“Everything in moderation” does not apply to drinking alcohol while pregnant.

Submitted by Jeffrey R. Wozniak, Ph.D., Associate Professor, FASD Research Program, University of Minnesota on behalf of the Minnesota Organization on Fetal Alcohol Syndrome (MOFAS)

Despite 40 years of scientific research demonstrating the clear risks of drinking during pregnancy, many women and their doctors are still are not convinced that there is no safe level of alcohol during pregnancy.

Alcohol is a teratogen that causes birth defects much like another well-known teratogen, thalidomide, albeit at lower rates.  Alcohol causes miscarriage, physical deformities, cardiac anomalies, microcephaly, and brain damage.  In the late 1950’s and early 1960’s, it was discovered that thalidomide caused miscarriages, missing arms and legs, and facial deformities, and it was taken off the market.  Although there may be a dosage below which thalidomide does not cause birth defects, would it be reasonable to consider it safe at low levels?  Would it be appropriate to tell women “it’s safe as long as you don’t take too much”?  No, the popular mantra “everything in moderation” simply doesn’t apply to teratogens like thalidomide or alcohol during pregnancy.

Drinking at any stage of pregnancy poses risks.  The developing fetus is at risk for a wide range of physical, intellectual, developmental and behavioral problems that may ultimately be diagnosed as a Fetal Alcohol Spectrum Disorder (FASD).  A recent survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicated that almost one in five pregnant women drinks alcohol early in pregnancy and some continue to drink throughout their pregnancy.  In Minnesota, approximately 8,500 babies are born each year with lifelong effects of prenatal alcohol exposure. FASD is the single-most common known cause of intellectual disability and it is 100% preventable.  Prevention only requires abstaining from alcohol during pregnancy.

As health care providers, we are a primary source of health information for women of child-bearing age, pregnant or not-yet-pregnant.  We are in the position to deliver this critical message and dispel myths about alcohol use during pregnancy.  Unfortunately, many clinicians and their patients mistakenly believe that only women with alcoholism are at risk; many believe that there are “safe” or “safer” periods during pregnancy; and many believe that wine is safe to consume during pregnancy.  In fact, social drinking can easily result in blood alcohol levels that cause brain damage; this brain damage can occur at any point in gestation; and research has never established a “safe” level of alcohol during pregnancy and likely never will because of tremendous variability in maternal genetics, nutrition, age, and other factors that substantially and unpredictably increase risk.

Forty years of scientific evidence supersedes public opinion and the popular media.  The U.S. Surgeon General, the Centers for Disease Control, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists could not be more clear in stating that women who are pregnant or could become pregnant should not consume any alcohol.  I ask fellow healthcare providers, please ask all women of childbearing age in your practice about alcohol use and provide information about FASD as routine preventative medicine.  Ask every woman, every time, and prevent FASD.

Side bar Statistics:

18% of U.S. women 18-44 report drinking alcohol in their first trimester
7% report binge drinking during their first trimester (5 or more drinks with in a couple of hours)
(Source – SAMHSA)

50% of pregnancies are unplanned
FAS = 2 per 1000 live births
FASD is estimated to be 2-5%
(Source – CDC, Morbidity and Mortality Weekly Reports)

60% of women over pour or underestimate the size of a drink, especially when pouring hard liquor
A balloon glass of wine contains 2-3X more alcohol than a standard drink.

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