Alcohol Use and Pregnancy

What’s the Problem?

Maternal prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities. Children exposed to alcohol during fetal development can suffer a wide array of disorders, from subtle changes in I.Q. to profound mental retardation. They can also suffer growth retardation in varying degrees and be born with birth defects of major organ systems.

The rate of “risk drinking” (seven or more drinks per week or five or more drinks on one occasion) during pregnancy remains high. Approximately one in 30 pregnant women in the United States engages in “risk drinking.” One of the most severe effects of drinking during pregnancy is Fetal Alcohol Syndrome (FAS), which includes abnormalities in three areas at the same time – disorders of the brain, growth retardation, and facial malformations. For more information, see the tip sheet on Fetal Alcohol Syndrome.

Who’s at Risk?

More than half of all women of childbearing age in the United States report that they drink alcohol. Also, more than 50% of pregnancies are unplanned. Alcohol consumed during the first three to eight weeks of pregnancy, when many women do not know they are pregnant, can subtly or profoundly affect the organ development of the embryo, depending on the amount consumed. Although early pregnancy is a particularly vulnerable time, damage to the fetus’ developing organ systems can occur throughout pregnancy as a result of continued alcohol exposure.

Women consuming alcohol who are pregnant or could become pregnant are at risk of having an alcohol-exposed pregnancy. Every year in the United States, more than 130,000 women are at risk of having a baby exposed to alcohol in the womb. Women who drink regularly or binge drink and who do not use effective contraception are at highest risk of having a baby with FAS or other alcohol-related condition.

Can It Be Prevented?

The good news is that prenatal alcohol exposure is completely preventable. Any woman who is pregnant or could become pregnant should avoid drinking alcohol. To reduce prenatal alcohol exposure, prevention efforts should target not only pregnant women who are currently drinking, but also women who could become pregnant, are drinking at high-risk levels, and engaging in unprotected sex. These women are also at risk of having an alcohol-exposed pregnancy.

Healthcare providers should routinely talk to women who are pregnant, planning to get pregnant, or could become pregnant about their alcohol use and advise women on the dangers of drinking in general and during pregnancy. Asking questions about alcohol use can present a challenge for providers since women who drink and already have children are often reluctant to seek help because they fear they will lose custody of their children if they admit using alcohol.

The Bottom Line

• Women of reproductive age should not engage in risk drinking (seven or more drinks per week or five or more drinks on any one occasion) if they are pregnant or at risk of becoming pregnant. If a woman does decide to drink, she should make certain that she is using birth control properly to avoid an unplanned, potentially alcohol-exposed pregnancy.
• Any time a pregnant woman drinks, she puts her unborn child in danger of having physical problems, behavioral challenges, and learning disabilities. No amount of alcohol use is considered safe for a pregnant woman.

Case Example

Jill, who already has two children, drinks alcohol at home in the evenings and on weekends, sometimes heavily. She finds out that she is pregnant again. Although Jill is aware that alcohol might affect her pregnancy, she is not quite sure how her baby could be affected by alcohol, or how much is too much. There are a number of reasons why she feels that she doesn’t want to or can’t stop drinking (i.e., she suffers from depression; she denies she has a drinking problem; she cannot control her drinking), so she doesn’t ask for help. She continues to drink frequently during her pregnancy (drinking at least seven drinks a week), or binge drinks (drinking at least five drinks on one occasion) on the weekends. She first learns about FAS when her baby boy is born showing physical signs of FAS (i.e., low birth weight, small head, facial abnormalities). She finds that her child will need special care throughout his life and will have problems in school and in relating to other people. She now says that if she had known how serious the consequences of her drinking could be for herself, her family, and her affected child, she would have sought help to stop drinking.