Alcohol During Pregnancy: Is there an acceptable limit?

I'm really, really interested in this particular topic for several reasons.  As a budding reproductive and perinatal epidemiologist, I'm very interested in exposures that can affect a woman's reproductive capacity and her ability to bring a pregnancy to full term (which is approximately 42 weeks).  Now that I'm pregnant, I've been doing PubMed searches to look at any epidemiological studies that have been done on the effects of different exposures during pregnancy and birth outcomes (low birthweight, pre-term birth, etc).

I am particularly interested in alcohol consumption during pregnancy because 1: I love me some wine (and scotch...with just 2 or 3 rocks...Perfect!), 2: differences in alcohol consumption among pregnant women in the US, Europe, and other parts of the world, and 3: the fact that Americans have very strong views about alcohol consumption during pregnancy.

Before I found out I was pregnant, I was a regular customer at Billy's parents house, where we'd talk late into the evening over several glasses of wine and delicious Scotch.  However, I'm not sure if it's the American in me or if it's due to the effect of the growing embryo inside of me, I did not crave that delicious glass of red wine with dinner and the smell of scotch made me feel queasy.  I've heard that several pregnant women experienced this and it's the body's way of making sure that you don't have a craving for it.  Which is good!  However, there are some nights when a glass of red wine just fits the bill!

I've talked to several people about their opinions on the matter.  Annie, one of Little Nacho's godmothers, gave birth in England, where she was told that one alcoholic drink per day was OK during pregnancy.  An MD/PhD reproductive epidemiologist from Ireland laughed at one of the alcohol-use questions in the questionnaire I had helped to develop for this large study I'm working on: we had a range of 0, less than 1, 1-3, or 4-6 drinks per day (during pregnancy) and he said in Ireland, the range would be up to 12 drinks per day!  Not that that's what he would allow, but what he's seen in his practice.  I almost fell out of my chair!

  A pediatrician who does research in Tibet told me that the women there would drink this home-fermented beer made out of barley.  His organization came into their town and tried to educate and encourage everyone to NOT drink the homemade beer because of the possible effects.  Guess what happened as a result?  The incidence of spina bifida increased something like two fold in the area where women stopped drinking the beer (this was over a 5 year period).  They then realized that the beer gave them their only source of folic acid.  So, instead of prohibiting alcohol, the group asked them to make sure to boil off a good amount of the alcohol if at all possible and then drink the beer.

So, why are so many Americans averse to the idea that a woman may be able to drink alcohol (in moderation, of course)?  I believe that it's because of the litigation-happy culture we all live in.  No nurses or doctors will go on the record and tell you that a glass of wine here and there is OK because, god forbid, anything happened to your baby, you can blame it on the doctor's advice.  However, there are several doctors who tell their patients (off the record, of course) that a glass of wine or beer now and then, especially beyond the first trimester, wouldn't hurt the growing fetus.  Of course, since doing trials on pregnant women to see what is an acceptable dose of alcohol re: birth outcomes is NOT ethical (right, Ann?), we don't really know what is an acceptable limit.  Several studies have been done that have retrospectively assessed alcohol intake during pregnancy and have tried to associate that with the babies' cognitive development, but they can't definitively say that so-and-so MODERATE amounts of alcohol during pregnancy causes a kid to do worse at cognitive functioning things than a kid whose mother abstained.

I understand that the best policy is always abstinence (as in sex education): it's foolproof!  However, I don't believe that when you see a woman who is pregnant drinking a glass of wine you should automatically be some sort of preggo-police and come over to her to lecture her about the risks of fetal alcohol syndrome (this happened to the wife of a fellow grad student).  I did read about this one pub owner kicking a lady out of the pub when she got belligerent when he wouldn't refill her 3rd pint of beer.  In that case, I'd totally support the owner!  But to come up to a woman, not knowing her or her beliefs or customs, and accusing her of putting her baby at risk is rude and uncalled for.

What do you guys think?  Do you think that America's no tolerance policy is keeping women from knowing all of the facts?  Do you think we should err on the side of caution or let women make the choice themselves after they've been given all of the known facts?

P.S. Don't worry.  In the almost 20 weeks of pregnancy, I've fully abstained from alcohol.  Not through my own choice, but because the smell makes me feel queasy, unfortunate as that is :)

Not a glass of champagne.  This was some sparkling grape juice my aunt Christine had so lovingly gotten just for me (and the kids) at the family Christmas party.  Billy, on the other hand, was forced to drink Vodka all night with my uncles.  He had no good excuse not to.