Given the rush to condemn any drinking during pregnancy despite the dearth of research evidence to support such a policy, you might guess that fetal alcohol effect, if not FAS itself, is a widespread phenomenon. But the Centers for Disease Control estimate that 8,000 "alcohol-damaged babies" are born each year, which works out to a rate of 2.7 for every 1,000 live births (0.27 percent).

Yet New York Times health columnist Jane Brody offered a much higher figure in 1986, when she announced, "An estimated 50,000 babies born last year suffered from prenatal alcohol exposure." (Brody, by the way, does not think it's enough merely to abstain from alcohol during pregnancy: "Even drinking before pregnancy [as little as one drink a day] may have an untoward result," she reported.)

Rosenthal does not offer her own estimate, but she says the CDC figure seems low, apparently because "on some Indian reservations, 25 percent of all children are reportedly afflicted." But as she later notes, "The CDC data show that the syndrome is 30 times more commonly reported in Native Americans than it is in whites, and six times more common in blacks." These figures indicate that alcohol-related damage among babies of white, middle-class women is actually less common than 2.7 cases per 1,000, since all groups are averaged together in producing the overall rate.

Indeed, it's not clear what the middle-class women who read the Times can learn from the experience of grossly dysfunctional families such as the one described at the beginning of Rosenthal's article or from reports about Native American children such as the mentally retarded boy in The Broken Cord. For one thing, styles of drinking vary widely across racial and socioeconomic groups.

White, middle-class women are more likely to drink than black women (and low-income women generally), but they tend to drink moderately. Black women are more likely to abstain, but those who don't are more likely to drink heavily. The fact that FAS rates are much higher among low-income minorities therefore contradicts the hypothesis that moderate drinking during pregnancy is damaging and that higher rates of abstinence would reduce FAS.

And a 1982 study by Boston University researcher Ralph Hingson suggests that other factors in the lives of poor, ghetto-dwelling women contribute to birth defects that have been ascribed solely to alcohol. After studying a sample of 1,700 women in Boston City Hospital, Hingson concluded that "neither level of drinking prior to pregnancy nor during pregnancy was significantly related to infant growth measures, congenital abnormality, or [other] features compatible with fetal alcohol syndrome."

Rather, a combination of factors-including smoking, malnutrition, and poor health care seems to be responsible for low birth weight and other problems often attributed to drinking. "The results underline the difficulty in isolating and proclaiming single factors as the cause of abnormal fetal development," Hingson and his colleagues wrote.

So the crusade against drinking during pregnancy is misdirected in several ways. It focuses on moderate rather than heavy drinking, on middle-class rather than low-income mothers, and on alcohol consumption rather than the set of behaviors that increases the risk of birth defects. The women most likely to give birth to damaged babies — the ones who abuse alcohol and drugs, smoke, and neglect their health — are not affected by messages tailored to the middle class.

The error in strategy is especially troubling given the nation's relatively poor performance in prenatal care. The number of birth defects in the United States has doubled in the last 25 years. While the U.S. neonatal death rate dropped in the 1980s, it still compares unfavorably with those of European nations, Japan, Australia, Singapore, Bermuda, and even Guam. Shrill warnings about low levels of drinking during pregnancy may make health experts feel virtuous. but they won't improve those figures one bit. Developing comprehensive community programs for high-risk mothers would help, but this requires more than Sunday supplement alarmism.

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