Alcohol and Pregnancy: What Do Doctors Really Think?

Drinking whilst pregnant

Recently the Centers for Disease Control and Prevention (CDC) released a new guideline advising sexually active women to avoid alcohol if they are not using birth control. By taking such a hard line against women drinking, the CDC aims to reduce the number of babies born with fetal alcohol spectrum disorders (formerly called “fetal alcohol syndrome”). But does drinking in the early stages of pregnancy really cause irreparable harm to all developing babies? Here’s what real Ob/Gyns have to say on the topic.

“Heavy drinking harms unborn babies.”

Doctors may differ in their opinions about the CDC guideline in general or on the possible effects of light drinking while pregnant, but they all agree on one thing: heavy drinking during pregnancy can cause a host of issues in an unborn child. These problems—collectively called “fetal alcohol spectrum disorders” or FASD—can include brain and organ damage, low IQ, and learning disabilities. Because of these known alcohol-related issues, doctors agree no woman should drink heavily during pregnancy.

But what about light drinking? Or even moderate drinking? It depends whom you ask. “European women routinely drink wine and beer while pregnant,” said Ob/Gyn Terry Hoffman, MD, of Mercy Medical Center in Baltimore. “And there was one large-scale study in Australia that indicated some children actually had better outcomes later in life when their mothers drank during pregnancy.”

On the other hand, Sherry Ross, MD, an Ob/Gyn in Santa Monica, Calif., feels women definitely should be mindful about any alcohol consumption if they’re not using birth control. “No amount of alcohol is safe or recommended during pregnancy,” she said. ““[Beyond FASD], drinking alcohol during pregnancy also puts you at risk for miscarriage, stillbirth, prematurity and sudden infant death syndrome (SIDS).”

Why aren’t the studies clearer on this issue? How can one study show one result while a different study concludes something else entirely? Well, part of the confusion relates to the way risk is calculated. And when it comes to alcohol use by pregnant women, it can be difficult to pin down that risk.

“The real risk of alcohol use during the first trimester can’t be precisely quantified.”

“If you never swim in the ocean, you will never be bitten by a shark,” Dr. Hoffman says to illustrate the concept of zero-risk behavior. “If you never fly in an airplane, you will never die in a plane crash.” It follows, then, if a woman never drinks a drop of alcohol before or during pregnancy, her baby cannot be born with FASD. This seems to be the CDC’s position. But is it really necessary for women to engage in zero-risk behavior to protect their unborn babies?

“The exact quantification of risk is difficult, and studies needed to quantify that risk could and should never be done for ethical reasons,” says David Adamson, MD, founder of ARC Fertility. In other words, experts would never intentionally expose a fetus to alcohol in order to test its effects, so it’s impossible to say with certainty how much harm alcohol may cause.

It’s worth noting too, in addition to studies, doctors look to anecdotal evidence to inform their opinions. “Let’s face it,” Dr. Hoffman says, “if one or two episodes of drinking early in pregnancy did us in, none of us would be here.” The fact is women have been using alcohol in the early stages of pregnancy for centuries, yet most babies are not born with fetal alcohol spectrum disorders.

Given this conflicting evidence, how can you make an informed decision about whether or not to use alcohol?

“You should discuss your alcohol use with your Ob/Gyn.”

Using or abstaining from alcohol is a personal choice every woman makes. Whether you are using birth control or not, you should discuss your alcohol use with your Ob/Gyn. This will help your doctor develop a holistic care plan that meets your individual needs. As many experts pointed out, the new CDC guidelines can serve as a starting point for a deeper conversation about issues surrounding sexual health and conception.

“I will discuss the CDC guidelines with patients,” said William Schweizer, MD, of NYU Langone Medical Center. “The conversation leads to the larger topic of preconception counseling, including screening for deleterious genes—such as those for cystic fibrosis and Tay-Sachs—and the importance of prenatal folic acid. Birth control options should be discussed. I also am an advocate of the morning after pill. Women should understand it is available without a prescription.”

And even if women decide to abstain from alcohol while not using birth control, they should be aware of other potential first-trimester risks.

“Alcohol is not the only substance that is dangerous to a developing baby.”

While the CDC guideline focuses on alcohol use, booze certainly isn’t the only thing that poses a risk to a fetus. “To put a restriction on alcohol drinking if not [using] contraception would mean that restrictions would need to be placed on many other things, such as some antidepressants, some antihypertensive drugs, and even aspirin—all have been associated with fetal anomalies and are contra-indicated in pregnancy,” said Sherley C. Samuels, MD, of Piedmont Newton Hospital near Atlanta.

Women who want to become pregnant should be aware of these many risks to a developing baby. By partnering with your Ob/Gyn, you can reduce those risks you believe to be significant while not completely altering your lifestyle.

“The CDC’s guideline might lead to improved autonomy by women for their own health.”

Women today enjoy an unprecedented ability to control their reproductive health. Even if women and doctors disagree with the CDC’s hard-line stance on alcohol use, perhaps the guideline will lead to more and better conversations between women and their doctors on this important topic.

“Fortunately, we live in a country that prizes individuality and self-determination. This includes, most of the time, a woman’s autonomy in reproductive choices,” said Dr. Adamson. “However, with the right of reproductive choice comes reproductive responsibility, to ourselves, our partners, resulting babies, and society. So if the [CDC’s] goal is to inform women better so they can exercise their reproductive autonomy with a better outcome for them and their babies, this information will have been very useful.”

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Mar 6

    1. Alcohol and Pregnancy. Centers for Disease Control and Prevention. http://www.cdc.gov/vitalsigns/fasd/index.html

    2. Fetal Alcohol Spectrum Disorders. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/fetalalcoholspectrumdisorders.html

    3. Fetal Alcohol Exposure. National Institute on Alcohol Abuse and Alcoholism. http://pubs.niaaa.nih.gov/publications/FASDFactsheet/FASD.pdf

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