Pregnant for the Holidays: To Toast or Not to Toast?

by Dr. Michele Brown, OB/GYN

Is drinking during pregnancy risky for your baby? You are all dressed up and ready to leave for the annual holiday party at your office, at your neighbor’s home, or maybe with family. The holidays are so special, festive and romantic, but this year there is a heightened sense of excitement because...you are pregnant.

With the holidays rapidly approaching, the age old question raises itself along with the clink of glasses -- can I join in the festivities with family and friends by having an alcoholic drink to celebrate. Maybe just one?

Alcohol and Pregnancy

The general rule has always been to avoid alcohol in pregnancy. The prevalence of alcohol use in pregnancy is estimated to be roughly 12.2% with 1.9% reporting binge drinking. Women have been shown to have a tendency to underestimate their alcohol consumption during pregnancy which often underestimates the fetal exposure also. Factors associated with alcohol use in pregnancy include education level, income level, temptation to drink in social situations, previous drinking history prior to the pregnancy and history of drinking at initiation of prenatal care.

High levels of chronic heavy prenatal alcohol consumption or frequent heavy intermittent use is a known cause of birth defects commonly referred to as Fetal Alcohol Syndrome. Among the characteristics of this condition are:

  • Cognitive developmental delays
  • Fetal growth retardation
  • Facial anomalies
  • Neurobehavioral deficits including learning disabilities, speech and language problems, hyperactivity and attention deficits.
  • High risk of preterm birth and small of gestational age babies

Moderate levels of alcohol consumption (1–2 drinks per day) during pregnancy can be associated with milder but clinically significant outcomes such as childhood cognitive, learning, attentional, and behavioral problems. Prenatal alcohol consumption, even at levels of less than one drink per day, may adversely affect fetal growth and development.

Is There a Safe Level of Drinking During Pregnancy?

The question always arises -- is there a safe level of drinking during pregnancy? It has been clearly found that heavy drinking harms a child's health and development but the role of light drinking has been far more controversial.

This issue is also relevant since in most industrialized countries, women of childbearing age drink alcohol and often this happens in the first trimester prior to pregnancy being recognized.

The mechanism of how alcohol acts as a toxin varies from direct alcohol toxicity, to placental dysfunction, fetal hypoxia, acetaldehyde toxicity, and nutritional deficits. The area of the brain that is commonly affected by alcohol is the hippocampus and development of the cerebral cortex.

What determines toxicity is the concentration of alcohol used, the pattern and quantity consumed and the stage of development of the fetus.

Research on Light Drinking During Pregnancy

newborn sleepingSome studies that have reported an association between very low levels of prenatal alcohol exposure and fetal growth, but the the association has not been consistent. Each study has looked at a single area of development. Although that outcome may not be affected by light drinking, light drinking may affect your baby in other ways.

Here are some recent studies and findings:

  • A recent article from the Journal of Epidemiology and Public Health in 2010 by Kelly studied data from 11,000 British children born from 2000 to 2002 found that cognitive deficits and problem behaviors at age 5 were less common among children exposed to light amounts of alcohol (1 or 2 drinks a week during pregnancy). In other words, light drinking may not be as risky for a child's early cognitive development as originally feared.
  • Robinson in the British Journal of OB/Gyn in 2010 also did studies that showed that light drinking (2–6 drinks per week) of alcohol in pregnancy was not a risk factor for child behavioral problems, although this study did not observe physical developmental outcomes.
  • The British Journal of OB/Gyn in 2007, Henderson also found no convincing evidence of adverse effects of prenatal alcohol exposure at low-moderate levels on consumption of less than 84 g of alcohol per week (½ pint of ordinary beer or lager contains 8 grams of alcohol and an ordinary glass of wine contains 12 g of alcohol). His study demonstrates that low levels of alcohol consumed during pregnancy, less than 60 g/week and not more than two standard drinks per occasion, were not associated with preterm birth or small-for-gestational-age infants.
  • O'Leary authored an article in the journal, Pediatrics in 2009, in which he also did not find an association between low levels of prenatal alcohol consumption and language delay at any period of time in a child's development, compared to mothers who engaged in heavy or binge drinking. He used language development as a significant milestone for children as he took the position that delay in that area might indicate further delay in a child's overall development.
  • In contrast, in Pediatrics in 2007, Sayal studied 12,678 pregnant women in England to determine whether very low levels of alcohol consumption during pregnancy (less than 1 drink per week) are independently associated with childhood mental health problems between 4 and 8 years of age. His conclusion was affirmative that during early pregnancy these low levels may have a negative impact and persistent effect on mental health outcomes. The developing brain in the first trimester may be especially vulnerable. However, alcohol use before the pregnancy was not associated with adverse outcomes. The other surprising finding was that girls seem to be more vulnerable to the effects of low levels of alcohol compared to boys although this may be a chance finding.

The American College of Obstetrics and Gynecology and the American Academy of Pediatrics continue to feel that no amount of alcohol is safe during pregnancy.

An OB/GYN's Recommendation

The exact safety threshold for the amount of alcohol is unknown, therefore the best advice is to avoid alcohol entirely. There is no established safe level of prenatal alcohol use, which has led to the recommendation of total abstinence. All clinicians taking care of pregnant women should routinely ask about exposure to alcohol during pregnancy. On the the other hand, the data shows that women who have conceived unexpectedly while drinking small quantities of alcohol, should be reassured that they have not placed their unborn child at increased risk of behavioral problems.

Finally, questions concerning a spouses drinking patterns are also important. It has been found that expectant fathers, or partners, could have a major impact on a pregnant woman's health habits. The expectant father could be an influential modifier of prenatal behaviors. Social support is directly related to the extent of alcohol use in pregnancy. Screenings, assessment and intervention with a partner can effectively reduce antenatal alcohol use and minimize fetal risk.

Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.

Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.