Prenatal Alcohol Exposure: Consequences of Imbibing During Pregnancy
Alcohol use in women of childbearing age is ubiquitous. In fact, the Centers for Disease Control and prevention (CDC) reported that 7.6% of pregnant women used alcohol and 1.4% admitted to binge drinking (at least 4 drinks at one time) in 2010. Alcohol appears to have negative effects throughout pregnancy. It freely crosses the placenta. Fetal Alcohol Syndrome (FAS) is the most severe and most well studied along the spectrum of alcohol related fetal damage (ARFD). FAS is diagnosed when three criteria are met: growth problems, facial dysmorphia, and central nervous system abnormalities. The prevalence of FAS is 10—50% in moderate to heavy drinkers (1-2 oz absolute alcohol per day) and chronic alcoholics. The short and long-term effects of light to moderate prenatal alcohol exposure are less well defined.
In this study, conducted at UCLA Department of Psychiatry and Biobehavioral Sciences , the authors investigate the ongoing and controversial issue of alcohol use during pregnancy; specifically, they were interested in the link between prenatal alcohol exposure and physical, cognitive and behavioral impairments, in those without strictly defined FAS. This study was unique because it controlled for IQ and compared kids exposed in utero to alcohol, to kids with underlying poor social functioning, who were not exposed to prenatal alcohol.
The authors concluded that children in the prenatal alcohol exposure group scored significantly lower than the non-exposed group in every area including executive functioning, attention, working, visuospatial memory, adaptive behavior, emotional/behavioral functioning, language abstraction ability and social cognition. They conclude that relying on IQ alone to guide parental, peer, and school expectations may be misleading.
In my 20 years of practice as an ob/gyn, I’ve been fortunate and privileged to care for health conscious and motivated women. Most in fact, feel horribly guilty and frightened to have had a New Year’s toast or a girls night out gone wild, only to find out that they were unknowingly pregnant at the time. Those who are knowingly drinking while pregnant seem only more than happy to abstain, once the risks and uncertainties are discussed. All pregnant women should be screened for alcohol use with detailed history or self-administered questionnaire. With that said, admission of alcohol use in pregnancy can be stigmatizing; thus women may be reluctant to admit to any amount of drinking.
Education and counseling about specific alcohol risks early on during pre-conceptual visits, routinely during obstetrical visits, with handouts and literature and reliable web sources make a huge impact. The truth is there is no confirmed “safe” threshold of alcohol exposure in pregnancy. This makes my job easy. I’m firm; no alcohol when pregnant, period. In fact, the US Surgeon General recommends abstinence from alcohol for women planning pregnancy, at conception and during pregnancy because a safe level has not been determined. Other countries including Canada, Australia and the United Kingdom, to name a few, follow suit. With that said, pregnant women have a thirst for knowledge and are typically highly motivated to modify behavior to help their unborn child.
The findings here support information already established in other studies. While kids with FAS may show normal development as preschoolers, many have severe brain dysfunction confirmed at a later age. In addition, normal IQ not withstanding, most have language, memory and activity level dysfunction. Finally, the overall rate of FAS is difficult to quantify diagnostic guidelines used currently vary.
Those with significant impairment due to FAS will be easily recognized; those who are more subtly affected may fall through the cracks. Early identification of kids at risk is essential so parents, practitioners and educators can intervene early and increase chances of these kids living productive meaningful lives.
In conclusion, this study supports what we really already know to be true: there is no established safe amount of alcohol in pregnancy. The findings confirm behavioral, emotional and cognitive risks that in utero alcohol exposure poses to a developing fetus. These disabilities can and will impact the everyday lives and social functioning of these kids. Pre-conceptual and prenatal education about alcohol avoidance are paramount. Early identification and intervention of those at risk are vital. My patients seem grateful and relieved to have definitive and unwavering advice about complete abstinence from alcohol during pregnancy from me and accurate, accessible and up to date information from outside resources.
Written by Dr. Alyssa Dweck MS MD FACOG, Maternal Science Inc and healthy mama brand Advisory Board Member