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Home > Research Articles > Facts About Alcohol Use During Pregnancy

The Arc of the United States

Monday, March 4, 2002

What is meant in warnings to pregnant women not to drink alcohol? Research has shown that even small levels of alcohol consumed during pregnancy may affect the fetus in damaging ways. In pregnant women, alcohol is not only carried to all organs and tissues, but also to the placenta, where it easily crosses through the membrane separating maternal and fetal blood systems. In this way, alcohol is transported directly to the fetus and to all its developing tissues and organs. When a pregnant woman drinks an alcoholic beverage, the concentration of alcohol in her unborn baby's bloodstream is the same level as her own. Unlike the mother, however, the liver of a fetus cannot process alcohol at the same adult's rate of one ounce every two hours. High concentrations of alcohol, therefore, stay in the fetus longer, often for up to 24 hours. In fact, the unborn baby's blood alcohol concentration is even higher than the mother's during the second and third hour after a drink is consumed. What kind of damage can occur to the fetus from alcohol consumption by the mother? There are two degrees of damage that can occur. The most severe is Fetal Alcohol Syndrome (FAS). The Fetal Alcohol Syndrome Study Group of the National Council on Alcoholism outlines minimal criteria for the diagnosis of FAS as being, "evidence of abnormalities in three specific areas: growth, central nervous system functions and facial characteristics." Fetal Alcohol Effects (FAE) include less severe birth defects in the same areas. In both FAS and FAE, birth defects are caused when a woman drinks alcohol during pregnancy. FAS and FAE form the single largest class of birth defects that are 100 percent preventable. Is there a safe amount of alcohol that a pregnant woman can drink? The best advice is not to drink during pregnancy. We do not know what is a safe level at this time, and it may vary considerably with different individuals. The adverse effects of alcohol may vary with the stage of pregnancy and the amount of alcohol consumed on each occasion. There appears to be no difference in the type of alcoholic beverage (beer, wine, hard liquor) and its effects during pregnancy. Early exposure presents the greatest risk for serious physical defects, and later exposure increases the chances of neurological and growth deficiencies or miscarriage. The First Trimester -- This appears to be the most critical time when abnormal features can be caused. Alcohol may affect the way cells grow and arrange themselves as they multiply, altering tissue growth in the part o f the fetus that is developing at the time of exposure. The brain is particularly sensitive to alcohol which diminishes the number of cells growing in the brain. Consequently, the brain is smaller and often its neurons are found in the wrong places. The early loss of cells in the developing fetus may help explain overall retarded growth and low birth weight in babies with FAS. Second Trimester -- Miscarriage is a major risk during this time. There may be times of fetal distress related to binge drinking (irregular periods of heavy drinking). Third Trimester -- During this period the fetus normally undergoes rapid and substantial growth. Alcohol can impair this growth. This is also the time of greatest brain development. Research with animals indicates the brain and central nervous system are at great risk during the third trimester. How common are FAS and FAE? Full-blown FAS occurs in an estimated one out of every 750 live births. Less severe FAE occurs in approximately 10 to 12 live births out of 1,000 (36,000 babies per year). Among known alcohol-abusing women, however, FAS occurs in 30 percent of recorded live births. What are the problems of children born with these disorders? Typically, children born with FAS and FAE have the following symptoms: Low birth weight and failure throughout their lives to catch up to their peers in physical growth. Head: Small head size Narrow eye slits Flat midface Low nasal ridge Loss of groove between nose and upper lip Central nervous system: Mental retardation Alcohol withdrawal at birth Poor sucking response Sleep disturbances Restlessness and irritability Developmental delays Short attention span Learning disabilities Organs and body parts: Muscle problems Bone and joint problems Genital defects Heart defects Kidney defects Do all children with FAS/FAE have mental retardation? No. A recent study of 61 adolescents and adults with FAS or FAE revealed IQ scores ranging from 20 to 105, with an average of 68. Fifty-eight percent of these individuals had an IQ score of 70 or below (Streissguth, et al., 1991). Can FAS be treated? Birth defects related to alcohol use are permanent. Surgery can repair some of the physical problems, and schools and day care centers offer programs to improve mental and physical development. However, children born with FAS remain below average in physical and mental development throughout their lives. How can FAS be prevented? Recent studies have shown that pregnant women will reduce or cease their alcohol intake if they are made aware of the harmful effects of alcohol on their babies. However, the most critical period of the fetus is in the first trimester when the mother may not even suspect she is pregnant. For such women, an early warning system is imperative. The best advice for a woman who drank before she knew she was pregnant is to stop drinking for the remainder of her pregnancy and get regular prenatal care. Some women who drink during pregnancy have normal children. Why? Not all women who drink, even those who drink heavily, during pregnancy will have children with FAS. FAS is one end of the spectrum of outcomes associated with drinking. Some children born to drinkers appear normal at birth, but as they grow, the less obvious physical, intellectual, and psychological problems resulting from alcohol exposure during pregnancy can become evident. At this time, there is not a known safe level of alcohol consumption during pregnancy. Can a father's drinking cause FAS? A father's drinking during or before pregnancy does not directly cause FAS. However, women's drinking behavior is influenced by the drinking behavior of their partners, families, and communities. A partner can play an important role in helping the pregnant woman refrain from alcohol consumption during pregnancy. Families and friends can also be a powerful influence. What about adults with FAS, will their children also have FAS? FAS is not a genetic (inherited) disorder. Unless the mother drinks during the pregnancy, her children should not have FAS. What about other drugs? Do they cause FAS? No drug or medication should be taken during pregnancy without first consulting a doctor. By definition, alcohol is the cause of FAS. We do not know whether other drugs might contribute to some of the physical, intellectual, and psychological problems seen in individuals with FAS. Why is it especially important to educate young people about FAS? There are rising numbers of teen pregnancies and teens who use alcohol. Statistics illustrate the problems: According to McDonald's Corporation, the average age of beginning alcohol use is 12.5. The National Council on Alcoholism has said that nearly 100,000 10- and 11-year olds get drunk at least once a week. The 1985 Statistical Abstract developed by the U.S. Department of Commerce showed there were 239,000 pregnancies of girls between the ages of 14 and 18. Given the estimates of the incidence of FAS and FAE, more than 3,300 babies, born to teenagers, might be affected by FAS or FAE in one year.