What Should You Expect?
FASD United joins the U.S. Surgeon General in raising awareness about avoiding prenatal alcohol exposure due to the risk of birth defects. Below, FASD United provides a personal perspective, the latest recommendations, and the science-based facts about prenatal alcohol exposure.
Need Support?
If you, your partner, or someone you know is pregnant and needs help to stop drinking alcohol, you can find accredited treatment resources in your area using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Treatment Navigator or the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator.
If you are finding it difficult to stop drinking alcohol, help is available. Visit your doctor to talk about your drinking, find a treatment resource, visit Recovering Mothers Anonymous, a 12-step recovery virtual network for women, or contact FASD United. FASD United can summarize the research on alcohol and pregnancy and direct you to resources and experts.
Studies have determined that the general and nutritional health of the mother and early and regular prenatal care are among many factors that contribute to a healthy baby and could possibly lessen the effects of prenatal alcohol exposure.
Partners, family, and friends also play a role in preventing alcohol-related birth defects by understanding the risks associated with prenatal alcohol exposure, encouraging healthy behaviors, and minimizing or abstaining from alcohol themselves in support of the birth mother.
U.S. Surgeon General Advisory
The most comprehensive review of alcohol and pregnancy research to date has been conducted by the Office of the Surgeon General within the Office of the Assistant Secretary for Health in the Office of the Secretary, U.S. Department of Health and Human Services. The Surgeon General first advised women to abstain from alcohol during pregnancy in 1981, and issued a new advisory in 2005.
The advisory states in part, “Based on the current, best science available we now know the following:
- No amount of alcohol use is known to be safe for a developing baby before birth;
- Alcohol exposure is unsafe for developing babies at every stage of pregnancy;
- Damage can occur in the earliest weeks of pregnancy, even before a woman knows she is pregnant;
- The cognitive effects and behavioral problems resulting from prenatal alcohol exposure are lifelong.”
For these reasons:
- Make a plan for a healthy baby — do not drink alcohol if you are pregnant or could become pregnant;
- A pregnant woman who has already consumed alcohol during pregnancy should stop in order to minimize further risk;
About half of all pregnancies are unplanned. As a result, many fetuses are exposed to alcohol when the mother does not know they are pregnant. The Surgeon General’s advisory also suggests that women of childbearing age should consult their physician about how best to reduce the risk of prenatal alcohol exposure.
Centers for Disease Control and Prevention
No amount of alcohol use is known to be safe for a developing baby before birth. Alcohol exposure is unsafe for developing babies at every stage of pregnancy regardless of the type of alcohol.
National Institute on Alcohol Abuse and Alcoholism
No amount of alcohol use is considered to be safe for a baby before birth.
American Academy of Pediatrics
The American Academy of Pediatrics recommends women who are pregnant or planning a pregnancy avoid drinking any alcohol.
American College of Obstetricians and Gynecologists
ACOG reiterates its long-standing position that no amount of alcohol consumption can be considered safe during pregnancy.
March of Dimes
Drinking alcohol when you’re pregnant can be very harmful to your baby. It can cause your baby to have a range of lifelong health conditions.
National Arc
There is absolutely no safe amount of alcohol use for a developing baby before birth. Risk of FASD increases as the amount of alcohol consumed increases.
Baby Center
All public health officials in the United States recommend that pregnant women, as well as women who are trying to conceive, play it safe by steering clear of alcohol entirely.
Know the Risk
Factors known to contribute to the risk of having a child with alcohol-related birth defects include: biological susceptibility, poor nutrition, poor general health, and a lack of prenatal care.
Some children exposed to alcohol prenatally have identifiable birth defects while some children exposed to alcohol during pregnancy have no apparent or quantifiable birth defects. Research is currently exploring both the genetic and protective factors involved in the manifestation of alcohol-related birth defects.
An examination of sociodemographic factors indicated that generally a higher proportion of women thirty years of age or older drink during pregnancy, but women around the age of 24 and younger face higher risks of binge drinking or drinking in the few months prior to recognizing they are pregnant (1). With regard to race and ethnicity, White women report a higher prevalence of alcohol use than Black or Hispanic women (2), although Hispanic women may increase use as they become more acculturated in the United States (3). Differences in prevalence based on geographic location appeared potentially important, with binge drinking more prevalent in the North-central sections of the United States and less so in the Southeast (4). Higher education (5) and higher income (6) were linked specifically to higher rates of alcohol use during pregnancy in some studies.
