Alcohol in Pregnancy
QUICK FACTS:
There is no safe amount of alcohol consumption during pregnancy.
Effects of fetal exposure to alcohol may be lifelong for the baby
There is no exact way to determine the relationship between the amount of alcohol consumed, and the potential damage caused by alcohol in an infant.
Alcohol exposure during pregnancy may cause physical abnormalities, brain and behavioral effects, or no detectable problems1.
A fetus in utero is especially susceptible to the effects of alcohol, because they do not process alcohol as efficiently as an adult and they are at a critical stage of development.2
In some studies, Fetal Alcohol Spectrum Disorder (FASD) has been diagnosed in up to 5% of live births3
POSSIBLE RISKS:
The following risks are POSSIBLE risks. They are not guaranteed and this list is not comprehensive. Alcohol in pregnancy may affect 2 major areas: structural growth and brain development.
Structural Growth Impairment:
Overall growth restriction
Head growth
Heart and other organ growth abnormalities
Skeletal growth abnormalities
Vision and hearing impairment
Brain Development Impairment:
Microcephaly (small head) is a sign of brain growth restriction
Seizures and nerve problems are signs of improper brain development
Cognitive, executive function, memory, and behavioral problems
Fetal Alcohol Spectrum Disorder (FASD):
Broad term used to describe the effects of alcohol exposure in an infant and includes the following4:
Fetal Alcohol Effects (FAE)
Alcohol-Related Birth Defects (ARBD)
Fetal Alcohol Syndrome (FAS)
Partial FAS (pFAS)
Characteristic facial features of FASD as shown here: https://depts.washington.edu/fasdpn/htmls/fas-face.htm
Possible Risks by Trimesters:
Alcohol exposure is dangerous to a fetus in all stages of gestation, but may have different effects at different times.
First Trimester:
Facial and structural abnormalities (classic facial features of FASD and small head)5
Second Trimester:
Risk of miscarriage
Third Trimester:
Weight, length, and brain growth5-7
Exposure in any trimester may cause neurobehavioral effects (brain development that will later affect behavior)
Takeaways:
Exposure earlier in pregnancy may typically cause physical abnormalities and risk of miscarriage.
Exposure later in pregnancy may typically cause more cognitive problems and overall growth restriction.
Neurobehavioral effects may occur with alcohol exposure at any point in gestation.
WHAT TO LOOK FOR:
Signs of Brain Development Impairment8-13:
Infancy:
Irritability, jitteriness, problems regulating states of sleep or arousal, developmental delay
Childhood:
Hyperactivity, inattention, cognitive delay, emotional reactivity, learning disabilities, memory difficulty
Adolescence:
Deficits in social skills, executive function (decision making, school, work, following social norms)
WHAT TO DO:
Early Detection and Intervention is very important for improving outcomes.
The initial workup to diagnose Fetal Alcohol Spectrum Disorder is performed by a multispecialty team.
Talk to your pediatrician or family physician
They can get you started with a multispecialty team to start the workup for a potential diagnosis of FASD
Bring up any concerns you may have that will aid them in early diagnosis
You can receive education about what to look for and when to bring your child in
Most children with FASD benefit from a variety of therapies including physical, speech, occupational, behavioral, and educational therapy.
- Henderson J, Gray R, Brocklehurst P. Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome. BJOG. 2007 Mar;114(3):243-52. doi: 10.1111/j.1471-0528.2006.01163.x. Epub 2007 Jan 12. Erratum in: BJOG. 2007 Jul;114(7):914-5. PMID: 17233797.
- Heller M, Burd L. Review of ethanol dispersion, distribution, and elimination from the fetal compartment. Birth Defects Res A Clin Mol Teratol. 2014 Apr;100(4):277-83. doi: 10.1002/bdra.23232. Epub 2014 Mar 10. PMID: 24616297.
- Williams JF, Smith VC; COMMITTEE ON SUBSTANCE ABUSE. Fetal Alcohol Spectrum Disorders. Pediatrics. 2015 Nov;136(5):e1395-406. doi: 10.1542/peds.2015-3113. Epub 2015 Oct 19. PMID: 26482673.
- Fetal Alcohol Exposure. National Institutes of Health. (2015). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/fetal-alcohol-exposure. (Accessed on 07/22/2021).
- Feldman HS, Jones KL, Lindsay S, Slymen D, Klonoff-Cohen H, Kao K, Rao S, Chambers C. Prenatal alcohol exposure patterns and alcohol-related birth defects and growth deficiencies: a prospective study. Alcohol Clin Exp Res. 2012 Apr;36(4):670-6. doi: 10.1111/j.1530-0277.2011.01664.x. Epub 2012 Jan 17. PMID: 22250768.
- O'Leary CM, Nassar N, Kurinczuk JJ, de Klerk N, Geelhoed E, Elliott EJ, Bower C. Prenatal alcohol exposure and risk of birth defects. Pediatrics. 2010 Oct;126(4):e843-50. doi: 10.1542/peds.2010-0256. Epub 2010 Sep 27. PMID: 20876169.
- The Interagency Coordinating Committee on FASDs. Consensus statement on recognizing Alcohol-Related Neurodevelopmental Disorder (ARND) in primary health care of children. 2011. www.niaaa.nih.gov/sites/default/files/ARNDConferenceConsensusStatementBooklet_Complete.pdf (Accessed on 07/22/2021).
- Hoyme HE, Kalberg WO, Elliott AJ, Blankenship J, Buckley D, Marais AS, Manning MA, Robinson LK, Adam MP, Abdul-Rahman O, Jewett T, Coles CD, Chambers C, Jones KL, Adnams CM, Shah PE, Riley EP, Charness ME, Warren KR, May PA. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics. 2016 Aug;138(2):e20154256. doi: 10.1542/peds.2015-4256. Epub 2016 Jul 27. PMID: 27464676; PMCID: PMC4960726.
- Paintner A, Williams AD, Burd L. Fetal alcohol spectrum disorders--implications for child neurology, part 2: diagnosis and management. J Child Neurol. 2012 Mar;27(3):355-62. doi: 10.1177/0883073811428377. Epub 2012 Jan 12. PMID: 22241713.
- Streissguth AP, Aase JM, Clarren SK, Randels SP, LaDue RA, Smith DF. Fetal alcohol syndrome in adolescents and adults. JAMA. 1991 Apr 17;265(15):1961-7. PMID: 2008025.
- Clarren SK, Smith DW. The fetal alcohol syndrome. N Engl J Med. 1978 May 11;298(19):1063-7. doi: 10.1056/NEJM197805112981906. PMID: 347295.
- Spohr HL, Willms J, Steinhausen HC. Fetal alcohol spectrum disorders in young adulthood. J Pediatr. 2007 Feb;150(2):175-9, 179.e1. doi: 10.1016/j.jpeds.2006.11.044. PMID: 17236896.
- O'Connor MJ, Paley B. Psychiatric conditions associated with prenatal alcohol exposure. Dev Disabil Res Rev. 2009;15(3):225-34. doi: 10.1002/ddrr.74. PMID: 19731386.