How much can I drink during pregnancy? And is my daughter's tiredness due to depression?

Drinking danger

Drinking danger

Q. I am hoping to become pregnant in the next few months and am worried about how much alcohol I am allowed to drink. My job involves entertaining clients a lot, which often includes alcohol. Everyone drinks at these events and no one ever refuses at least one drink. Recently I have heard that complete abstinence from alcohol during pregnancy is recommended. Is it necessary to stop drinking before I get pregnant? Or is it good enough to stop drinking as soon as I discover that I am pregnant? How risky is it to have the odd drink during early pregnancy?

A. It is not difficult to find medical experts who say that any amount of alcohol is potentially damaging to the developing baby in early pregnancy. So if you want to remove the risk of harm to your future baby completely, you should completely avoid all alcohol both before and during pregnancy. This is the advice of the American National Institute on Alcohol Abuse and Alcoholism. The British Royal College of Obstetricians and Gynaecologists takes a more relaxed attitude, saying "women should be careful about alcohol consumption in pregnancy and limit this to no more than one standard drink per day". There is no conclusive evidence that "the odd drink" causes any harm to the developing fetus. Whatever you decide to do about drinking, if you are trying to get pregnant, don't forget to start taking folic acid supplements. A dose of 400 micrograms a day will substantially reduce your risk of having a baby with spina bifida. You should start this supplement before you get pregnant, and continue it for the first three months of pregnancy.

All tired out

Q. I am writing to ask for your help regarding my daughter. She is 33 and has quite a demanding job. She is tired all the time and lacking in energy. She sleeps poorly and has poor teeth and nails (both flecked with white). She has depressed and negative feelings about everything, despite having a very good diet of a variety of fresh foods. She is too tired to do anything apart from her job. She turns down invitations, and is losing out on friendships.

A. Your daughter has many of the classical symptoms of clinical depression - poor sleep, depressed and negative feelings, inability to enjoy things and lack of energy. Of course, she may be suffering from some other illness that is making her depressed and unwell, so it would be important for other illnesses to be considered before trying to help her with her depression. People suffering from depression may be unaware of the severity of their symptoms. Long-standing depression makes people forget what it is like to feel well. There are a number of ways to help. Sometimes a combination of treatments, such as antidepressant medication plus cognitive behavioural therapy (CBT), works best. Clinical depression is not just about feeling down; it is a treatable illness with serious symptoms. Your daughter deserves some help, and you should try to persuade her to see a sympathetic doctor who should take her symptoms seriously.

Irritated throat

Q. I am slightly embarrassed by my problem and realise it is probably nothing terminal. I have a constant (it really is constant) cough in my throat. It feels just like when you have to clear your throat before speaking. It doesn't hurt, I can't feel anything down there, there is no bad taste in my mouth, but it never goes away. It even keeps me awake at night. I'm 30 years old, and I'd say it has been going on for a couple of years. I asked my doctor about it six months ago. He just gave me a blank look, had a quick look, prescribed antibiotics that made me ill, and sent me away.

A. These are the symptoms of laryngopharyngeal reflux. It is a common condition that is caused by acid escaping from the stomach and working its way up the oesophagus as far as the throat. It causes a continuous feeling of wanting to cough and clear the throat, because the acid irritates the back of the throat. Sometimes it is associated with heartburn and indigestion, but it can cause throat symptoms without any indigestion symptoms. A few suggestions are: lose weight if you are overweight; cut down on coffee, cheese, chocolate and fried foods; don't wear tight-fitting clothes around the stomach; and don't smoke. You might also benefit from a course of anti-acid medication such as omeprazole (only available on prescription).

Have your say: readers write

Two more ideas on treating "frozen shoulders", from SB of Nottingham and PS of Reading:

I had a frozen shoulder 14 years ago, and I can still remember how painful it was. I needed help to wash and dress. I couldn't drive, and even writing was agony. I had steroid injections and physiotherapy, but I was in too much pain to co-operate. A neighbour told me that her daughter had been helped by acupuncture. I had acupuncture in the physiotherapy department of our local NHS hospital. I was pain-free in a month, and never had a recurrence.

One technique is for a specialist to "manipulate" the shoulder under general anaesthetic, followed by intensive physiotherapy. This cured my problem. The peril of not having treatment is that the muscles atrophy and one becomes incapacitated.

Send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail Dr Kavalier regrets that he is unable to respond personally to questions