Is it safe to drink a little alcohol while pregnant, such as an occasional glass of wine?
No. According to the CDC and the U.S. Surgeon General, “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.” According to the American Academy of Pediatrics: “There is no safe amount of alcohol when a woman is pregnant. Evidence based research states that even drinking small amounts of alcohol while pregnant can lead to miscarriage, stillbirth, prematurity, or sudden infant death syndrome.”
When you drink alcohol, so does your developing baby. Any amount of alcohol, even in one glass of wine, passes through the placenta from the mother to the growing baby. Developing babies lack the ability to process, or metabolize, alcohol through the liver or other organs. They absorb all of the alcohol and have the same blood alcohol concentration as the mother. It makes no difference if the alcoholic drink consumed is a distilled spirit or liquor such as vodka, beer, or wine.
Alcohol is a teratogen, a toxic substance to a developing baby, and can interfere with healthy development causing brain damage and other birth defects. Most babies negatively affected by alcohol exposure have no physical birth defects. These children have subtle behavioral and learning problems that are often undiagnosed or misdiagnosed as Autism or Attention Deficit Disorder instead of one of the Fetal Alcohol Spectrum Disorders.
If you know a woman who is having difficulty abstaining from alcohol, the NOFAS mentoring network, The Circle of Hope helps and supports women who have used alcohol or illicit drugs while pregnant.
The Simple Approach
Thousands of pieces of research have shown alcohol to be a neurotoxin in utero. That means alcohol is a toxic substance to the developing baby just like carbon monoxide and lead. Alcohol causes the death of developing brain cells in the embryo or fetus. Common sense advises not exposing a developing baby to any amount of a toxic substance.
Medical Experts on light drinking during pregnancy – watch on Youtube
Several research studies available through the Collaborative Initiative on FASD (CIFASD).
The University of Queensland, 2013. This study finds “women who regularly drink as little as two glasses of wine per drinking session while pregnant can adversely impact their child’s results at school.”
Alcoholism: Clinical and Experimental Research, 2012. The study concludes, “Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.”
International Journal of Epidemiology, 2012. This study states, “Even low amounts of alcohol consumption during early pregnancy increased the risk of spontaneous abortion substantially.”
Alcohol Research & Health, 2011. This study found that drinking at low to moderate levels during pregnancy is associated with miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome (SIDS).
Alcohol, Health, and Research World, 1997. This study states, “even a small amount of alcohol may affect child development.”
Myth: My doctor said it’s fine to have a glass of wine or two while pregnant.
Your doctor might not be informed about the risk of prenatal alcohol exposure or could be uncomfortable talking with you about the risks to your embryo or fetus associated with prenatal alcohol use. Unfortunately, many doctors are not properly educated about the risks associated with prenatal alcohol exposure. The American Congress of Obstetricians and Gynecologists (ACOG) advises women to not consume any alcohol while pregnant. Some doctors tell women that it’s okay to drink a little wine because they are not comfortable talking with women who might not be interested in abstaining from alcohol or have difficulty doing so.
Myth: My friends or family members drank a bit and their kids are fine.
Every pregnancy is different. Not everyone who drinks while pregnant will have a child with measurable problems at birth, adolescence, or even adulthood, just like not every cigarette smoker will develop lung cancer. The fact remains that alcohol is toxic to the developing baby. Why take the risk?
Also, some children may have subtle damage from being exposed to alcohol that is not evident until school-age or later, such as problems with learning and behavior. In many of these cases, the problems are most often not linked to the prenatal alcohol exposure, inhibiting an accurate diagnoses and delaying appropriate intervention. According to Dr. Susan Astley Ph.D. and Dr. Therese Grant Ph.D., “Children exposed to and damaged by prenatal alcohol exposure look deceptively good in the preschool years. The full impact of their alcohol exposure will not be evident until their adolescent years.”
Myth: There is no evidence of any effects from just one drink.
Dr. Michael Charness of Harvard Medical School gives just one example: “We’ve been able to show very striking effects of alcohol on the L1 cell adhesion molecule, a critical molecule for development, at concentrations of alcohol that a woman would have in her blood after just one drink.”
Myth: A little bit of wine helps to reduce stress and can be healthy while pregnant.
The potential benefits of alcohol use during pregnancy to the mother are separate from and are outweighed by the potential risk to the mother’s developing child. The scientific and medical research is very clear: No published biomedical research has found any risk-free benefit of prenatal alcohol exposure for the embryo or fetus. Hundreds of papers have conclusively demonstrated that alcohol use has the potential to cause both physical and functional damage to a growing baby.
The good news is that the vast majority of women in the U.S. stop drinking alcohol when they are pregnant. Those who continue drinking may do so because they do not understand the risks of continued drinking or because alcohol is a part of their lifestyle that they do not want to or cannot give up. Women commonly cite the need to relax as one of the reasons they drink during pregnancy even if they understand the risks. Pregnant women should ask their doctor about the diet and exercise that is appropriate for them, and to relax they might listen to soothing music, pamper themselves, take a bath, read, eliminate guilt, try deep breathing or meditation, schedule time for themselves with no responsibilities or distractions, and don’t hesitate to ask their friends and family for help if they feel overwhelmed or uncomfortable.
Myth: On a holiday or special occasion, it’s perfectly fine to at least have a few celebratory sips.
