Is it safe for a woman to have an occasional beer, glass of wine, or other alcoholic beverage when she is pregnant?
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 known safe time during pregnancy or safe type of alcohol.” According to the American Academy of Pediatrics: “There is no safe amount of alcohol when a woman is pregnant. Evidence-based research has found that drinking even small amounts of alcohol while pregnant can increase the risk of miscarriage, stillbirth, prematurity, or sudden infant death syndrome.”
When you drink alcohol, so does your developing baby. Any amount of alcohol, even the alcohol 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. The embryo or fetus has the same blood alcohol concentration as the mother. It makes no difference if the alcoholic drink consumed is a beer, glass of wine or a distilled spirit or liquor such as vodka.
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 they 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
More than forty years of published research has 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 can cause 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
There are several research studies published by scientists from the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), the world’s leading FASD research consortium, that have examined moderate prenatal alcohol exposure.
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.
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 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. Thousands 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 more damage to the developing baby than many illicit drugs. 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 still can potentially cause harm to the growing baby. Some women who do not have the disease of alcoholism could have children with measurable effects of alcohol exposure. It is true that drinking patterns associated with alcohol use disorders pose the highest risk to the unborn baby.
Myth: Alcohol can only cause physical deformities. If the baby looks normal, it must be fine.
The vast majority (over 85%) of children with characteristics or disabilities from prenatal alcohol exposure have no physical birth defects, only cognitive and/or behavioral consequences. There is a wide range of effects, and 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 women 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 other women have a genetic make-up that reduces their vulnerability for having an alcohol-effected birth. However, science has not demonstrated how these genetic and epigenetic (changes in how genes are expressed without altering the underlying DNA sequence) factors contribute to the vulnerability of a specific woman’s pregnancy. This uncertainty is the primary reason for the recommendation of abstention from any alcohol during pregnancy as the safest course.
Myth: A single drink containing one ounce of alcohol during pregnancy, or occasionally during pregnancy, has been scientifically linked to affects that can be diagnosed as an FASD.
While only abstention from alcohol during pregnancy completely eliminates any risk to the embryo or fetus there is no published research or documented case of an individual prenatally exposed to an ounce of alcohol being diagnosed with an FASD. It is possible that a drink could have a subtle harmful effect, but it has not been scientifically shown that such an effect would reach the criteria necessary for a diagnosis under the FASD umbrella.
Statements from Medical Experts
Dr. Kenneth Jones – Researcher who co-discovered “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?”