Q: I am a 32 years old woman. I am asthmatic and alcoholic; I have been drinking 4 pegs 5 days a week for the past 3 years. I had an acute asthma attack and was on steroids for almost 3 months. My asthma problem is under control now. I am still using seroflo but not regularly. Five years ago I underwent MTP and another one again a year later. With my drinking and MTP history, my doctor told me that my fertility was at its lowest ebb and I was unlikely to get pregnant at all. However, I have missed my period this month and am experiencing various other symptoms that are associated with an early pregnancy. The pregnancy card test has shown a positive result. Every doctor I visit gives me a moral lecture but doesn't tell me whether I should go ahead with the pregnancy or not. I am aware of the foetal alcohol syndrome and problems associated with drinking during pregnancy. Ever since I have discovered that I am pregnant I have quit drinking. I have always had a regular cycle of 25 days so I am certain this is not a false alarm. Should I continue with the pregnancy, what are the chances of miscarriage, abnormal birth defects in the child owing to my drinking and MTP? What are the tests that can affirm whether my child would have any abnormalities if I did go ahead with the pregnancy? Should I quit drinking as I have had innumerable drinks after conception because this pregnancy was accidental and my doctor said I was practically infertile? Will the steroids I take affect my baby? I was on a heavy dose of wysolone for a long time.

A:Firstly, calm down. Secondly, do meet a mature obstetrician. Thirdly, all medical advice is based on probability. There is no certainty and no black and white. The decisions are taken on balance of evidence. On some issues no clear information may be available. The doctor can only share the knowledge. Finally the decision is to be taken by the patient herself. As far as we know, asthma, salbutamol and alcohol or past MTP, do not lead to abortion. Stress may be harmful. Regarding birth defects use of alcohol during pregnancy could be harmful, as you yourself know, but not the past use. Likewise steroids used during pregnancy are harmful but not the ones taken earlier. The Asthma and salbutamol are not known to produce birth defects. A high resolution ultrasonographic examination carefully done by a trained skilled ultrasonologist can detect the fetal alcohol syndrome and cleft lip in the fetus. The first examination is advised around 15-16 week of pregnancy. But it does not exclude all the abnormalities. It is difficult to say the effect of alcohol use very early in the pregnancy. This may require some literature search. But foetal alcohol syndrome can be suspected by a good ultrasound examination. The decision about discontinuation of pregnancy can safely be taken upto 20 weeks of pregnancy. The steroids are known to produce cleft lip, which can be detected by an ultrasound. The decision is also based on preciousness of the pregnancy. It would be advisable to also take genetic counsellors help regarding other likely defects and complications etc. associated with any pregnancy without reference to facts enumerated in this case.