!?"
Jezebel, Elle and USA Today all expressed (righteous) outrage at the idea that a government agency should suggest an entire population of adult women stop drinking because of theoretical fetuses.
Just one problem: That's not quite what the CDC said
"We definitely didn't make any recommendations for women who are pre-pregnant," said Lela McKnight-Eily, an epidemiologist and clinical psychologist on the Fetal Alcohol Syndrome Prevention Team at the CDC.
"It's more a matter of women knowing and being informed that if they are drinking alcohol, sexually active and not using birth control, that they could be exposing a baby to a teratogen, and that could cause fetal alcohol spectrum disorders," McKnight-Eily said.
The warning was really directed at the three out of four women who reported wanting to get pregnant "immediately," but who said they continued drinking as they tried to conceive.
It was intended to inform women about the risks of alcohol and pregnancy (both expected and unexpected) -- not to control the behavior of women who aren't trying to have a baby.
"Women should have conversations with their health professionals about drinking alcohol and their health, in general, "McKnight-Eily added. "Particularly if they are planning to get pregnant or trying to get pregnant, this should be part of the conversation that they're having."
McKnight-Eily declined to comment on the Internet backlash unleashed by the report.
What the report really said
The report rightly noted that half of pregnancies in the United States are unplanned, and found no difference in alcohol consumption between women who were trying to get pregnant and women who weren't.
While the report did note that sexually active women of reproductive age who drink alcohol and don't use birth control are at risk for alcohol-exposed pregnancies, the thrust of the warning was directed at the group actively trying to conceive.
“Every woman who is pregnant or trying to get pregnant -- and her partner -- want a healthy baby," Coleen Boyle, director of CDC’s National Center on Birth Defects and Developmental Disabilities, said in a statement. "But they may not be aware that drinking any alcohol at any stage of pregnancy can cause a range of disabilities for their child."
Who's at risk
According to the report, which surveyed more than 4,000 non-pregnant, non-sterile women between ages 15 and 44, the highest risk for alcohol-exposed pregnancy was in women between the ages of 25 and 29, who were married or cohabitating, and had given birth to one child previously. Women who smoked were at a slightly higher risk of having an alcohol-exposed child than nonsmokers.
There also was a link between a mother's education and alcohol-exposed pregnancy. That finding tracks with previous CDC research showing that alcohol use during pregnancy is twice as common among women with college degrees than among women with high school diplomas or less.
Experts say the guideline isn't realistic
"People can take six months to get pregnant. They can take a year to get pregnant," Amy Bryant, an assistant professor of obstetrics and gynecology at the University of North Carolina, told The Huffington Post. "Personally, I think it’s a pretty unrealistic mandate."
Despite the paternalistic undertones many saw in the CDC's message, Bryant noted that the agency is simply trying to give clear guidance to women about their reproductive health.
"They see the cases of fetal alcohol syndrome," she said.
Advising women about drinking during pregnancy is particularly fraught, since drinking during pregnancy hasn't been studied much, largely for ethical reasons. As a result, the CDC takes a hard-line stance: No amount of alcohol is safe during pregnancy.
"It's really unclear what the effect of alcohol is on miscarriage and on conception," Bryant said. "It’s probable that that one glass of wine is not going to do anything, but you tell women that it’s safe to drink in pregnancy and then you end up with all this fetal alcohol syndrome -- and it is entirely preventable."
While the CDC team could have framed the recommendation better, the new report is in line with the agency's long-held stance on alcohol during pregnancy.
"There isn't a new guideline. It's been recommended for decades that women not drink during pregnancy," McKnight-Eily said.
"We think that there are a lot of mixed messages out there, and we want to give women a clear message that there is no safe time, there is no safe amount or type of alcohol to drink during pregnancy."
In trying to cut through this misinformation and simplify mixed messages for women, the CDC's public health message got confused, giving many the impression it was more punitive than clarifying.
"They really do want people to be aware, even in early pregnancy, alcohol can affect a fetus," Bryant said. "But I think it's a little excessive to say that any woman who's not on contraception shouldn't drink."