Alcohol and Pregnancy Science
Alcohol, like the chemical element mercury, is a teratogen (a substance that interferes with normal prenatal development). Alcohol can cause central nervous system (brain and spinal cord) malformations with associated neurobehavioral dysfunction. By comparison, lead is a neurotoxin but not a teratogen in that it produces neurobehavioral dysfunction in the absence of brain and spinal cord malformations.
Science definitively recognizes that alcohol crosses the placenta into the blood supply of the developing embryo or fetus. An embryo or fetus has neither the developed organ systems nor enzymes able to metabolize alcohol.
The first paper in the medical literature describing a constellation of birth defects linked to prenatal alcohol exposure was published in France in 1968 by Dr. Paul Lemoine. The first paper by U.S researchers appeared in 1973, authored by Drs. David Smith and Ken Lyons Jones from the University of Washington. As of 2021, more than 5,000 published papers have confirmed the toxicity of alcohol and the underlying mechanisms of alcohol-induced damage to the embryo or fetus, and the physical and functional birth defects related to prenatal alcohol exposure.
No published study has suggested that alcohol is not a teratogen or demonstrated that prenatal alcohol exposure has any potential benefit to human development.
Alcohol can cause damage to multiple regions of the developing brain, specifically to the corpus callosum (connects brain hemispheres), cerebellum (consciousness and voluntary processes), basal ganglia (movement and cognition), hippocampus (emotional behavior and memory), and the hypothalamus (sensory input), among other neural regions.
Ethanol is the principal psychoactive constituent in alcoholic beverages. In utero it has been found to:
- Interfere with the normal proliferation of nerve cells;
- Increase the formation of free radicals- cell-damaging molecular fragments;
- Alter cells ability to regulate cell growth, division, and survival;
- Impair the development and function of astrocytes, cells that guide the migration of nerve cells to their proper places;
- Interfere with the normal adhesion of cells to one another;
- Alter the formation of axons, nerve cell extensions that conduct impulses away from the cell body;
- Alter the pathways of biochemical or electrical signals within cells;
- Alter the expression of genes, including genes that regulate cell development.
Human development occurs in an orderly process of biochemical and structural transition during which new constituents are being formed and spatially arranged throughout gestation. At any time in the span of development these ongoing processes can be subtly or severely disturbed or abruptly halted resulting in abnormal development or fetal death.
Therefore, at any time alcohol is present, it has the potential to harm development. For example, the hallmark facial dysmorphology associated with fetal alcohol syndrome will only occur if alcohol is present during the specific window of development.
According to the Institute of Medicine, “Of all the substances of abuse, including marijuana, cocaine, and heroin, alcohol produces by far the most serious neurobehavioral effects on the embryo or fetus.”
Statements from Experts:
“When talking about the prenatal effects of alcohol we usually think exclusively about the dose, the strength, and the timing of alcohol exposure. However, perhaps even more important are factors involving the mother – her genetic background and nutritional status to name just two. Based on those maternal factors, what may be a completely safe amount of alcohol for one woman to drink during her pregnancy may be a serious problem for another woman’s developing fetus. Without knowing those genetic and nutritional factors that are critically involved with the way a woman metabolizes alcohol, it is not possible to make any generalizations about a “safe” amount of alcohol during pregnancy. What may be” safe” for one woman may be “devastating” for another woman’s unborn baby.”
Dr. Ken Lyons Jones – Co-Discovered ‘Fetal Alcohol Syndrome’ in 1973
“Moderate levels of alcohol have been shown to disrupt the activity of a number of molecules that are critical for normal brain development. One such example, the L1 cell adhesion molecule, guides the migration of brain cells and the formation of connections between brain cells. Children with mutations in the L1 gene have developmental disabilities and brain malformations, and, importantly, the function of the L1 molecule is also disrupted by concentrations of alcohol that a woman would have in her blood after a single drink. These kinds of experiments support the view that women who are pregnant or trying to conceive would be safer to abstain from alcohol than to engage in even occasional light drinking. Absence of proof is not proof of absence. The absence of evidence for developmental abnormalities in babies who were exposed to small amounts of alcohol prenatally does not prove that light drinking is safe. Clinical studies do not have the power to detect small effects of alcohol on brain development, and even significant effects might be missed if the wrong test is used or if testing is conducted at the wrong developmental period. More practically, it is impossible to assure a mother that a child’s light prenatal alcohol exposure did not result in a small drop in the IQ of her child. Light drinking is not essential to the health or well being of a pregnant woman, so why take a chance?”
