How Dangerous is Consuming Alcohol During Pregnancy?
A teratogen is an agent that results in the disturbance of the normal process of development of the embryo in a pregnant woman. Numerous substances are known to be teratogens. Depending on the time of exposure, the teratogen can have very extreme effects or relatively mild effects.
Most often, during early development, teratogens affect the central nervous system (CNS; the brain and spinal cord). When embryos are exposed to teratogens in the womb, significant alterations in development of tissues in the brain can occur, resulting in long-lasting and permanent dysfunction in the individual.
There are numerous types of substances that can be serious teratogens when a woman who is pregnant is exposed to them, and they can be absorbed by the developing child. Alcohol is a serious teratogen, and numerous research studies have identified it as having significant effects on the embryo throughout all stages of development. Alcohol is also one of the most commonly used and abused drugs in the United States.
According to information provided by the National Institute on Alcohol Use and Alcoholism, in 2015:
- Approximately 86 percent of people over the age of 18 reported that they drank alcohol at some time in their lifetime.
- About 27 percent of people over the age of 18 reported they engaged in binge drinking behavior within the prior month.
- Slightly over 15 million adults over the age of 18 qualified for a diagnosis of an alcohol use disorder. Of these individuals, 5.3 million were women.
- The prevalence of fetal alcohol syndrome (FAS) is estimated to be between two and seven cases per 1,000 births.
- The prevalence of fetal alcohol spectrum disorders (FASD; having some of the symptoms of FAS but not having the disorder) was estimated to be as high as 20-50 cases per 1,000 births.
According to the Centers for Disease Control and Prevention (CDC):
- There is no way to tell how many people have symptoms of FASD.
- The CDC suspects that FAS occurs in about 0.3 of 1,000 children between the ages of 7 and 9 years old.
- Studies using in-person assessment of school-aged children throughout the United States bring forth higher estimates than epidemiological data.
- Based on in-person examinations, the actual number of FASDs in the United States may be as high as 2-5 children per 100 school children (2-5 percent of this population).
Using Alcohol When Pregnant
Major health organizations, including the CDC, the World Health Organization (WHO), and the National Institutes of Health, consistently make public statements that there is no safe level of alcohol use during any time when a woman is pregnant. In addition, the type of alcohol (e.g., beer, wine, liquor, etc.) does not affect this notion. Alcohol is alcohol. Whenever a pregnant woman drinks alcohol, the fetus is exposed to alcohol as well.
Numerous research studies have documented the effects of alcohol use on the fetus. The major effects are outlined below.
- A pregnant woman ingesting alcohol delivers alcohol to her baby directly through the umbilical cord. Heavy alcohol use during pregnancy can result in miscarriages, stillbirth, and birth defects.
- Neural tube defects occur when the portion of the embryo that develops into the central nervous system (the neural tube) suffers an insult. This insult typically occurs within the first month of pregnancy when this area is being differentiated. Neural tube deficits/defects can be extremely serious.
- Spina bifida, a neural tube defect, is a serious condition that occurs when the spinal column in the fetus does not close completely. This can lead to issues with paralysis, particularly in the legs.
- Chiari malformations occur when tissue from the brain extends into the spinal cord. Individuals with these malformations experience numerous developmental and cognitive problems.
- Anencphaly occurs when the brain and spinal cord do not develop correctly. Most infants with this condition do not survive.
Numerous other cognitive and behavioral effects are associated with children who have been exposed alcohol in the womb. Again, the physical, cognitive, and behavioral symptoms that can occur as a result of exposure to alcohol in utero are collectively termed fetal alcohol spectrum disorders (FASDs).The symptoms of FASDs include any of the following (numerous symptoms may be present):
- Stunted growth
- Significantly decreased birth weight and significantly lower-than-expected body weight in infants
- Significantly decreased head circumference compared to normal ranges
- Delays in reaching normal developmental milestones (e.g., first instance or age at which the infant begins walking, talking, toilet training, etc.)
- Abnormal facial features, most often the development of alterations around the eyes or a lack of a philtrum, which is the ridge just below the nose and above the upper lip
- Decreased intellectual ability
- Issues with poor attention, impulse control, and hyperactivity, with common co-occurring diagnoses of attention deficit hyperactivity disorder (ADHD)
- Learning disabilities
- Issues with forming new memories
- Issues with balance and coordination
- Sensory disturbances, such as issues with vision or hearing
- Malformed or poorly developed skeletal structures.
