The Dangers of Drinking for Two: Alcohol and Birth Defects
Fetal alcohol exposure is a leading cause of birth defects and developmental disorders. Recent estimates of the number of US children affected by fetal alcohol exposure range from 1 per 2,000 live births to 1 per 100 live births.
Pick up a bottle of beer, wine or hard liquor, and you'll see the following on the label:
GOVERNMENT WARNING: ACCORDING TO THE SURGEON GENERAL, WOMEN SHOULD NOT DRINK ALCOHOLIC BEVERAGES DURING PREGNANCY BECAUSE OF THE RISK OF BIRTH DEFECTS.
The stark wording is an attempt to prevent fetal alcohol syndrome (FAS), fetal alcohol effects (FAE), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD).
Alcohol and Pregnancy Don't Mix
When a woman drinks alcoholic beverages, the alcohol in her blood crosses the placenta freely and enters the embryo or fetus through the umbilical cord. Children affected by prenatal exposure to alcohol may suffer lifelong consequences, including mental retardation, learning disabilities, and serious behavior problems.
All drinks containing alcohol can hurt an unborn baby. A standard 12-ounce can of beer has the same amount of alcohol as a four-ounce glass of wine or a one-ounce shot of straight liquor. In addition, some alcoholic drinks, such as malt beverages, wine coolers, and mixed drinks, often contain more alcohol than a 12-ounce can of beer. Studies have not been done to establish a known safe amount of alcohol that a woman can drink while pregnant.
Any time a pregnant woman participates in regular drinking (risk-drinking), she increases her chance of having a spontaneous abortion and puts her unborn child at risk for growth deficiencies, learning disabilities, and behavioral problems. Birth defects associated with prenatal exposure to risk-drinking alcohol intake can occur in the first 3-8 weeks of pregnancy, before a woman even knows that she is pregnant.
Findings from the Centers for Disease Control and Prevention (CDC) show that one in eight women of childbearing age (18–44 years old) reported "risk-drinking" (drinking seven or more drinks per week, or five or more drinks on any one occasion). Drinking alcohol at these levels could pose a serious health threat to the unborn fetus. One of every 29 women who knows that she is pregnant reports risk-drinking.
Fetal Alcohol Syndrome (FAS)
Fetal alcohol syndrome (FAS), caused by drinking alcohol during pregnancy, is one of the leading known causes of mental retardation and birth defects. It is characterized by:
- Abnormal facial features, including small head size, narrow eye slits, and abnormalities of the nose and lip areas
- Growth deficiencies
- Central nervous system (CNS) problems
Children with FAS may have problems with learning, memory, attention span, problem solving, speech, and/or hearing. These problems often lead to difficulties in school and problems getting along with others. FAS is an irreversible condition that affects every aspect of a child's life and the lives of his or her family. FAS is 100% preventable—if a woman does not drink alcohol while she is pregnant.
Fetal Alcohol Effects (FAE), Alcohol-related Neurodevelopment Disorder (ARND), and Alcohol-related Birth Defects (ARBD)
Many terms have been used to describe children who have some, but not all, of the clinical signs of FAS. Three such terms are:
Fetal Alcohol Effects (FAE)
In the past, FAE was generally used to describe children who did not have all of the clinical signs of FAS, but who had various problems, including growth deficiency, behavioral problems, or problems with motor and speech skills. FAE has also been used to describe children who have all of the diagnostic features of FAS, but at mild or less severe levels. Because experts in the field were unable to agree on a single definition for FAE, the Institute of Medicine (IOM) proposed the terms ARND and ARBD.
Alcohol-Related Neurodevelopmental Disorder (ARND)
ARND describes the functional or mental impairments linked to prenatal alcohol exposure, such as behavioral or cognitive abnormalities including learning difficulties, poor school performance, poor impulse control, and problems with mathematical skills, memory, attention, and/or judgment.
Alcohol-Related Birth Defects (ARBD)
ARBD describes malformations of the skeletal system and major organ systems, such as defects of the heart, kidneys, bones, and/or auditory system.
Common Questions About Alcohol and Pregnancy
How are birth defects caused by drinking alcohol during pregnancy?
The exact mechanism(s) by which alcohol damages the fetus and critical times of exposure are not known. Exposure during the first trimester results in the structural defects (ie, facial changes) characteristic of FAS, whereas the growth and CNS disturbances could occur from alcohol use during any time in pregnancy.
Does drinking during pregnancy always result in FAS?
Not all women who drink heavily during pregnancy will have a child with FAS. Why some women are more susceptible than others is not clear. By not drinking at all during pregnancy, women can ensure that their babies will not have FAS or any other alcohol-related outcomes.
How much alcohol is reasonably acceptable to drink without running the risk of a child developing FAS?
There is no known safe amount of alcohol that a woman can drink while pregnant. Any time a pregnant woman engages in regular drinking, she increases her chance of having a spontaneous abortion and puts her unborn child at risk for growth deficiencies, learning disabilities, and behavioral problems.
Is FAS hereditary or is there a hereditary disposition to getting it?
FAS is not hereditary. It can only occur if a woman drinks alcohol during her pregnancy. Currently, it is not known why some children are more likely to develop FAS than other children if their mothers drank during pregnancy.
Can FAS be treated? How?
There is no cure for either fetal alcohol syndrome or fetal alcohol effect. They are irreversible, lifelong conditions that affect every aspect of a child's life and the lives of his or her family members. With early identification and diagnosis, a child with FAS can receive services that can help maximize his or her potential.
The easiest way to prevent FAS is to abstain from alcohol use during pregnancy. Any amount of alcohol consumed during pregnancy is potentially dangerous to an unborn baby. If a pregnant woman is drinking during pregnancy, it is never too late for her to stop. The sooner a woman quits drinking, the better it will be for both her and her baby. If a woman is not able to quit drinking, she should contact her local social service agency or health plan for alcohol abuse treatment, if needed. If a woman is not yet pregnant, she should use an effective form of birth control until her drinking is under control.
Mothers aren't the only ones who can help prevent FAS, though. Significant others, family members, schools, social organizations, and communities alike can help prevent FAS through education and intervention.
National Institute on Alcohol Abuse and Alcoholism
National Organization on Fetal Alcohol Syndrome (NOFAS)
The Society of Obstetricians and Gynaecologists of Canada
Fetal alcohol syndrome. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncbddd/fas/. Accessed November 2002.
Fetal alcohol syndrome: 10 things you need to know. American Academy of Pediatrics website. Available at: http://www.aap.org/advocacy/chm98fet.htm. Accessed November 2002.
Last reviewed July 2008 by Kari Kassir, MD
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