Drinking Alcohol During Pregnancy

Drinking alcohol during pregnancy can cause physical and mental birth defects. Each year, more than 40,000 babies are born with some degree of alcohol related damage. Although many women are aware that heavy drinking during pregnancy can cause birth defects, many do not realize that moderate or even light drinking also may harm the fetus.

In fact, no level of alcohol use during pregnancy has been proven safe. Therefore, the March of Dimes recommends that pregnant women do not drink any alcohol - ;including beer, wine, wine coolers and hard liquor throughout their pregnancy and while nursing. In addition, because women often do not know they are pregnant for a few months, women who may be pregnant or those who are attempting to become pregnant should abstain from alcoholic beverages.

Women who continue to drink alcohol, even in small amounts, while attempting to become pregnant, may reduce their chances of conceiving, according to recent studies.

A recent government survey indicated that, between 1995 and 1999, alcohol use among pregnant women decreased. In 1999, 12.8 percent of pregnant women reported having had at least one drink during pregnancy, compared to 16.3 percent in 1995. However, the rates of binge drinking (more than five drinks on one occasion) and frequent drinking (more than seven drinks per week) did not decline and remained high (2.7 percent of pregnant women reported binge drinking, and 3.3 percent reported frequent drinking). The survey suggests that about 130,000 pregnant women consumed these risky levels of alcohol in 1999. Women who binge drink or drink frequently greatly increase the risk of alcohol-related damage to their babies.

When a pregnant woman drinks, alcohol passes swiftly through the placenta to her baby. In the unborn baby' s immature body, alcohol is broken down much more slowly than in an adult’s body. As a result, the alcohol level of the baby's blood can be even higher and can remain elevated longer than the level in the mother's blood. This sometimes causes the baby to suffer lifelong damage.

What are the hazards of drinking alcohol during pregnancy? According to the Centers for Disease Control and Prevention (CDC), each year between 1,300 and 8,000 babies in the United States are born with fetal alcohol syndrome (FAS), a combination of physical and mental birth defects. FAS occurs in about 6 percent of the babies born to women who are alcoholics or chronic alcohol abusers. These women either drink excessively throughout pregnancy or have repeated episodes of binge drinking.

FAS is one of the most common known causes of mental retardation, and the only cause that is entirely preventable. Babies with classic FAS are abnormally small at birth and usually do not catch up on growth as they get older. They may have small eyes, a short or upturned nose and small, flat cheeks. Their organs, especially the heart, may not form properly.  Many babies with FAS also have a brain that is small and abnormally formed, and most have some degree of mental disability. Many have poor coordination and a short attention span and exhibit behavioral problems.

The effects of FAS last a lifetime. Even if not mentally retarded, adolescents and adults with FAS have varying degrees of psychological and behavioral problems and often find it difficult to hold down a job and live independently.

As many as 10 times the number of babies born with FAS are born with lesser degrees of alcohol-related damage. This condition is sometimes referred to as fetal alcohol effects (FAE) or fetal alcohol spectrum disorder (FASD). These children may have some of the physical or mental birth defects associated with FAS. The Institute of Medicine has proposed more specific diagnostic categories for FAE, referring to the physical birth defects (such as heart defects) as alcohol-related birth defects (ARBD), and to the mental and behavioral abnormalities as alcohol-related neurodevelopment disorders (ARND).

In general, alcohol-related birth defects (such as heart defects) are more likely to result from drinking during the first trimester, while growth problems are more likely to result from drinking in the third trimester. However, drinking at any stage of pregnancy can affect the brain.

During pregnancy, how much alcohol is too much? No level of drinking has been proven safe. The full pattern of FAS usually occurs in offspring of chronic alcohol abusers, most often in women who drink four to five or more drinks daily. However, it has occurred in women who drink less. ARBD and ARND can occur in babies of women who drink moderately or lightly during pregnancy.

Researchers are taking a closer look at the more subtle effects of moderate and light drinking during pregnancy. A 2001 study by researchers at Wayne State University in Detroit found that 6- and 7-year-old children of mothers who had as little as one drink a week during pregnancy were more likely than children of non-drinkers to have behavior problems, such as aggressive and delinquent behaviors. These researchers found that children whose mothers drank any alcohol during pregnancy were more than three times as likely as unexposed children to demonstrate delinquent behaviors.

