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Poring Over Poo Is Yet Another Example of Increasing Policing of Pregnancy

04/05/2016 16:41

A Scottish hospital is to start testing meconium - the first faeces passed by newborns - to establish how much their mothers drank in pregnancy. This is reportedly to pave the way for more targeted interventions among pregnant women and enable healthcare professionals to establish which "groups" are failing to disclose just how much alcohol they are consuming.

The researchers believe they may well uncover wealthier, educated women disguising their habits - noting "it's much easier to conceal problem drinking if you are affluent and if you are clever." At least they are not concealing their objectives.

Less than a year ago, another team of researchers who analysed drinking patterns among ‎UK pregnant women - while finding no evidence of negative birth outcomes among those who reported consuming alcohol - declared there to be an "urgent" need for the development of a biological marker that could establish how much a woman had drunk during pregnancy - ie a test that is independent of the woman's word. If you can't trust women to tell the truth apparently, you must find a way to extract it from her - or indeed via her newborn, and the baby's first bowel movement is in principle one way of doing this. Meconium, the tarry substance which accumulates in a foetus from around the second trimester, carries molecules that have been ingested in the womb.

Despite the very best efforts to obtain it and a series of systematic reviews, there is no convincing evidence of harm at low to moderate levels of alcohol consumption during pregnancy. Some studies have demonstrated positive neurodevelopmental outcomes and other benefits for the children of mothers who drank set against other pieces of research which conclude the opposite. Either way, the impact - an IQ point or 2 either up or down - is unlikely to affect lifelong outcomes. This notwithstanding, abstinence is advised and women report dramatically reducing their alcohol intake during pregnancy, with the majority abstaining altogether. Indeed, alcohol consumption in pregnancy has fallen sharply over the years. In 1998, 2/3 of women reported drinking during pregnancy. By 2010, this was 40%. Most recent figures from the ONS show just one in ten pregnant women reported drinking in the last week.

Pregnant women today will go to considerable lengths to protect and promote the wellbeing of their foetus, and are very worried by any suggestion they could be causing harm. At bpas, we see women so anxious about the damage they may have caused by alcohol consumed before they knew they were pregnant they consider abortion. But a small number of pregnant women will drink excessively, and heavy alcohol consumption across pregnancy is associated with more negative outcomes. People's lives are complex, their reasons for relying on alcohol diverse, and being pregnant does not change that - if anything the reverse. Even among these women, only around 4 to 5 percent will deliver babies affected by Foetal Alcohol Syndrome or FAS, which is characterised by facial dysmorphology and cognitive impairments . In England, 252 people received a diagnosis of FAS in 2013. In Scotland there were on average 10 diagnoses a year between 2010 and 2013. While some children may not display the full physical features associated with FAS, they may nevertheless be deemed to be affected by associated neurodevelopmental difficulties falling under the broader label of Foetal Alcohol Spectrum Disorder, or FASD - the prevalence of which is unclear.

While alcohol is obviously the common denominator in FAS and FASD, it is nevertheless a very complex condition. Socioeconomic status appears key, with research showing the risk of having a baby affected by FAS is 16 times higher among more deprived women than their more affluent counterparts - even with the same levels of consumption. The nutritional status of the pregnant woman also appears to play a significant role, with studies showing major nutritional deficiencies among those mothers with affected children. Genes, age and number of children are also all in the mix.

This Scottish study will involve collecting meconium and a blood spot sample from 750 babies, with their mothers' consent, over the course of a year. Researchers say the data generated will allow better targeting of interventions to reduce alcohol consumption in pregnancy and enable them to compare the relative efficacies of meconium and blood spot samples for working out the extent of prenatal alcohol exposure.

All those involved and interested in women's reproductive health and advocacy need to get to grips with this emerging science, which is developing in a context in which pregnancy seems increasingly policed, and women held accountable for all manner of outcomes in their offspring - from obesity to autism and asthma. If meconium testing starts in the UK, it deserves real consideration as to the social, medical and ethical issues it raises. We must engage with these, and consider the consequences - for the woman, her child, and their relationship. Evidence of exposure to alcohol in utero is a long way from a diagnosis of FASD. How will this information be gathered, how will it be used?

Ultimately, we support babies by supporting pregnant women. We support pregnant women by fostering an environment of trust where a woman who is struggling with any issue in her pregnancy knows she can confide in those caring for her, and receive non-judgmental support. In the United States, where women can face punitive measures for substance abuse in pregnancy, women end pregnancies for fear of the consequences of continuing. Even in the absence of criminal sanction, pregnant women may feel scrutinised and stigmatised to the point they may avoid seeking ante-natal care altogether. The suggestion that her baby's first motion may be gathered to test whether she was being truthful is unlikely to prove conducive to an atmosphere of confidence and support.

"Newborns tested for alcohol after shock research shows 42% of mums drink while pregnant," ran the frontpage of the Herald which broke the story last week. The real shock here is that we're not more shocked by poring over poo to catch women out.

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