From the March of Dimes Re: Alcohol

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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. Manny 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 birthweight 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 breastfed 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-)

A national help and referral line for people affected by alcohol and

drug abuse.

The National Council on Alcoholism

1-800-NCA-CALL (1-)

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