People who are pregnant or have recently given birth are typically under a lot of scrutiny. There are mom-shamers on every corner of the internet (and real life) ready to pounce on the next thing they're doing wrong. This is especially true in relation to breastfeeding: People are either doing it too long, not enough or too publicly for others' tastes. Now, a new study on alcohol in breast milk contributing to lower cognitive development in children is (understandably) fueling the shame-fire — but the results are not as straightforward as they may sound.
The research, published in the journal Pediatrics, examined data from 5,107 Australian infants who were evaluated every two years until the age of 11 as well as from their mothers, who answered questions on alcohol and tobacco use. The study found that increased or riskier maternal alcohol consumption during lactation was associated with reductions in abstract reasoning in their children at ages 6 and 7.
This decrease in cognitive development wasn't seen in children who were not breastfed. Additionally, once the children who were breastfed and demonstrated reduced cognitive ability at ages 6 and 7 reached ages 8 to 11, this association was no longer observed, which the researchers chalk up to the kids having increased levels of education.
The researchers also note that this is the first study "to directly examine cognitive outcomes in relation to lactational alcohol and nicotine exposure" — so these findings could have far-reaching effects on guidelines on alcohol consumption while breastfeeding. But the results are more nuanced than many reports make it seem. Here are a few important caveats to keep in mind about this particular study.
Breastfeeding & alcohol-consumption rates are different in Australia
In this particular study, 91.7 percent of the children had been breastfed at some point, while 8.2 percent had not. So how does that stack up against the American population? According to the Centers for Disease Control, approximately 82.5 percent of children in the U.S. were breastfed at some stage — in other words, a rate significantly lower than the study population in Australia.
Also, the culture surrounding alcohol consumption is different in Australia. For instance, a study published in the journal BMJ Open in 2015 found that 40 to 80 percent of pregnant individuals in Australia, New Zealand and the U.K. drank alcohol while expecting compared to about 10 percent of pregnant people in the United States according to the CDC.
Why does this matter? The mothers in the study answered a 10-question survey to determine whether their alcohol use could be deemed "risky," but given the cultural differences in alcohol consumption (both in general and during pregnancy), a person's perception of their alcohol use may not be consistent across countries.
If this were a randomized, controlled trial (where one group receives a set amount of alcohol during pregnancy and another doesn't and then the effects are tested later), the findings would be stronger.
An incomplete picture
There are several limitations to the study that have made some people question the results, including Dr. Diane Spatz, a professor at the University of Pennsylvania School of Nursing who did a visiting professorship in Australia in 2007, and Dr. Melissa Bartick, an assistant professor of medicine at Cambridge Health Alliance and Harvard Medical School, neither of whom were involved in the new study.
First of all, the study does not detail the effect of just alcohol consumption in lactation, Spatz told CNN, noting that a high level of alcohol exposure in pregnancy could also affect a child's cognition.
In addition, the study does not make a distinction between mothers who breastfed exclusively or whether there was any kind of supplementation — the researchers simply looked at whether the child had been breastfed at any point. This is a pretty significant variable.
Furthermore, the study relied upon existing data from a large population, which is much less accurate when it comes to claiming causal relationships than a study in which the direct effects of alcohol use during lactation are observed while controlling for other variables. Of course, conducting that type of research on alcohol and breastfeeding is easier said than done but would be necessary to determine any actual causation between alcohol in breast milk and cognitive development in children.
"I think the study is helpful, but it doesn't definitely answer the question. The question is, how much, if any, alcohol is safe during lactation?" Bartick told CNN. "I would advise mothers to avoid alcohol and not to use alcohol, not to use beer to try to increase their milk supply. I think that's safe to advise."
What did we learn from this?
For starters, these findings indicate that we need more research in this area to better understand the relationship of alcohol consumption while breastfeeding and cognitive ability in children.
For now, the CDC recommends that while not drinking alcohol at all is the safest option, having one alcoholic beverage per day isn't harmful — especially if the mother waits at least two hours after a single drink before nursing.
And, as Tara Haelle points out in an article in Forbes, the findings from this study should not be used as yet another way to criticize or shame parents who breastfeed.