'I can't serve you. You're pregnant'
Dining with a friend in California last month, a member of popular parenting website BabyCenter was aghast when a waitress refused to serve her alcohol because she was pregnant.
"My friend ordered a glass of wine and before the server walked off, I said I would like one as well," she wrote.
"She said she can't serve me. I said, 'My OB says a glass of wine in moderation is ok.' She replied that she has heard that before and still refused to serve me. I was flabbergasted, embarrassed and downright p*ssed. I ate my meal with my friend and decided not to make a scene. When I got home that night I looked up the law. Essentially she violated my civil rights, and discriminated against me."
The incident set comment feeds afire, with impassioned arguments from both sides of the great moral divide as to whether restaurants have the right to refuse service and, indeed, if one should indulge in even the occasional tipple while pregnant.
The hotly debated post was published the same day the findings of a Danish study on the effects of low and moderate drinking in early pregnancy were made available.
In the research, doctors from Aarhus University Hospital and the Institute of Public Health, Medical Psychology Unit at the University of Copenhagen, Denmark, looked at the incidence of adverse neuropsychological effects among five-year-olds whose mothers were recruited from the Danish National Birth Cohort during their first antenatal visit - with 1628 women taking part.
Defining lower levels of alcohol consumption as one-to-four drinks per week, moderate as five-to-eight and high levels as nine or more, and classifying binge drinking as five or more drinks in one sitting, researchers found that low-to-moderate weekly drinking in early pregnancy had no significant impact on IQ, attention span, or executive functions such as planning, organisation and self-control.
They also discovered that high levels of alcohol were associated with lower attention span.
However, the study authors stress that the amount of alcohol in a standard drink varies significantly from country to country and conclude that the most conservative advice for women is to abstain from alcohol during pregnancy.
"High prenatal exposure to alcohol has consistently been associated with adverse effects on neurodevelopment. Areas such as intelligence, attention and executive functions have been found to be particularly vulnerable. However, less is known about the effects of low to moderate, weekly average consumption levels and binge drinking," said co-authors Ulrik Schiøler Kesmodel and Erik Lykke Mortensen.
"Our findings show that low to moderate drinking is not associated with adverse effects on the children aged five. However, despite these findings, additional large scale studies should be undertaken to further investigate the possible effects."
Professor Elizabeth Elliott, faculty member of Paediatrics and Child Health at The University of Sydney and Children's Hospital, counters the findings by saying that foetal alcohol spectrum disorders such as birth defects, brain and organ damage and problems with development, growth and learning are well recognised and associated with differing levels of alcohol exposure during pregnancy.
She adds that it's impossible to set a "safe" level of drinking and warns that research suggesting otherwise could easily be misconstrued by a lay audience.
"We have to be very careful and the media has to be careful of these issues that are potentially harmful. If you've got someone who does drink during pregnancy they will be reassured with that sort of message and they'll think, 'Oh, that's fine. I can keep going,'" she said.
"One of the problems that women tell us is that they get mixed messages. They get messages that it's okay, not okay, one drink can hurt them, binge drinking is the only thing that hurts them.
"What we are saying is that the safest option - as the National Health and Medical Research Council and Department of Health and Ageing propose in their guidelines - is that women avoid alcohol during the period of pregnancy and when planning a pregnancy."
Currently pregnant with her first child, Ellen Adele has decided to abstain from drinking but says even that draws a reaction.
Recalling a recent dinner with a room full of doctors, she says they expressed surprise at her decision and suggested that the no alcohol rule is more to deter people from drinking excessively than anything else.
However, it's a theory she's unwilling to try out.
"I've heard that the guidelines are purposefully strict to deter problem drinkers, rather than prevent all alcohol consumption, but I don't want to make any decisions that might result in my baby being born with an abnormally small head," she said.
"Everything you read says there is not enough evidence about safe levels of alcohol consumption during pregnancy, and as such it's not a risk I'm prepared to take."
Beyond abnormal facial features and other visually evident birth defects, Vicki Russell, from Australia's National Organisation for Foetal Alcohol Syndrome and Related Disorders, says the true extent of foetal alcohol exposure can take years to establish.
"Determination of any adverse impact on a child probably cannot be qualified until the child is five-to-six years or more in age. Learning and memory cannot be easily assessed in very young children," she said.
"It affects the individual in very unique ways and will continue to affect each person across their lifespan, not just in infancy or childhood."
Laura Pulini isn't worried. Never a heavy drinker, the proud mum of one-year-old Isaac admits to having the odd glass of wine throughout her pregnancy after seeing friends and family members do the same without consequence.
Usually ordering a "watered down" drink such as a shandy or wine spritzer, she never felt judged for her decision and reports being readily served in restaurants.
"I would definitely be taken aback if someone felt the right to comment on my choice to enjoy the occasional drink throughout my pregnancy," she said.
"However I think if I was regularly getting intoxicated and drinking at a level that was unsafe then I would think it is more acceptable to step in and say something."
Adele agrees that while drinking in moderation while pregnant is a personal choice people are entitled to scientifically based opinions on pregnant women's behaviour and should intervene if it looks like they're going to harm themselves or their unborn child.
"From what I know about pregnant ladies, none of us take this business lightly," she said.
"My own super-high level of neuroticism seems quite standard across my cohort and as such I would assume that any woman I saw drinking probably only has one drink a month, and has researched the risks completely. Those women who drink like they're unencumbered, however, deserve the full wrath of the pregnancy police."
- Sydney Morning Herald