Celeste M. Krauss, MD
Fetal alcohol exposure is one of the leading causes of birth defects and developmental disorders. Estimates place the number of US children affected by fetal alcohol exposure at almost 1 case for every 1,000 live births.
Pick up a bottle of beer, wine or hard liquor, and you'll see the following on the label:
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) and other alcohol-related problems.
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
intellectual disability, learning disabilities, physical problems (like abnormal facial features or abnormal growth) and serious behavioral 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. There is no known safe amount of alcohol that a woman can drink while pregnant.
Any time a pregnant woman participates in regular drinking, she increases her chance of having a
and puts her unborn child at risk. Problems associated with prenatal exposure to alcohol can occur in the first few weeks of pregnancy, before a woman may even knows that she is pregnant.
Findings from the Centers for Disease Control and Prevention (CDC) show that about 1 in 8 pregnant women reported alcohol use during pregnancy.
Fetal alcohol syndrome (FAS), caused by drinking alcohol during pregnancy, is characterized by:
Children with FAS may also 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 their family. FAS is 100% preventable—if a woman does not any drink alcohol while she is pregnant.
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 problems with behavior and learning and whose mother drank alcohol while pregnant. In 1996, 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.
Children with ARBD might have all or some of these.
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, such as facial changes, characteristic of FAS, whereas the growth and central nervous system problems could occur from alcohol use during any time in pregnancy.
Not all women who drink during pregnancy will have a child with FAS. However, avoiding all alcohol during pregnancy ensures the developing baby will not have FAS or any other alcohol-related outcomes.
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 miscarriage and puts her unborn child at risk for growth deficiencies, learning disabilities, and behavioral problems. In general, FAS severity increases with the amount of alcohol consumed.
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.
FAS is not treatable, nor can it be cured. Effects have to be managed with lifelong care, including coordinating medical, educational, and social services. The earlier these services are employed, the better the outcomes may be.
The easiest way to prevent FAS is to abstain from all alcohol use during pregnancy. Any amount of alcohol consumed during pregnancy is potentially dangerous to an unborn baby. If a your are a pregnant woman who is drinking, it is never too late 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
A 2005 message to women from the U.S. Surgeon General. Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/ncbddd/fasd/documents/sg-advisory.pdf. Accessed October 13, 2014.
Alcohol and drugs. March of Dimes website. Available at: http://www.marchofdimes.org/pregnancy/alcohol-during-pregnancy.aspx. Updated July 2012. Accessed October 13, 2014.
Alcohol use in pregnancy. Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/ncbddd/fasd/alcohol-use.html. Updated April 17, 2014. Accessed October 13, 2014.
Fetal alcohol spectrum disorders. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders.aspx. Updated October 6, 2014. Accessed October 13, 2014.
Fetal alcohol syndrome (FAS). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 30, 2013. Accessed October 13, 2014.
Where we stand: alcohol during pregnancy. American Academy of Pediatrics Healthy Children website.
http://www.healthychildren.org/English/ages-stages/prenatal/Pages/Where-We-Stand-Alcohol-During-Pregnacy.aspx. Updated July 18, 2014. Accessed October 13, 2014.
Last reviewed September 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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