Expectant Mothers

Play it Smart, Alcohol and Pregnancy Don’t Mix

NOFAS joins the United States Surgeon General in advising women to abstain from alcohol during pregnancy due to the risk of birth defects. As women consider the risk—often for the first time when they are already pregnant—it’s not uncommon to hear mixed messages. Below, NOFAS provides a personal perspective, the latest recommendations, and the science-based facts about the risk of drinking alcohol during pregnancy.

If you have just found out you are pregnant and you have been drinking alcohol, stop drinking now and talk with you doctor. Any time during pregnancy that you stop drinking you increase the chance that your baby will not be affected by alcohol.

If you are finding it difficult to stop drinking, help is available.  Visit your doctor to talk about your drinking, or find a professional in your area using the Substance Abuse and Treatment Facility Locator. You can also contact NOFAS by email or at (800) 66-NOFAS.

Alcohol and Pregnancy: A Personal Perspective
“Every other week there seems to be another article in the media suggesting that “moderate” alcohol use is safe while pregnant. It’s important to understand that we all have a different view of what moderation is, and that it is very easy to underestimate the amount of alcohol we actually consume. I drank while I was pregnant, all five times. I had no idea that drinking on the weekends would harm my children. Today, I have a 37 year old that plays with baby dolls; she has Fetal Alcohol Syndrome (FAS) and intellectual disability. I have another daughter that suffers with chronic migraines and a host of other health problems. My last two children both died before they were three months old. There is not a day that goes by that I do not regret the fact that I drank while pregnant. I would not wish that on another mother. I love women–they are all my sisters–and I want them to know it is not safe to drink any alcohol while pregnant. Don’t risk it, wait, there’ll be plenty of time to celebrate and consume alcohol, after the baby is born!”
Kathleen Tavenner Mitchell
Vice President and International Spokesperson
National Organization on Fetal Alcohol Syndrome

United States Surgeon General Advisory
The most comprehensive review of alcohol and pregnancy research to date has been conducted by the Office of the Surgeon General within the Office of the Assistant Secretary for Health in the Office of the Secretary, U.S. Department of Health and Human Services. The Surgeon General first advised women to abstain from alcohol during pregnancy in 1981, and issued a new advisory in 2005.

 The advisory states in part, “Based on the current, best science available we now know the following:

• No amount of alcohol consumption can be considered safe during pregnancy;
• Alcohol can damage the embryo or fetus at any stage of pregnancy;
• Damage can occur in the earliest weeks of pregnancy, even before a woman knows she is pregnant;
• The cognitive effects and behavioral problems resulting from prenatal alcohol exposure are lifelong.”

“For these reasons:

• A pregnant woman should not drink alcohol during pregnancy;
• A pregnant woman who has already consumed alcohol during pregnancy should stop in order to minimize further risk;
• A woman who is considering becoming pregnant should abstain from alcohol.”

About half of all pregnancies are unplanned. As a result, many women consume alcohol without knowing that they are pregnant. The Surgeon General’s advisory also suggests that women of childbearing age should consult their physician about how best to reduce the risk of prenatal alcohol exposure.

Recommendations
Centers for Disease Control and Prevention
There is no known safe amount of alcohol to drink while pregnant. There is also no safe time during pregnancy to drink and no safe kind of alcohol.

National Institute on Alcohol Abuse and Alcoholism
No amount of alcohol is safe for pregnant women to drink.

American Academy of Pediatrics
The American Academy of Pediatrics recommends women who are pregnant or planning a pregnancy avoid drinking any alcohol.

American College of Obstetricians and Gynecologists
ACOG reiterates its long-standing position that no amount of alcohol consumption can be considered safe during pregnancy.

March of Dimes
Drinking alcohol when you’re pregnant can be very harmful to your baby. It can cause your baby to have a range of lifelong health conditions.

National Arc
There is no absolute safe amount of alcohol that a woman can drink during pregnancy. Risk of FASD increase as the amount of alcohol consumed increases.

Baby Center
All public health officials in the United States recommend that pregnant women, as well as women who are trying to conceive, play it safe by steering clear of alcohol entirely.

Alcohol and Pregnancy Science
Alcohol, like the chemical element mercury, is a confirmed teratogen (a substance that interferes with normal prenatal development). Alcohol can cause central nervous system (brain and spinal cord) malformations with associated neurobehavioral dysfunction. By comparison, lead is a neurotoxin but not a teratogen in that it produces neurobehavioral dysfunction in the absence of brain and spinal cord malformations.

Science definitively recognizes that when a pregnant woman consumes alcohol, the alcohol crosses the placenta into the blood supply of the developing embryo or fetus. An embryo or fetus has neither the developed organ systems nor enzymes able to metabolize alcohol.

The first paper in the medical literature describing a constellation of birth defects linked to prenatal alcohol exposure was published in France in 1968 by Dr. Paul Lemoine.