Dr. Michael Charness – Harvard Medical School
Medical Studies
CIFASD:
There are several research studies published by scientists from CIFASD-the world’s leading FASD research consortium, that have examined moderate prenatal alcohol exposure.
University of Queensland:
In 2013, this study found “women who regularly drink as little as two glasses of wine per drinking session while pregnant can adversely impact their child’s results at school.”
Clinical and Experimental Research:
This 2012 study concludes, “Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.”
International Journal of Epidemiology
This 2012 study states, “Even low amounts of alcohol consumption during early pregnancy increased the risk of spontaneous abortion substantially.”
Alcohol Research & Health:
This 2011 study found that drinking at low to moderate levels during pregnancy is associated with miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome (SIDS).
Alcohol, Health, and Research World:
From 1997, this study states, “even a small amount of alcohol may affect child development.”
“Every other week there seems to be another article in the media suggesting that “moderate” alcohol use is safe while pregnant. It’s important to understand that we all have a different view of what moderation is and that it is very easy to underestimate the amount of alcohol we actually consume. I drank while I was pregnant, all five times. I had no idea that drinking on the weekends would harm my children.
I love women – they are all my sisters – and I want them to know it is not safe to drink any alcohol while pregnant. Don’t risk it, wait, there’ll be plenty of time to celebrate and consume alcohol after the baby is born!”
Kathleen Mitchell
FASD United; Creator of Recovering Mother’s Anonymous
Myths:
“My doctor said it’s fine to have a glass of wine or two while pregnant.“
Your doctor might not be informed about the risk of prenatal alcohol exposure or could be uncomfortable talking with you about the risks to your embryo or fetus associated with maternal alcohol use. Unfortunately, many doctors are not properly educated about the risks associated with prenatal alcohol exposure. The American Congress of Obstetricians and Gynecologists (ACOG) advises women to not consume any alcohol while pregnant.
“My friends or family members drank a bit and their kids are fine.“
Every pregnancy is different. Not everyone who drinks while pregnant will have a child with measurable problems at birth, adolescence, or even adulthood, just like not every cigarette smoker will develop lung cancer. The fact remains that alcohol is toxic to the developing baby. Why take the risk?
Also, some children may have subtle damage from being exposed to alcohol that is not evident until school-age or later, such as problems with learning and behavior. In many of these cases, the problems are most often not linked to the prenatal alcohol exposure, inhibiting an accurate diagnoses and delaying appropriate intervention. According to Dr. Susan Astley Ph.D. and Dr. Therese Grant Ph.D., “Children exposed to and damaged by prenatal alcohol exposure look deceptively good in the preschool years. The full impact of their alcohol exposure will not be evident until their adolescent years.”
“There is no evidence of any effects from just one drink.“
Dr. Michael Charness of Harvard Medical School gives just one example: “We’ve been able to show very striking effects of alcohol on the L1 cell adhesion molecule, a critical molecule for development, at concentrations of alcohol that a woman would have in her blood after just one drink.”
“A little bit of wine helps to reduce stress and can be healthy while pregnant.“
The potential benefits of alcohol use during pregnancy to the mother are separate from the potential risk to the mother’s developing child. The scientific and medical research is very clear: No published biomedical research has found any risk-free benefit of prenatal alcohol exposure for the embryo or fetus. Thousands of papers have conclusively demonstrated that alcohol use has the potential to cause both physical and functional damage to a growing baby.
Women commonly cite the need to relax as one of the reasons they drink during pregnancy even if they understand the risks. Pregnant women should ask their doctor about the diet and exercise that is appropriate for them, and to relax they might listen to soothing music, pamper themselves, take a bath, read, try deep breathing or meditation, schedule time for themselves with no responsibilities or distractions, and don’t hesitate to ask their friends and family for help if they feel overwhelmed or uncomfortable.
“On a holiday or special occasion, it’s perfectly fine to at least have a few celebratory sips.“
The human body functions the same, whether it’s a holiday or not. Alcohol does not lose it’s toxicity in utero because it happens to be New Year’s Eve, or because wine is consumed instead of whiskey, or because the drinker has an advanced academic degree or high socioeconomic status. The risk of prenatal alcohol exposure is not a risk to the health of the expectant mother; it is a risk to the development of her offspring.
The guidance to abstain from alcohol when pregnant is not intended to interfere with a woman’s lifestyle choice to consume alcohol or in any way judge a woman for choosing to enjoy her favorite alcoholic beverage; it is intended to eliminate the chance her baby will have even the slightest reduction in their intellectual and physical abilities.
