Pregnancy and Alcoholism: The Effects of Drinking While Pregnant
Alcohol impacts the fetus via the mother’s blood, which passes through the umbilical cord. The detrimental effects of drinking alcohol during pregnancy on the unborn infant are well documented. Drinking while pregnant can cause miscarriage, stillbirth and a range of lifelong physical, behavioral, and intellectual disabilities known as fetal alcohol spectrum disorders (FASDs).1
Alcohol Use and Pregnancy Facts and Stats
- According to the 2013 U.S. National Survey on Drug Use and Health, 9.4% of all pregnant women reported alcohol use.2
- In multiple surveys prior to 2001, 20% of all women reported consuming some alcohol during pregnancy. Rates of alcohol use during pregnancy have decreased in the last 15 years due in part to increased public education and awareness regarding the detrimental effects on the infant.3
- An estimated 3.3 million women ages 15 to 44 who are sexually active drink alcohol and do not use birth control. Moreover, three in four women who want to get pregnant don’t cease drinking when they stop using birth control, according to a report from the U.S. Centers for Disease Control and Prevention.4
- An estimated 53% of U.S. women younger than 30 may not know they are pregnant and episodically engage in heavy drinking including binge drinking, a behavior particularly damaging to fetal development.5
- Mental health disorders often co-occur with alcohol problems. Depressed pregnant women are more likely to drink alcohol, binge drink and not receive prenatal care than women who are not depressed.6
FASDs Facts and Stats
FASDs are a leading cause of intellectual disability in the U.S. and worldwide. The global prevalence of Fetal Alcohol Syndrome (FAS), the worst manifestation of FASD, is estimated at 2.9%, although regional prevalence estimates are as high as 55.42%. The prevalence of FASD is 22.77% with regional highs as high as 113.22%.5 Greater amounts and frequency of alcohol consumption increase the risk. The highest risk is associated with binge drinking due to episodes producing the highest blood-alcohol levels.6
Infants with FAS can experience withdrawal symptoms such as jitteriness, irritability and poor feeding within 12 hours post-delivery. The following characteristics and behaviors can affect children with FASDs:
- Abnormal facial features, such as a smooth ridge (philtrum) between the nose and upper lip
- Small head size
- Shorter-than-average height
- Low body weight
- Poor coordination
- Hyperactive behavior
- Difficulty with attention
- Poor memory
- Difficulty in school (especially with math)
- Learning disabilities
- Speech and language delays
- Intellectual disability or low IQ
- Poor reasoning and judgment skills
- Sleep and sucking problems as a baby
- Vision or hearing problems
- Problems with the heart, kidney or bones1
Prevention and Diagnostic Research
Prevention of FASDs is challenging due to the combined incidence of unplanned pregnancies and patterns of heavy alcohol consumption in women of childbearing age. An additional complication is that many prenatally exposed infants do not exhibit craniofacial abnormalities or growth deficits that help confirm diagnosis.5
Prior to pregnancy, interventions may focus on contraception, pregnancy planning and boosting awareness of FASDs. During pregnancy, cessation and/or reduction of alcohol exposure and the implementation of potential interventions such as nutritional supplements (or future pharmacological therapy) may be implemented. Early diagnosis of FASD is crucial because in the absence of a diagnosis, children experience higher rates of secondary disabilities including disrupted education, delinquency, institutional confinement, inappropriate sexual behaviors, alcohol/drug problems and mental health issues. Identification of mothers at risk may prevent alcohol exposure to unborn infants and FASDs in subsequent pregnancies.6
Previous studies have identified ethanol metabolites in neonatal meconium, placenta and in newborn dried blood spots as biomarkers for fetal alcohol exposure. These biomarkers, however, are not predictors of infant health outcomes.5 However, they can be useful in identifying women at risk at various points, such as prior to pregnancy, early in pregnancy, throughout the pregnancy and when the baby is born.6 Validated, highly specific alcohol metabolites with a wider time window of detection than alcohol itself include:
- Ethyl glucuronide (EtG): Detected in blood/plasma/serum, urine, hair and meconium
- Ethyl sulfate (EtS): Detected in blood/plasma/serum, urine, hair and meconium
- Fatty acid ethyl esters (FAEEs): Detected in blood/plasma/serum, hair and meconium
- Phosphatidylethanol (PEth): Detectable for four to six weeks in blood following low-to-moderate prenatal alcohol consumption
A study on 68 alcohol-exposed pregnant mothers in western Ukraine analyzed if changes in microRNAs (miRNAs) in maternal blood in alcohol-exposed pregnant mothers, either alone or in conjunction with other clinical variables, could predict infant outcomes. The average gestational time in this study was 18 to19 weeks and many women reported alcohol use in the previous month, well into the critical period for a host of problems to the developing fetal brain. Researchers concluded that maternal plasma miRNAs predict infant outcomes, and may be useful in classifying difficult-to-diagnose FASD subpopulations.5
The simplest approach to identify women at risk is self-reporting. However, not all women are honest about this. Women should be asked about alcohol consumption if they are pregnant and queried about drinking alcohol and the use of contraceptives even if they aren’t pregnant but could be in the future. Efforts to reduce the stigma associated with prenatal alcohol consumption may improve the accuracy of self-reported drinking.6
For screenings to be effective, women must be reassured they will not be stigmatized or lose custody of their children. Moreover, appropriate treatment must be readily available. The optimal approach for identifying women at risk of having a child with an FASD is a combination of screening tests, self-reporting measures and effective biomarkers incorporated into routine obstetric and gynecologic care.6
Most programs choose to treat pregnant, alcohol-dependent women with short-acting benzodiazepines. It is absolutely mandatory that pregnant women seek inpatient, medically-supervised treatment due to the high risks to both mother and child. If you have a drinking problem and are pregnant or considering getting pregnant, call us today at 888-478-7519. During a confidential assessment, we will help you determine if our alcohol treatment program is the right choice for you.
- Alcohol Use in Pregnancy. Centers for Disease Control and Prevention website. http://www.cdc.gov/ncbddd/fasd/alcohol-use.html Updated July 21, 2016. Accessed November 13, 2016.
- Konijnenberg C1. Methodological Issues in Assessing the Impact of Prenatal Drug Exposure. Subst Abuse. 2015 Nov 8;9(Suppl 2):39-44. doi: 10.4137/SART.S23544. eCollection 2015.
- Bhuvaneswar CG, Chang G, Epstein LA, Stern TA. Alcohol Use During Pregnancy: Prevalence and Impact. Prim Care Companion J Clin Psychiatry. 2007;9(6):455-460.
- Millions of Pregnant Women Put Their Babies at Risk With Alcohol: CDC. HealthDay website. https://consumer.healthday.com/pregnancy-information-29/pregnancy-news-543/millions-of-pregnant-women-put-their-babies-at-risk-with-alcohol-cdc-707678.html Published February 2, 2016. Accessed November 13, 2016.
- Balaraman S, Schafer JJ, et al. Plasma miRNA Profiles in Pregnant Women Predict Infant Outcomes following Prenatal Alcohol Exposure. PLoS One. 2016 Nov 9;11(11):e0165081. doi: 10.1371/journal.pone.0165081. eCollection 2016.
- Montag AC. Fetal alcohol-spectrum disorders: identifying at-risk mothers. Int J Womens Health. 2016;8:311-323. doi:10.2147/IJWH.S85403.