It is estimated that approximately one-third of the children who display FASD symptoms will also have heart malformations. These most often occur in the ventricles of the heart or the arteries, and can result in permanent disabilities for these children. Other cardiac issues can also develop as a result of exposure to alcohol in the womb.
Renal issues can also be linked to alcohol use by a pregnant mother. Issues that can occur include hypoplasia (developmental issues with the kidneys that can lead to malformations in the kidneys and significant lifelong renal issues) or bilateral renal agenesis (being born without any kidneys).
Most of the issues associated with having FASDs are not reversible. These children grow up requiring assistance throughout their lifetime in numerous areas. There is no way to predict which children will develop FASDs, and there is certainly no way to predict how one’s alcohol consumption affects different manifestations of an FASD. It has been suggested that 6-10 percent of children who are exposed alcohol in the womb develop FASD symptoms; however, these figures are not set in stone.
- Fetal alcohol syndrome (FAS) is a specific syndrome that consists of mental retardation, skeletal system malformations, malformations of the heart and brain, poor growth rate, learning disabilities, and poor motor skills. The facial features associated with FAS include small eyes, flat cheeks, thin lips, and a short or upturned nose. Often, the facial features may fade as the child develops; however, the cognitive and other physical issues do not fade and are irreversible. FAS is a preventable cause of mental retardation in children, and it is believed to result from significant alcohol use during pregnancy (e.g., binge drinking, heavy drinking nearly daily, etc.).
- Combinations of different symptoms associated with FASDs result in different disorders.
- Alcohol-related neurodevelopmental disorder describes children who have numerous cognitive and behavioral difficulties as a result of fetal alcohol exposure but fewer physical symptoms.
- Alcohol-related birth defects describe physical malformations, such as issues with the skeletal system, auditory system, heart, kidneys, etc., but they do not include significant cognitive and behavioral issues.
- In most cases, there is a combination of physical, cognitive, and behavioral issues associated with early exposure to alcohol.
- Other subclinical issues that may not be fully recognizable as being related to alcohol use can include issues with poor growth and development, lower IQ levels, mild disabilities, and other cognitive issues.
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The CDC, WHO, and numerous other organizations report that fetal alcohol exposure is the major preventable cause of developmental delays and birth defects in children throughout the world. FAS is the most easily preventable cause of mental retardation in children throughout the world.
Some pregnant women may think they can still drink “nonalcoholic” beer, wine, etc. It is important to remember that most of the major health organizations in the world emphatically state that there is no safe level of alcohol use for women who are pregnant and the majority of these “nonalcoholic” beers and wines contain very low levels of alcohol. Because the effects of alcohol also interact with other factors, including genetics, personal vulnerabilities, and other environmental effects, even using very small amounts of alcohol may result in serious effects to the developing child.
It is better to be safe than sorry and discontinue any form of alcohol use, including “nonalcoholic” beverages.
What About the Mother?
Numerous research studies have documented the dangers associated with even moderate alcohol use.
According to the CDC, some of the concerns that pregnant women should have about themselves when drinking alcohol, in addition to concerns for their developing child, include increased risk of the following:
- Injuries as a result of accidents, falls, and burns
- Increased risk of being involved in violent or aggressive crimes, such as sexual assault, intimate partner violence, and even suicide
- Alcohol poisoning as a result of a high blood-alcohol level
- Engaging in risky behaviors, such as having unprotected sex, driving a motor vehicle while under the influence, etc.
- The development of issues with high blood pressure that can affect the fetus as well as cardiac arrest or stroke
- Acute and long-term cognitive issues, such as issues with memory, problem-solving, etc.
- Development of mental health issues, such as anxiety or depression
- Social problems, including family problems, not paying attention to the needs of the developing child, etc.
- Development of an alcohol use disorder
- Longer-term effects associated with alcohol use, such as damage to numerous organ systems like the brain, liver, cardiovascular system, etc.
In many cases, a woman does not realize she is pregnant until several weeks after conception; often, women find out they are pregnant within 4-6 weeks after conception. Any woman who finds out she is pregnant should immediately stop using alcohol. Anyone who plans to get pregnant should abstain from any alcohol use.
Upon learning of pregnancy, a woman should make an appointment with her physician as soon as possible. The physician can monitor the development of the child and identify any potential reversible situations. In the majority of cases where women who drink small to moderate amounts find out they are 4-6 weeks pregnant and stop drinking alcohol, there are no significant complications. However, continuing to drink alcohol at any level results in an increased risk of serious issues in the developing child.
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