Days to go: 62听听听听听听听听听听听听听听
Waist size: 97 centimetres (38 inches)
Pregnant women can be forgiven for feeling bullied this week. First we鈥檙e told that drinking even small quantities of alcohol during pregnancy might reduce our chances of becoming grandmothers, by . Then the UK鈥檚 National Institute of Clinical Excellence (NICE) recommends that to check if they鈥檝e been smoking.
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As a pregnant woman, I can鈥檛 help feeling like I鈥檓 being clobbered with a great big stick.
I鈥檝e already complained about the guidelines for alcohol consumption during pregnancy, but having attended the press conference regarding alcohol consumption and sperm counts, I can鈥檛 resist pointing out what could be a major flaw in its conclusions 鈥� or at least how they鈥檝e been reported.
Harsh judgements
of Aarhus University Hospital in Denmark told a meeting of the what she had found when she compared men鈥檚 sperm counts with the amount of alcohol that their mothers said they had drunk in the months before they gave birth to these sons. The sons of mothers who drank more than 4.5 alcoholic drinks a week during late pregnancy 鈥� a drink being one 330-millilitre beer or a 120-millilitre glass of wine 鈥� had average sperm counts of 25聽million per millilitre, making them 鈥渟ub-fertile鈥� according to the standard classification. The sons of mothers who drank the least had average sperm counts of 40聽million/ml.
What鈥檚 odd about the study is that women classified as drinking 鈥渕ore than 4.5 drinks a week鈥� could actually have been drinking anywhere between 4.5 drinks a week and 20 drinks a week, because women consuming up to 20 drinks a week were included in the same category. It鈥檚 therefore quite possible that a handful of women who drank huge amounts of alcohol during pregnancy might have skewed the results 鈥� something the researcher herself admitted, but few media outlets chose to report.
Non-smoker? We鈥檒l see
I also bristled at the news that pregnant women in the UK could soon be breathalysed to determine whether or not they smoke. But given the harm that smoking can do to fetuses, I decided to see if the idea could perhaps be justified.
There鈥檚 no doubt that smoking during pregnancy is bad for a baby鈥檚 health, raising the risk of miscarriage, preterm birth, low birthweight and lower IQ. It also seems that doctors and midwives are struggling to find the time and resources to identify pregnant smokers and help them quit, so a breathalyser might seem like a good way of doing this.
NICE cites a recent study in which Zara Usmani of the University of Glasgow, UK, and her colleagues compared what 2584 pregnant women told healthcare workers about smoking with what measurements of carbon monoxide (CO) in their breath suggested was in fact the case. They found that 206 women who claimed to be non-smokers had CO levels higher than 2 parts per million (ppm), suggesting that they might in fact be smokers ().
They also concluded that around 27 per cent of smokers said they weren鈥檛 when asked at their first midwife appointment.
We鈥檙e NICE, really
NICE insists that the test won鈥檛 be compulsory, should be given in a non-judgemental way, and isn鈥檛 designed to catch women out. However, it recommends that only women with a CO reading of 7聽ppm or more should be referred to services that will help them stop smoking. The assumptions behind Usmani鈥檚 study suggests that this cut-off will not detect a large number of smokers.
NICE adds that women who admit to being light or infrequent smokers should also be referred if they register a reading of 3聽ppm, while 鈥渘on-smokers鈥� with a reading of more than 10聽ppm should be advised about possible CO poisoning as the result of a gas leak.
All of this raises the question of what will happen to women who say they don鈥檛 smoke, but whose CO readings suggest they do 鈥� although they鈥檙e not as high as 7聽ppm. A previous study found that a cut-off of even 6聽ppm frequently missed people smoking less than six cigarettes a day and even some smoking 10 per day ().
Midwife or policewoman?
Will midwives turn a blind eye to women with similar readings who claim they don鈥檛 smoke, or will they judge them as liars 鈥� in which case, what will they do about it? I certainly wouldn鈥檛 want to be a midwife in that difficult position.
Another problem is that CO is eliminated from the body fairly quickly 鈥� within around 4 hours of smoking a cigarette (). So if a woman was set on deceiving the authorities, it wouldn鈥檛 be that difficult to do.
It鈥檚 true that breathalysing women may serve to make them more aware of the harm they could be doing to their babies, or warn them that their child is being exposed to smoke, even if they don鈥檛 admit to being the source.
However, it seems unlikely to stop die-hard smokers who don鈥檛 want to quit, or women who enjoy the occasional cigarette and don鈥檛 want to be made to feel guilty about it. Then there are the pregnant non-smokers like me, who may just feel resentful of being made to feel that we鈥檙e being watched.
Read previous Bumpology columns: Why can鈥檛 my baby sleep when I do?, Choosing the sex of your child, Pregnant at the cheese and wine party, Is my baby making me forgetful?, What does an amniotic cocktail taste like?, My fetus is smarter than an earthworm, Ultrasound reveals breastfeeding mechanics, Boxing clever with the kung-fu fetus, Can old wives鈥� tales tell me my baby鈥檚 sex?, Active fetus, boisterous child? Uh-oh.
