Top critical review
Expecting Better from this Book
Reviewed in the United States on October 24, 2018
I was excited to read this book - I bought it online when I found out I was expecting a child. There is a lot of hokum and pseudoscience surrounding pregnancy and health. I wanted a book that would cut through that and give an evidence-based survey of pregnancy-related topics, and hear the scientific community's consensus (as much as they have one) on those topics.
However, I was shocked seeing a review on the book talking about the "myth" that alcohol is inadvisable during pregnancy. Certainly the author isn't advising any amount of alcohol is advisable, given the overwhelmingly consensus on the issue from public health advocates?
I immediately read the entire alcohol part of the book. I soon learned not only would this book not provide me with the best evidence from health advocacy groups and scientist groups, they would provide evidence that directly contradicted it.
The author says it's fine to drink some alcohol during pregnancy, and details how much and why she thinks this. She walks through studies and literature on the topic that she examined. Given that the CDC, the American Pregnancy Association, the World Health Organization, National Council on Alcoholism and Drug Dependence, the March of Dimes, and others all agree and firmly say the best advice is to abstain from alcohol completely, I really needed an extraordinary explanation from the author as to why I should ignore those experts. Not surprisingly, I found her analysis underwhelming and unpersuasive, and not worthy of ignoring the consensus shared by experts in the field.
Ask yourself, who is a more trusted source? An economist writing a book to a mass audience for profit, or the March of Dimes, the CDC, WHO, American Pregnancy Association, the UK Health Ministry, Fetal Alcohol Syndrome scientists and advocacy groups? Do all those independent groups have a profit motive to give distorted and wrong health advice?
And fetal alcohol syndrome is not some one in a million risk that parents shouldn't really worry about. A recent study showed 1% to 5% of kids studied had fetal alcohol syndrome disorder, and it was being chronically under-diagnosed.
To be fair, while this has been the consensus for a while, you could find outliers when the author first wrote this book. For example, the UK's health ministry used not advise against very light alcohol use, but they have since examined emerging research on fetal alcohol syndrome disorder (FASD) and they now say the best advice is to abstain completely - joining the consensus among other health groups like CDC, WHO, etc.
So has the author been concerned about the emerging evidence since she wrote this book? I saw Dr. Oster was asked about recent studies showing that even light alcohol use was unsafe during pregnancy by a health journalist, and her answer was illuminating. Dr. Oster basically said for those studies she'd want to see them be replicated and more details about the links between behavior and harm. That's fine (we should fund lots of replication studies!), but note when she looked at studies that didn't find a danger for pregnant women to drink moderately - she didn't say "well I'm going to wait to see if these can be replicated and more detail provided" - she took them to the bank and said you can make conclusive decisions about your child's health outcomes based on these studies.
I would agree there is not an abundance of studies showing that a tiny amount of alcohol will lead to significant medical risks. But there have also been no similar studies showing that having one cigarette (or two, or three) during your pregnancy is a significant risk. So in this book, does the author similarly suggest smoking a very small amount of tobacco is perfectly acceptable, given the absence of studies? No, she follows the scientific consensus here. Why the double standard?
With things that pose a serious risk to children (like lead paint), we may not ever know exactly where the line is between what is harmless and what will irreversibly harm a child. When the activity is something that is avoidable, the scientific community generally urges avoiding it entirely.
I'm sure Dr. Oster is well-intentioned, but this is a book about health written for profit to a popular audience, and even in the best circumstances that is a fraught situation. There is a profitable market for people with academic credibility to sell a message that, while it goes against the consensus of the public health community, it's something many people want to hear. I hope the book gets updated with the many advances in our understanding of FASD, or at least explains why they have a double standard on very light tobacco use.