Researchers at the University of Washington at Seattle followed to age 14 a group of middle-class children whose mothers were  "social drinkers, who drank an average of about two drinks per day. At age 7 years, when given intelligence tests, these children scored seven points lower than the average for all children in the study. At age 14, alcohol-exposed children remained more likely to have learning problems, especially with mathematics and memory, and behavioral difficulties, including attention problems. Other researchers also have reported behavioral problems in alcohol-exposed children including hyperactivity, impulsivity, poor social and communication skills and alcohol and drug use.

If a pregnant woman has one or two drinks before she realizes she is pregnant, can it harm the baby? It is unlikely that the occasional drink a woman takes before she realizes she is pregnant will harm her baby. The baby's brain and other organs begin developing around the third week of pregnancy, however, and are vulnerable to damage in these early weeks. Because no amount of alcohol is proven safe, a woman should stop drinking immediately if she even suspects she could be pregnant, and she should abstain from all alcohol if attempting to become pregnant.

What other problems can drinking alcohol during pregnancy cause? Consuming alcohol during pregnancy increases the risk of miscarriage, low birth weight and stillbirth. Heavy drinkers are two to four times more likely to have a miscarriage between the fourth and sixth months of pregnancy than are nondrinkers. A recent Danish study found that women who drank five or more drinks a week were three times more likely to have a stillborn baby than women who had fewer than one drink a week.

Is it safe to drink alcohol while breastfeeding? Small amounts of alcohol do get into breast milk and are passed on to the baby. One study found that the breast fed babies of women who had one or more drinks a day were a little slower in acquiring motor skills (such as crawling and walking) than babies who had not been exposed to alcohol. Large amounts of alcohol may also interfere with ejection of milk from the breast. For these reasons, the March of Dimes recommends that women abstain from alcohol while they are nursing.

Can heavy drinking by the father contribute to FAS? To date, there is no proof that heavy drinking by the father can cause FAS. There is, however, increasing evidence that heavy alcohol use by the male can lower the level of the male hormone testosterone, leading to low sperm counts and, occasionally, to infertility. Men who stop drinking during their partner’s pregnancy also help the partner avoid alcohol.

What is the March of Dimes doing to prevent and treat FAS and FAE? March of Dimes-supported researchers are investigating the influence of alcohol on pregnancy. One current grantee is exploring the role of a gene in causing craniofacial and brain defects in FAS, with the ultimate goal of developing treatment to prevent these defects in babies of mothers who continue to drink during pregnancy.

The March of Dimes also works to prevent FAS and FAE by educating the general public, teenagers, adults of childbearing age and expectant mothers about the dangers of alcohol and other drugs to unborn children. Because there currently is no way to predict which babies will be damaged by alcohol, the safest course is not to drink at all during pregnancy and to avoid heavy drinking during childbearing years (because at least 50 percent of pregnancies are unplanned). All women who drink should stop as soon as they think they are pregnant. Heavy drinkers should avoid pregnancy until they believe they can abstain from alcohol throughout pregnancy. The March of Dimes has also developed tools for health care providers to aid in the screening and diagnosis of affected children.

Where can a woman get help in stopping drinking? Some women find it difficult to stop drinking. These organizations can help:

 Alcoholics Anonymous (AA) Local chapters are listed in the white pages of local phone books.

1-800-ALCOHOL (1-800-252-6465) A national help and referral line for people affected by alcohol and drug abuse.

 The National Council on Alcoholism 1-800-NCA-CALL (1-800-622-2255)

American Academy of Pediatrics Committee on Substance Abuse and Committee on Children with Disabilities. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics, volume 106, number 2, August 2000, pages 358-361.

Centers for Disease Control and Prevention. Alcohol use among women of childbearing age—United States, 1991-1999. Morbidity and Mortality Weekly Report, volume 51, number 13, April 5, 2002, pages 273-276.

Centers for Disease Control and Prevention. Fetal alcohol syndrome. Atlanta, GA, April 8, 2002.

Institute of Medicine. Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington, D.C., National Academy Press, 1996.

Kesmodel, U., et al. Moderate alcohol intake during pregnancy and the risk of stillbirth and death in the first year of life. American Journal of Epidemiology, volume 155, number 4, February 15, 2002, pages 305-312.

©National Institute on Alcohol Abuse and Alcoholism. Fetal alcohol exposure and the brain. Alcohol Alert, number 50, December 2000.

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