eLetters in response to:

Elizabeth R. Disney, William Iacono, Matthew McGue, Erin Tully, and Lisa Legrand
Strengthening the Case: Prenatal Alcohol Exposure Is Associated With Increased Risk for Conduct Disorder
Pediatrics 2008; 122: e1225-e1230.

Sources of Financial Assistance: None.

Conflict of Interest: We are founders of Winedoctors.com, dedicated to transparency and accuracy of information as it relates to moderate wine consumption. We are also wine makers.

To Whom It May Concern:

Re: PEDIATRICS Vol. 122 No. 6 December 2008, pp.e1225-e1230 (doi:10.1542/peds.2008-1380)

“Strengthening the Case: Prenatal Alcohol Exposure Is Associated With Increased Risk for Conduct Disorder”/”What were you Drinking 17 Years ago?”

To the Editor: We are not often moved to respond, but when a scientific publication paints itself as “strengthening the case”, implying a movement or ordered momentum with an inherently bias looking to provide evidence based on a belief, rather than sound science, we sat down at our desks. As scientists we are bound to present evidence, but based on adherence to the scientific method. Research tells us that 20% of critical details of a recognized event are irretrievable after one year from its occurrence and 50% are irretrievable after 5 years.

Admittedly, studies of parous women and alcohol consumption are ethically challenged, and as a result, from which it is difficult to extract data. Rare reports have been published with tracking alcohol consumption prospectively in pregnant women. The original documentation of “Fetal Alcohol Syndrome” was indeed a case report of 3 pregnant native American women with no prenatal care, one of whom had diptheria, and all of whom were alcoholic, and generalized for generations of gravidas. This was our first retrospective confound. These were unique cases of extreme consumption.

We take issue with the following: The study starts with a homogenous 98% Caucasian population. Twin pregnancies have an inherent risk profile distinct from singleton pregnancies regardless of gestational age at delivery. IVF pregnancies carry their unique risk profile, not including Twin-twin transfusion syndrome, intrauterine growth restriction and discordant growth and different from spontaneous twins. Remarks regarding management issues that preceded twin deliveries, as well as mode of delivery were not included. There was no mention of the type of alcohol, wine versus beer versus spirits and whether binge drinking was observed. No mention is made of studies that show a higher rate of mental illness in parents of twins versus singletons.

We do not advocate the routine consumption of alcohol in pregnancy, but “Strengthening the Case” is a strong statement. Where were you 17 years ago?

1 Bradburn N, Rips L, Shevell S. Answering autobiographical questions: The impact of memory and inference on surveys. Science, New Series 1987; 236(4798):157-161. 2 Jones, KL and Smith David W; “Recognition of the Fetal Alcohol Syndrome in Early Infancy”: The Lancet: Nov 3, 1973 (999-1001). 3 Kallio, U; Parents of twins report more mental health symptoms than parents of singletons. European Society for Human Reproduction and Embryology, 7 Jul 2008.

Mary Jacobson, MD, MSc Assistant Professor Department of Obstetrics and Gynecology Stanford University

Lynn Gretkowski, MD Clinical Adjunct Faculty Department of Obstetrics and Gynecology Stanford University


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