The human body functions the same, whether it’s a holiday or not. Alcohol does not somehow lose it’s toxicity in utero because it happens to be New Year’s Eve, or because wine is consumed instead of whiskey, or because the drinker has an advanced academic degree and a high socioeconomic status. The risk of prenatal alcohol exposure is not a risk to the health of the expectant mother; it is a risk to the development of her offspring.
The guidance to abstain from alcohol when pregnant is not intended to interfere with a woman’s lifestyle choice to consume alcohol or in any way judge a woman for choosing to enjoy her favorite alcoholic beverage; it is intended to eliminate the chance her baby will have even the slightest reduction in their intellectual and physical abilities.
Myth: One glass of wine is not enough for the developing baby to even be exposed to the alcohol.
Any alcohol consumed by a pregnant woman is passed to the developing baby, even if it’s a small amount. There is no threshold of prenatal alcohol consumption below which the baby is not exposed.
Myth: Drinking wine is better than using heroin or cocaine while pregnant.
Alcohol, including wine, causes far more damage to the developing baby than any other drug. 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.” No type of alcohol or illicit drugs consumed during pregnancy are completely without risk.
Myth: You have to be an alcoholic to drink enough to cause real damage
The medical research is clear: Drinking at a level below the threshold for alcoholism can still cause damage to the growing baby. There are many women who are not alcoholics that have children with measurable effects of alcohol exposure. Damage can be caused by a pregnant woman’s lack of awareness of the risks–not only as a result of her alcoholism.
Myth: Alcohol can only cause physical deformities. If the baby looks normal, it must be fine.
The vast majority (over 85%) of children with damage from prenatal alcohol exposure have no physical birth defects, only cognitive and/or behavioral consequences. There is such a wide range of effects that most subtle behavioral and cognitive difficulties are rarely diagnosed as alcohol-related.
Myth: It is alarming and even condescending for a doctor or anyone else to advise a woman to abstain from alcohol during pregnancy.
In the United States 50% of pregnancies are unplanned, so it is possible that the first time a woman is told that alcohol can harm her pregnancy is after she is already pregnant and has been drinking. It is important for physicians to advise the woman of the risks of alcohol use during pregnancy, be nonjudgmental, and provide guidance for an appropriate intervention if necessary. If a woman has been drinking alcohol during her pregnancy, the earlier she stops the greater the chance that her child will not have alcohol-related birth defects.
All women should be reminded of the risk of prenatal alcohol exposure. If a woman is informed of the risk and decides to drink, that is her decision–NOFAS is opposed to any rules, regulations, or statutes that seek to punish or sanction women for drinking alcohol during pregnancy. Practitioners should always inform their patients about the risks of known exposures.
It is important for pregnant women to be reminded that proper nutrition, good general health, and early and regular prenatal doctor visits might help reduce the effects of light drinking during pregnancy. It is believed that some women have a genetic predisposition that increases the vulnerability of their embryo or fetus to alcohol exposure, and, consequently, some women have a genetic make-up that reduces their vulnerability for having an alcohol-effected birth. However, the scientific community does not know for sure whether or not these genetic and epigenetic factors (changes in how genes are expressed without altering the underlying DNA sequence) contribute to the vulnerable pregnancies for certain women.
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.
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.
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.
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.
Statements from Medical Experts
Dr. Kenneth Jones – First named “Fetal Alcohol Syndrome” in 1973
“When talking about the prenatal effects of alcohol we usually think exclusively about the dose, the strength, and the timing of alcohol exposure. However, perhaps even more important are factors involving the mother – her genetic background and nutritional status to name just two. Based on those maternal factors, what may be a completely safe amount of alcohol for one woman to drink during her pregnancy may be a serious problem for another woman’s developing fetus. Without knowing those genetic and nutritional factors that are critically involved with the way a woman metabolizes alcohol, it is not possible to make any generalizations about a “safe” amount of alcohol during pregnancy. What may be” safe” for one woman may be “devastating” for another woman’s unborn baby.”
Dr. Michael Charness – Harvard Medical School:
“Moderate levels of alcohol have been shown to disrupt the activity of a number of molecules that are critical for normal brain development. One such example, the L1 cell adhesion molecule, guides the migration of brain cells and the formation of connections between brain cells. Children with mutations in the L1 gene have developmental disabilities and brain malformations, and, importantly, the function of the L1 molecule is also disrupted by concentrations of alcohol that a woman would have in her blood after a single drink. These kinds of experiments support the view that women who are pregnant or trying to conceive would be safer to abstain from alcohol than to engage in even occasional light drinking.
Absence of proof is not proof of absence. The absence of evidence for developmental abnormalities in women who drink small amounts occasionally during pregnancy does not prove that light drinking is safe. Clinical studies do not have the power to detect small effects of alcohol on brain development, and even significant effects might be missed if the wrong test is used or if testing is conducted at the wrong developmental period. More practically, it is impossible to assure a mother who drinks lightly during pregnancy that her drinking did not result in a small drop in the IQ of her child. Light drinking is not essential to the health or well being of a pregnant woman, so why take a chance?”
If You Already Drank While Pregnant:
If you have just found out you are pregnant and you have been drinking alcohol, stop drinking now and talk with your 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 or at (800) 66-NOFAS.
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 or distilled spirits (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 concentration 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.” No type of alcohol or illicit drugs consumed during pregnancy are completely without risk.
Alcohol used during pregnancy can result in FASD. An estimated 40,000 newborns each year are believed to have an FASD, Fetal Alcohol Spectrum Disorders, with damage ranging from major to subtle.
1 in 100 newborns in the U.S. might 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.