Breast milk alcohol harms child brain: truth or fear-mongering?

OK. So be honest with me.

IF you’ve had a kid, and breast-fed them, tell me you haven’t had the occasional alcoholic beverage. If your partner's birthed a bub, tell me you haven't seen her partake occasionally.

Because let me tell you, (and I'll make it quick because Child Services will be knocking down my door in a minute), sometimes you just need one. When your body's been knocked around, you're sleep deprived, you've sorted the kid / your partner / the house / your work (in no particular order), sometimes you just want half a glass of [insert your preferred beverage].

I am not alone in this (as you will come to see) irresponsible and reckless behaviour. Accordingly to the World Health Organisation, up to 83% of breastfeeding women report consuming alcohol. Older maternal age, increased education, and longer breastfeeding duration are associated with increased alcohol consumption duration lactation.

Guidance over time has gone from "the occasional drink is fine" to "no alcohol at all during pregnancy and breastfeeding" to now "don't drink at all if there is any chance you could get pregnant". This guidance is off the back of the fact that over 50% of pregnancies are unplanned, ergo you don't know when you'll get pregnant, so safer not to drink at all.

In the CDC's words “women of reproductive age who drink alcohol and don't want to become pregnant should take birth control. And anyone who wants to become pregnant should cut out alcohol altogether.”

(Intellectually I can see what they're trying to achieve, and all I can say is "Thanks Grandpa for your oppressive, non-practical advice. It's right up there with the abstinence from sex policies. I’m super glad you can take away time from your browsing on chastitybeltsonline.com to educate me. Hey, how about this advice right back at ya “men who don’t want to father a baby or get STDs shouldn’t randomly stick their penises (penes? penii? pasta?) in people. No? Don't want to include that in your governmental health policies? My bad.")

🙄

Back to the article that started me on this rant.

A study in Pediatrics has found that mothers who drink alcohol while breastfeeding have infants with lower cognition scores by age 6 years.

(Wait, so now my 1st born kid will have to go to special school because I had a drink or two? And my 2nd born kid will have to go to an extra super dooper mega special school?!)

This study was plastered everywhere in the media, must be pretty important. What kind of study was it? An observational study, following 5,000 children from infancy to age 11 years.

(Ah, the good ol' observational study, level V evidence, the lowest of low.)

What about confounders? The finding was independent of prenatal alcohol consumption, sex (of the child - not how much you were getting when you were breastfeeding), child and maternal age, income, birth weight, breastfeeding duration, learning delay, head injury, and pregnancy and breastfeeding tobacco smoking.

What about after their cognition after age 6 years? The difference was no longer present by age 10-11 years.

(Phew. Well, how does drinking alcohol while breastfeeding (allegedly) mess with your kid's brain?)

The authors postulate that the decreased cognition was due to:

• Breast milk ethanol interfering with normal brain development;
• Increased cerebral cortex apoptosis and necrosis;
• Decreased myelination causing decreased processing speeds;
• A secondary change in feeding and sleeping, thereby modifying brain development or causing behavioural changes that reduce exposure to enriching stimuli.

(Fair enough. These all sound fairly science-y.)

THEN they hit you with this (and this is where I start to have my doubts):

“The reason why there is no association between breast milk alcohol exposure and decreased cognition at ages 11 is because there is 'increased' education.”

(So what education EXACTLY has your child been receiving prior to age 11 years? Because normally they have, you know, school. Are you saying that the transition from primary to secondary school magically negates any ill effects from substance exposure prior. ARE YOU?)

(It gets better… And for this bit I must quote verbatim:)

“A mother who uses alcohol while breastfeeding may have a current alcohol use disorder and be more likely to provide insensitive handling of her child or to have problems with self-regulation, impulsivity, impaired judgment, and the ability to make safe choices for herself and/or her child.”

(Wow, that’s some word slinging right there. OR, she might have had a long day and be feeling like a glass of wine and a foot massage is in order. I know, it’s a tenuous line between a relaxing wine and massage and gross child abuse and negligence, but I guess that’s life. Trust me when I say that half a glass of wine when you're dealing with a toddler and a baby makes for much more 'sensitive handling of children', and indeed the only 'impaired judgment' that may exist dates back to the time when you decided to have children in the first place.)

The authors are gracious enough to take time away from stabbing in the dark to discuss some study limitations:

1. Alcohol intake was recorded retrospectively. What this means is that you have just had a baby, you are pretty much the most messed up you’re ever going to be in your life – physically, psychologically, HORMONALLY – and someone asks you "What did you drink 6 months ago?". Seriously, $100 to a breastfeeding mum who can remember what she had for lunch that day.

2. Alcohol intake was averaged out. And here I hashtag #recall #accuracy #not

3. (And I quote) “The size of the relationship between breast milk alcohol exposure and cognition was small, and clinical implications are limited UNLESS MOTHERS DRINK LARGE QUANTITIES OR BINGE DRINK.” Wow, so this study is headlining, telling 83% of mothers that they’ve screwed with their kid's brain and this is in the fine print? I'd hazard a guess that if a pregnant or breastfeeding mum is binge drinking or an alcoholic, they got some other shizzle going on in their lives that could/would affect their child's cognition.

4. There was no record of the amount and frequency of breastfeeding, the timing of maternal alcohol consumption, or the amount of ethanol in breast milk (so to be clear, you didn't measure the stuff you were measuring. Whoops.)

5. The measure of cognition was not comprehensive (see point 4.)

So just to summarise - these authors found a relationship between drinking alcohol during breastfeeding and reduced cognition at aged 6 years – but the key factors in the study (you know, alcohol, breastfeeding, cognition) were poorly measured (or not measured at all) and relied on accurate and detailed recall by sleep-deprived, hormonally-challenged mothers, now being retrospectively accused of gross child negligence and abuse.

That's some quality evidence right there baby.

REFERENCES
Gibson L & Porter M. Pediatrics 2017; 142(2).
Haastrup et al. Basic Clin Pharmacol Toxicol.2014;114(2):168–173.
Lange et al. BJOG.2016;123(6):900–909.
Maloney et al. Birth. 2011;38(1):3–9.
Giglia & Binns. Drug Alcohol Rev. 2007;26(5):493–500.
Popova et al. J Obstet Gynaecol Can. 2013;35(8):695–696.
Nascimento et al. Pediatr. 2013;31(2):198–204.
Breslow et al. Breastfeed Med. 2007;2(3):152–157.
Wilson et al. Drug Alcohol Rev. 2017;36(5):667–676.