Drinking while pregnant: What we know and what we don’t

Will an occasional drink during pregnancy harm a baby? While we’ve long known that heavy alcohol consumption during pregnancy can cause these problems, the effects of an occasional glass of wine is less understood.
Will an occasional drink during pregnancy harm a baby? While we’ve long known that heavy alcohol consumption during pregnancy can cause these problems, the effects of an occasional glass of wine is less understood.

“It’s our anniversary Saturday. Would it be OK to have a glass of wine?” “Can I have an occasional beer with dinner?” “I just found out I’m pregnant – but I had a couple drinks last weekend. Is my baby going to be OK?”

Pregnant women often have questions like these. Unfortunately, the advice they get can be confusing. Almost all national health organizations recommend complete abstinence when it comes to drinking during pregnancy, while some obstetricians – including myself – say it’s OK to have a drink now and then.

Still, we can’t ignore the potentially devastating effects of fetal alcohol spectrum disorders (FASD): low birthweight, developmental delays, behavioral problems, and health problems such as seizures and visual or hearing impairment. As many as one in 100 children born in Texas may have an FASD.

While we’ve long known that heavy alcohol consumption during pregnancy can cause these problems, the effects of an occasional glass of wine is less understood. Because we’re just not sure, there has been a push for women to refrain from consuming any alcohol while trying to get pregnant and during pregnancy.

What studies say about drinking while pregnant

The research is conclusive: Binge drinking and heavy consumption of alcohol in pregnancy pose a definite risk to the developing fetus. However, we just don’t have the same level of conclusive information when talking about low-level alcohol consumption.

For example, a 2012 Danish study examined the effects on 5-year-olds whose mothers drank alcohol during pregnancy, categorized as follows:

  • Low consumption: One to four drinks a week
  • Moderate consumption: Five to eight drinks a week
  • High consumption: Nine or more a week
  • Binge drinking: Five or more drinks during a single occasion

Researchers who knew nothing about the maternal consumption of alcohol during the pregnancy examined the 5-year-old children of those pregnancies. They performed tests on IQ, attention span, and executive functions such as planning, organization, and self-control. They were unable to tell any difference between children whose mothers drank low to moderate amounts of alcohol and those who abstained completely during pregnancy.

While this would seem to suggest that low-level alcohol consumption is safe during pregnancy, there are other factors to consider. First, while the study included 1,600 women, that’s still a relatively small sample size. Second, children’s brains are still developing at age 5, and the full effects that alcohol may have had on them may not yet be measurable.

The authors of the study concluded that more large-scale studies are needed to investigate the effects of low and moderate alcohol consumption during pregnancy – and that for now it’s best for pregnant women to avoid alcohol.

National health organizations advise abstaining from alcohol

There have been a number of publicized statements on alcohol use and pregnancy in the past year.

In November 2015, the American Academy of Pediatrics published a report that focused on recognizing, diagnosing, and treating FASD. They also reaffirmed their recommendation that no amount of alcohol should be consumed during any trimester of pregnancy. This follows the advice of most health organizations focused on pregnancy, such as the American Congress of Obstetricians and Gynecologists.

The CDC caused controversy in February when it published a report intended to raise awareness of the risk of FASD due to drinking before a woman realizes she is pregnant. The report recommended that women who are sexually active and want to get pregnant should avoid alcohol, and women who are sexually active and don’t want to get pregnant should use an effective birth control method. The report noted that half of pregnancies are unplanned, and even for women trying to conceive, most won’t know they’re pregnant until four to six weeks into the pregnancy.

In a press release announcing the report, a CDC official was quoted as saying: “It is critical for healthcare providers to assess a woman’s drinking habits during routine medical visits; advise her not to drink at all if she is pregnant, trying to get pregnant or sexually active and not using birth control; and recommend services if she needs help to stop drinking.”

Other countries also are beginning to recommend completely abstaining from alcohol during pregnancy. The UK Department of Health in January 2016 issued new guidelines that advise just that. Previous guidelines said while pregnant women should avoid alcohol, if they did choose to drink, they should “not drink more than 1 to 2 units of alcohol once or twice a week and should not get drunk." While the new guidelines no longer give a range of how much a woman could drink if she wanted to, they do say the risk of harm to the baby is likely low if a woman drinks a small amount during pregnancy.

Managing risks while preserving rights

Some pregnant women tell me they feel judged when they have a drink. I am not sure how we got to the point that in May 2016, New York City had to clarify guidelines prohibiting bars and restaurants from refusing to serve alcohol to pregnant women. The guidelines – which also apply to selling and serving foods such as soft cheeses and raw fish – are intended to discourage discrimination against pregnant women.

I understand the messages can seem mixed. For example, venues in New York City that serve alcohol are required by law to post a sign warning of the dangers that alcohol can pose to a developing fetus, but employees of that bar or restaurant must serve pregnant women alcohol if they order it.

Obviously, this is a complex issue. The debate that the New York City guidelines renewed over the risks of drinking while pregnant and preserving a woman’s right to make her own decisions followed the backlash a few months before to the CDC recommendation that women not drink unless they were using contraception. Some women felt that the CDC was being condescending and interfering in their right to make decisions about how they live their lives.

Having a drink during pregnancy is a personal decision

We know drinking heavily during pregnancy is not safe for the baby. We are less sure about the risks of low to moderate drinking, and until we have better information, it’s understandable that health organizations and providers would advise complete abstinence from alcohol.

But women make decisions about risks and outcomes for our health and the health of our children all the time. We decide what contraception to use based on our acceptance of the risk of an unintended pregnancy. We weigh risks and benefits of using anti-nausea medications or other drugs during pregnancy.

Healthcare providers need to educate women about what we know regarding alcohol consumption during pregnancy. Women need to be allowed to make their own decisions based on the amount of risk they are willing to accept. Many will say, “If there is any risk, I will follow the guidelines and not drink at all.” Others may examine the risks and choose to have an occasional drink.

The trouble with guidelines that recommend total abstinence is they don’t involve nuance. There are certainly women who truly have a problem with alcohol and whose drinking puts their babies at risk. We need to identify those women early and get them help. For women who do not have an unhealthy relationship with alcohol and who want to have a drink on a special occasion, they shouldn’t fear being judged or have others make that decision for them.

What if I drank before I realized I was pregnant?

Women frequently come to us worried because they had a few drinks before they noticed a missed period. I assure them there is little evidence to suggest that they harmed their pregnancy.

I also use this opportunity to discuss how much they normally drink and to educate them about the risks of drinking during pregnancy. If they don’t want to stop drinking entirely, we discuss what might be a reasonable limit. I tell patients I think one to two drinks a week is unlikely to be harmful – but that I can’t guarantee that there are no possible risks. Most of the time, they just want to know it’s OK to have a glass of wine to celebrate a special occasion.

If you have a problem with alcohol, don’t be ashamed to ask for help. Addiction is a disease, and most people can’t manage it on their own. Your physician can refer you to a therapist or program that may be able to help. The sooner you get your drinking under control, the better it will be for you and your baby.

If you are concerned about the amount of alcohol you drank before you knew you were pregnant, want to know more about the effects of alcohol during pregnancy, or need help managing an unhealthy relationship with alcohol, talk with your physician. You can schedule an appointment online or call 214-645-8300.

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