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Drinking in Pregnancy

ASSOCIATION OR CAUSE?

It is important to be clear about the difference between the two terms association and cause. A substance taken by the pregnant woman can be completely harmless to the foetus or it can be associated with foetal harm or it can be the cause of the harm to the foetus. 

An association between foetal harm and a particular substance is found when harm (usually similar in most cases) is found when the mother has taken an identifiable substance during pregnancy. It basically means that most of the women who give birth to babies with particular forms of damage are women who have used the same substance when they were pregnant. This does not mean that the substance under investigation has been shown to be the cause of the harm. 

For a relationship to be seen as causal there has to be three aspects present;

1. The connection between the use of the substance and the harm is seen more frequently than could happen by chance.
2. The connection between the use of the substance and the harm cannot be explained by the design of the research project (this means that if a research project only collected information on alcohol consumption in pregnancy but not consumption of other drugs then the design of the project was poor as any foetal harm would then be attributed to alcohol.
3. The connection cannot be explained by "confounding" factors. These are other behaviours or substances, which may also be linked to features of FAS such as poor diet.

References:

• Abel E (1998) Fetal Alcohol Abuse Syndrome Plenum Press New York
• Institute of Medicine (1996) Fetal Alcohol Syndrome National Academy Press Washington D.C.