The Truth About Alcohol and Pregnancy

If you’re a pregnant woman who normally consumes alcoholic beverages, on an occasional or a regular basis, you may be wondering whether you can drink while pregnant. There is considerable information about the effects of drinking during pregnancy, and the general consensus is that it is best to play it safe and abstain.

Even so, there is some debate about the necessity for total abstinence. So, a look at the current state of the debate is warranted.

Prevalence of Alcohol Use During Pregnancy

According to the Harvard Health Blog, a Harvard Medical School publication (Sept. 10, 2013), against common advice for pregnant women to abstain from alcohol use during pregnancy, up to half of pregnant women do report drinking alcohol  (at some time and in some amount) during their pregnancy. Because it may be several weeks before a woman knows that she is pregnant, more than 3 million U.S. women are currently at risk of exposing their developing fetuses to alcohol.

Among pregnant women, smoking cigarettes seems to be linked to drinking alcohol, as it is among the general population. A survey, conducted as part of the Maternal Health Practices and Child Development (MHPCD) project (Alcohol Health & Research World, 2002; Vol. 24, #4), found that 76 percent of adult women who reported smoking during their first trimester of pregnancy also said that they drank alcohol during that period.

According to MedlinePlus.gov (U.S. National Library of Medicine), how much you drink is just as important as how often you drink. They offer the following findings:

• Even if you don’t drink often, drinking a large amount at one time can harm your baby.
• Binge drinking (5 or more drinks at one sitting) greatly increases a baby’s risk of developing alcohol-related damage.
• Drinking moderate amounts of alcohol when pregnant may lead to miscarriage.
• Heavy drinkers (those who drink more than 2 alcoholic beverages a day) are at greater risk of giving birth to a child with fetal alcohol syndrome, also called fetal alcohol spectrum disorder (to be discussed later in this article).

It is well known that heavy drinking can be harmful to a developing fetus, but the risks of light and moderate drinking aren’t as well documented. An article in the Journal of Epidemiology and Community Health (October 2010) reported that the 5-year-old children of women who drank up to one to two alcoholic drinks per week or per occasion while pregnant were not at an increased risk of behavioral or cognitive problems. However, the study noted that developmental problems could show up later, so a follow-up study is planned to look at these children again as they get older.

How Does Alcohol Consumption During Pregnancy Affect the Fetus?

Predicting the impact of drinking on any given pregnancy is impossible, because some women naturally have higher levels of the enzyme that breaks down alcohol in their bodies. Women with low levels of this enzyme may be more susceptible to causing potential harm to their fetus because the alcohol they consume circulates in their bodies for a longer period of time.

When a pregnant woman drinks, alcohol travels through her blood and into the baby’s blood, tissues, and organs. Alcohol breaks down much more slowly in a baby’s body than in an adult’s, so the baby’s blood alcohol level remains increased longer than the mother’s does.

Potential Dangers to the Fetus

According to the March of Dimes Foundation, whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality, potential dangers to a fetus caused by a mother’s alcohol consumption during pregnancy include:

• Premature birth (the baby is born before 37 weeks of pregnancy) – premature babies may have serious health problems at birth and later in life
• Brain damage and problems with growth and development
• Birth defects, including heart defects, hearing problems or vision problems
• Fetal alcohol spectrum disorders (FASDs) – children with FASDs may have a range of problems, including intellectual and developmental disabilities such as trouble learning, communicating, or understanding social cues. They also may have problems or delays in physical development. Binge drinking (consuming four or more drinks within 2 to 3 hours) during pregnancy increases the chances of having a baby with FASD.
• Low birth weight (a baby that is born weighing less than 5 pounds, 8 ounces)
• Miscarriage (when a baby dies in the womb before 20 weeks of pregnancy)
• Stillbirth (when a baby dies in the womb after 20 weeks of pregnancy)

Risks for Fetal Alcohol Syndrome

According to the International Journal of Environmental Research and Public Health (Feb. 2010), the risk for fetal alcohol syndrome differs according to the amounts of alcohol consumed.

• With very high repetitive doses, there is a 6–10% chance of the fetus developing the fetal alcoholic syndrome.
• With lower repetitive doses, there is a risk of “alcoholic effects” mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency.
• Prenatal exposure to alcohol may predispose the baby to susceptibility for alcohol abuse later in life.

Signs and Symptoms of Fetal Alcohol Syndrome

The Centers for Disease Control and Prevention (CDC) lists on its CDC Fetal Alcohol web page information about a group of birth defects that are described together as fetal alcohol syndrome, or fetal alcohol spectrum disorders. Medical problems associated with FASDs are lifelong and can range from mild to severe.

Complications seen in the infant may include:

• Behavior and attention problems
• Heart defects
• Changes in the shape of the face
• Poor growth before and after birth
• Poor muscle tone and problems with movement and balance
• Problems with thinking and speech
• Learning problems
• Cerebral palsy
• Premature delivery
• Pregnancy loss or stillbirth

How Can You Keep Your Baby Safe from Alcohol During Pregnancy?

Many doctors suggest following recommendations of the Centers for Disease Control (CDC), the American Academy of Pediatrics and the U.S. Surgeon General, which are to encourage complete abstinence from alcohol consumption during pregnancy. Of course, giving up alcohol during pregnancy may be hard. Alcohol is often part of social activities, such as parties or dinners with friends. Your healthcare provider can provide resources to help you if you feel it will be difficult for you to stop drinking alcohol while you are pregnant.

Here are some general tips to help you stop drinking during pregnancy:

• Think about when you usually drink alcohol and plan to drink other beverages, such as fruit drinks or water.
• Avoid situations or places where you usually drink, especially bars.
• Get rid of all the alcohol in your home.
• Tell your partner and your friends and family that you’re not drinking and ask for their support in not offering you alcoholic beverages during your pregnancy.

For further assistance:

• Talk to your healthcare provider about alcohol treatment programs available in your area.
• Join an Alcoholics Anonymous support group.
• Visit the National Council on Alcoholism and Drug Dependence (NCADD) website (www.ncadd.org).
• Check out resources from the Substance Abuse and Mental Health Services Administration  (SAMHSA) website (www.samhsa.gov) or call 1-800 662-4357.