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
neurodevelopmental 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)
References
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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