“One glass of wine is not enough for the developing baby to even be exposed to the alcohol.“
A developing baby is exposed to the same concentration of alcohol as the mother during pregnancy. There is no threshold of prenatal alcohol consumption below which the baby is not exposed.
“There is no evidence of any effects from just one drink.“
Dr. Michael Charness of Harvard Medical School gives just one example: “We’ve been able to show very striking effects of alcohol on the L1 cell adhesion molecule, a critical molecule for development, at concentrations of alcohol that a woman would have in her blood after just one drink.”
“Drinking wine is better than using heroin or cocaine while pregnant.“
Alcohol, including wine, causes more damage to the developing baby than many illicit drugs. The Institute of Medicine says, “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” No type of alcohol or illicit drugs consumed during pregnancy are completely without risk.
“You have to be an alcoholic to drink enough to cause real damage.”
The medical research is clear: Drinking at a level below the threshold for alcoholism still can potentially cause harm to the growing baby. Women who do not have the disease of alcoholism could still have children with measurable effects of alcohol exposure. It is true that drinking patterns associated with alcohol use disorder poses the highest risk to the unborn baby.
“Alcohol can only cause physical deformities. If the baby looks normal, it must be fine.“
The vast majority (over 85%) of children with characteristics or disabilities from prenatal alcohol exposure have no physical birth defects, only cognitive and/or behavioral consequences. There is a wide range of effects, and most subtle behavioral and cognitive difficulties are rarely diagnosed as alcohol-related.
“It is alarming and even condescending for a doctor or anyone else to advise a woman to abstain from alcohol during pregnancy.“
In the United States 50% of pregnancies are unplanned, so it is possible that the first time a woman is told that alcohol can harm her pregnancy is after she is already pregnant and has been drinking. It is important for physicians to advise women of the risks of alcohol use during pregnancy, be nonjudgmental, and provide guidance for an appropriate intervention, if necessary. If a women becomes pregnant, stop drinking alcohol. The sooner she stops drinking, the better for the baby.
All women and expectant parents should be reminded of the risk of prenatal alcohol exposure. If a woman and her partner are informed of the risk and decides to drink, that is her decision – FASD United is opposed to any rules, regulations, or statutes that seek to punish or sanction women for drinking alcohol during pregnancy. Federal, state, and local policies should be enacted and expanded to ensure access to therapeutic rehabilitation services for women unable to abstain from alcohol.
It is important for pregnant women to be reminded that proper nutrition, good general health, and early and regular prenatal doctor visits might help reduce the effects of light drinking during pregnancy. It is believed that some women have a genetic predisposition that increases the vulnerability of their embryo or fetus to alcohol exposure, and other women have a genetic make-up that reduces their vulnerability for having an alcohol-effected birth. However, science has not demonstrated how these genetic and epigenetic (changes in how genes are expressed without altering the underlying DNA sequence) factors contribute to the vulnerability of a specific woman’s pregnancy. This uncertainty is the primary reason for the recommendation of abstention from any alcohol during pregnancy as the safest course.
“A single drink containing one ounce of alcohol during pregnancy, or occasionally during pregnancy, has been scientifically linked to affects that can be diagnosed as an FASD.“
While only abstention from alcohol during pregnancy completely eliminates any risk to the embryo or fetus, there is no published research of an individual diagnosed with an FASD who was exposed to an ounce of alcohol. It is possible that one or an occasional drink could have a subtle harmful effect, but it has not been scientifically shown that such an effect would reach the criteria necessary for a diagnosis under the FASD umbrella.
(1): Altfeld et al., 1997; CDC, 2009; Chambers et al., 2005; Floyd et al., 1999; Hollander, 1995; Jones-Webb et al., 1999; Morris et al., 1994; Perriera & Cortes, 2006; Tsai et al., 2007a,b
(2) Floyd et al., 1999; Hanna et al., 1994; Hollander, 1995; Perriera & Cortes, 2006; Project CHOICES, 2002; Tsai & Floyd, 2004; Tsai et al., 2007a,b
(3) Chambers et al., 2005
(4) Tsai & Floyd, 2004
(5) CDC, 2009; Chambers et al., 2005; Floyd et al., 1999; Hollander, 1995; Tsai et al., 2007a
(6) Chambers et al., 2005; Chang et al., 2006; Hollander, 1995; Morris et al., 1994