Is there a safe level of alcohol (or Kava) during pregnancy?
Just after the September Baby Boom we were able to get away for a week on a family holiday to Fiji. If you've been there you'll remember the locals' fondness for the root extract Kava. Kava is said to give a sense of relaxation, wellbeing and happiness and its positive effects were extolled by most Fijians we met.
My ears pricked up when I was told of Kava's benefits for the pregnant woman. A local shop owner confidently told me that it promoted relaxation in labour; an easy birth and the baby upon its arrival would automatically be on 'Fijian time'.
I can't find any published data to support Kava's benefits in pregnancy. Reported cases of severe toxicity mean it's unlikely to enter mainstream use.
It made me think, though, about our social drug for relaxation, wellbeing and happiness. Alcohol in Australia is consumed nearly universally in young women approaching pregnancy. Unlike Kava, there is abundant data that alcohol is directly harmful in pregnancy.
Thankfully, the pregnancy itself provides strong incentive and motivation to cease alcohol intake. Of all women who drink alcohol, 87% manage to quit when the pregnancy is confirmed. 6.6% drink less and only 6.4% continue with their usual intake.
New patients often ask me whether low levels of alcohol are safe. The answer is maybe, for some women, but no "safe" level has ever been determined. There is no exact dose-response relationship and small amounts may harm some foetuses and leave others untouched. Differences in a mother's body size or racial background might be important. Remember that person you knew in your early 20s who was gone after just one drink?
We do know that at certain doses and durations alcohol can cause stillbirth, birth defects and a disability called fetal alcohol syndrome.
We know that alcohol freely crosses the placenta from mother to baby and fetal levels will match maternal levels within two hours of intake. That fact alone makes the World Health Organization's recommendation for zero alcohol in pregnancy seem pretty sensible.
I admit I scoffed at Kava's role in pregnancy but it got me thinking. Some say one or two glasses are fine every now and then. However, we can't guess each individual's safe level of alcohol during pregnancy. My advice is simply... no alcohol (or Kava) during pregnancy.