The first paper in U.S. medical literature appeared in 1973 authored by Drs. David Smith and Ken Lyons Jones. As of 2012, nearly 4,000 papers have been published confirming the toxicity of alcohol to the embryo or fetus, the underlying mechanisms of alcohol-induced damage to the embryo or fetus, and the physical and functional birth defects related to prenatal alcohol exposure.

No published study has suggested that alcohol is not a teratogen or demonstrated that prenatal alcohol use has any potential benefit to human development.

The basic and biomedical research demonstrates that alcohol damages the developing brain through multiple actions at different cellular sites interfering with normal development by disrupting cell migration, cell functions, and causing cell death.

Alcohol can cause damage to multiple regions of the brain, specifically to the corpus collosum (connects brain hemispheres), cerebellum (consciousness and voluntary processes), basal ganglia (movement and cognition), hippocampus (emotional behavior and memory), hypothalamus (sensory input), among other neural regions.

Ethanol is the principal psychoactive constituent in alcoholic beverages. In utero it has been found to:

• Interfere with normal proliferation of nerve cells;
• Increase the formation of free radicals–cell damaging molecular fragments;
• Alter cells ability to regulate cell growth, division and survival;
• Impair the development and function of astocytes, cells that guide the migration of nerve cells to their proper places;
• Interfere with the normal adhesion of cells to one another;
• Alter the formation of axons, nerve cell extensions that conduct impulses away from the cell body;
• Alter the pathways of biochemical or electrical signals within cells;
• Alter the expression of genes, including genes that regulate cell development.

Human development occurs in an orderly process of biochemical and structural transition during which new constituents are being formed and spatially arranged throughout gestation. At any time in the span of development these ongoing processes can be subtly or severely disturbed or abruptly halted resulting in abnormal development or fetal death.

Therefore, at any time alcohol is present it has the potential to harm development. For example, the hallmark facial dysmorphology associated with Fetal Alcohol Syndrome will only occur if alcohol is present during the specific window of development.

Of all the substances of abuse, including marijuana, cocaine and heroin, alcohol produces by far the most serious neurobehavioral effects on the embryo or fetus.

Women at Risk
Factors known to contribute to the risk of having a child with alcohol-related birth defects include: biological susceptibility, poor nutrition, poor general health, and a lack of prenatal care.

Some light and moderate drinkers have offspring with identifiable birth defects while some women who consume alcohol throughout pregnancy have offspring without any apparent or quantifiable birth defects. Research is currently exploring both the genetic and protective factors involved in the manifestation of alcohol-related birth defects.

An examination of sociodemographic factors indicated that generally more older women (~30 or 35 years old and older) drink during pregnancy, but younger women (~24 years old or younger) face higher risks of binge drinking or drinking in the few months prior to recognizing they are pregnant (Altfeld et al., 1997; CDC, 2009; Chambers et al., 2005; Floyd et al., 1999; Hollander, 1995; Jones-Webb et al., 1999; Morris et al., 1994; Perriera & Cortes, 2006; Tsai et al., 2007a,b). With regard to race and ethnicity, White women report a higher prevalence of alcohol use than Black or Hispanic women (Floyd et al., 1999; Hanna et al., 1994; Hollander, 1995; Perriera & Cortes, 2006; Project CHOICES, 2002; Tsai & Floyd, 2004; Tsai et al., 2007a,b), although Hispanic women may increase use as they become more acculturated in the United States (Chambers et al., 2005). Differences in prevalence based on geographic location appeared potentially important, with binge drinking more prevalent in the North-central sections of the United States and less so in the Southeast (Tsai & Floyd, 2004). Higher education (CDC, 2009; Chambers et al., 2005; Floyd et al., 1999; Hollander, 1995; Tsai et al., 2007a) and higher income (Chambers et al., 2005; Chang et al., 2006; Hollander, 1995; Morris et al., 1994) were linked specifically to higher rates of alcohol use during pregnancy in some studies.

Key Facts on Alcohol and Pregnancy

There is no safe amount or type of alcohol to consume during pregnancy.  Any amount of alcohol, even if it’s just one glass of wine, passes from the mother to the baby.  It makes no difference if the alcohol is wine, beer, or liquor (vodka, rum, tequila, etc.)

A developing baby can’t process alcohol.  Developing babies lack the ability to process alcohol with their liver, which is not fully formed.  They absorb all of the alcohol and have the same blood alcohol content as the mother.

Alcohol causes more harm than heroin or cocaine during pregnancy.  The Institute of Medicine says, “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”

Alcohol used during pregnancy can result in FASD.  An estimated 40,000 newborns each year are affected by FAS, Fetal Alcohol Syndrome, or have FASD, Fetal Alcohol Spectrum Disorders, with damage ranging from major to subtle.

1 in 100 babies have FASD, nearly the same rate as Autism.  FASD is more prevalent than Down Syndrome, Cerebral Palsy, SIDS, Cystic Fibrosis, and Spina Bifida combined. Alcohol use during pregnancy is the leading preventable cause of birth defects, developmental disabilities, and learning disabilities.