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When Just a Little Is Too Much: The Risks of Alcohol-Exposed Pregnancy

The conditional relationship is very clear: If a woman doesn't drink during pregnancy, her child will have a zero risk of FASD. There is no more motivated group of people then women who are pregnant or who want to become pregnant.
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One of my challenges in working with patients suffering from addictive illnesses is to help increase their motivation to stick with a long-term recovery plan. This is a significant challenge for many reasons, especially because the disease of addiction affects the brain's ability to value long term recovery. The one exception to this difficulty, in many cases, is when a female patient gets pregnant. I have witnessed women who struggled for years with an addictive illness discover they are pregnant and, when the pregnancy is wanted, are able to make incredible strides in their recovery. They are often able to maintain sobriety throughout their pregnancy though the challenge of maintaining sobriety after the baby is born can be significant. Of course, there are many women whose addictive illnesses are severe enough that they struggle to achieve any level of sobriety and providing them with appropriate treatment becomes doubly important because of the two lives that now depend on that sobriety. Even women who do not have addictive illnesses make significant changes to their lifestyle including quitting coffee cold turkey -- something they could not have previously imagined getting through their day without -- or putting an end to their daily sushi takeout. The instinct to protect their child is an incredibly powerful motivator.

Yet over 3 million U.S. women, including those who want to get pregnant, are at risk for alcohol-exposed pregnancy -- a completely preventable disorder. The culprit? A lack of awareness. Most women know that alcohol is harmful to a fetus during pregnancy, but how many know the importance of refraining from drinking alcohol even when planning to get pregnant?

The Centers for Disease Control (CDC), the nation's health watchdog, recently announced a recommendation that pregnant women refrain from drinking -- period. But the agency goes even further, extending the recommendation to include women who might get pregnant or are planning to get pregnant.

The pool of women at risk of alcohol-exposed pregnancy is defined as women who had sex with a male, drank alcohol and did not use contraception. The risk pool was so defined because about half of pregnancies are unplanned and, even in cases in which a pregnancy is planned, a woman may drink before she knows she has conceived. In fact, three in four women who wanted to get pregnant as soon as possible reported that they did not abstain from alcohol.

If the figures on drinking among women who are at risk of or are planning a pregnancy are alarming, those for women who know they are pregnant are even more so. 10 percent of pregnant women reported drinking alcohol in the previous 30 days, with about a third of those reporting that they had engaged in binge drinking (four or more alcoholic drinks in two to three hours) -- the most damaging form of alcohol consumption for the fetus. Surprisingly, among women who reported having engaged in binge drinking, pregnant women had a significantly higher frequency of binge drinking than non-pregnant women.

Women (and their partners) can be confused by some news articles and even statements from some OB-GYN physicians who say that "there isn't evidence that light drinking is dangerous." The problem is that there is also no evidence that light drinking is safe. We simply don't know yet, though there is ongoing research that will hopefully provide clearer answers. Even so, it is more accurate to say that there is no safe level of alcohol use during pregnancy.

In addition to an increased risk of miscarriage, stillbirth and prematurity, alcohol use in pregnancy can cause significant birth defects and developmental disabilities. Severely affected babies may have low body weights and abnormal appearances, but the most common symptoms are a group of lifelong physical, behavioral and learning problems including hyperactivity, poor language skills, difficulty concentrating and poor math skills collectively known as fetal alcohol spectrum disorder (FASD).

FASD affects one in 100 newborns nationwide -- that's 40,000 births annually. That's about the same rate as autism and more than spina bifida, Down syndrome, cerebral palsy, SIDS and cystic fibrosis combined.

FASD is not obvious at birth, giving rise to a temporal disconnect between cause and effect that has contributed to a lack of awareness of the problem and an underestimation of its prevalence. When FASD is diagnosed, it is often not until the affected children reach school age. More often than not though, it is not diagnosed at all. In fact, in about 80 percent of cases, the symptoms are never even traced back to the mother's consumption of alcohol during pregnancy.

What can we do as a society to reduce the prevalence of FASD? Many years of studies have shown that evidence-based interventions to reduce alcohol-exposed pregnancies such as alcohol screening and brief intervention (SBI) can be very effective. SBI involves asking patients a series of screening questions in primary healthcare settings designed to identify risky drinking patterns. Those who are found to be drinking too much are referred for professional treatment. Another intervention is the CHOICES program, which aims to reduce the risk of alcohol-exposed pregnancy among non-pregnant women who are drinking too much and not using contraception consistently or effectively. CHOICES helps women reduce alcohol use, increase contraception use or both. Even for those who do not have problematic drinking, it is crucial that providers and educators help all women of child bearing age understand that once birth control is discontinued, drinking should be discontinued as well.

It's enormously important that these and similar efforts are broadly integrated into the clinical setting, including family, women's, student and public health clinics. Unlike other threats to child health, the spectrum of conditions related to fetal alcohol exposure is completely preventable. The conditional relationship is very clear: If a woman doesn't drink during pregnancy, her child will have a zero risk of FASD. There is no more motivated group of people then women who are pregnant or who want to become pregnant. They just need the information that will allow them to make the best choices for themselves and their unborn child.

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Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.