Alcohol and Pregnancy

The topic of ‘alcohol and pregnancy’ has attracted a lot of media attention. This is because of concerns over the adverse health impact of alcohol during pregnancy on the developing baby. For this reason, revised UK-wide guidelines on alcohol consumption during pregnancy were published on 8 January 2016. The Chief Medical Officers for the UK now recommend that pregnant women, or women planning to become pregnant do not drink any alcohol at all. This is a recent change from previous advice to keep any alcohol intake to a minimum.

Research shows that experts do not know how much, if any, alcohol is completely safe for you to drink whilst pregnant. For this reason, the safest approach is total abstinence – ie not drinking any alcohol while you are pregnant or planning to become pregnant.

Why is alcohol harmful to the developing baby?

The potential harm caused to your developing baby by drinking alcohol relates to how much you drink and how often you drink.

Advice on alcohol abstinence in pregnancy is particularly relevant during the first trimester (first three months’ of pregnancy). This is the stage of pregnancy when your baby is at their most vulnerable because their major body organs – brain, spinal cord and nervous system, heart and kidneys are developing; as are their facial features. Where women choose to drink during the first trimester and continue to drink heavily throughout their pregnancy; this has been shown to cause irreversible damage to their baby’s growth and development.

The National Institute for Health and Clinical Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists (RCOG) recommend that women do not drink during pregnancy, because of the increased risk of miscarriage associated with excessive alcohol use. In addition to the risk of miscarriage, more recent studies have found that drinking heavily, particularly during the first three months’ of pregnancy also increases the risk of having a preterm birth and a baby with low birthweight.

What does the Department of Health recommend?

The UK Department of Health (DH) recommends that if you are pregnant or planning to become pregnant, you should not drink any alcohol at all. However, despite the UK-wide recommendation to abstain from alcohol during pregnancy, some women will still choose to drink while pregnant. If this is the case, it is important that they know how this decision could affect their baby in the longer term.

How could alcohol affect my baby?

When you consume alcoholic drinks the alcohol passes directly into your blood circulatory system, and if you are pregnant, will then cross the placenta and enter your developing baby’s blood stream. Because your baby’s liver is one of the last of their major body organs to develop and because the liver doesn’t mature until late pregnancy; your baby is unable to process the alcohol circulating around their small body. Consequently, where they are exposed to too much alcohol this can have a significantly adverse impact on their health and development.

Your midwife and doctor will explain this to you. Should you however, opt to drink after the first three months’ of pregnancy; studies show that this can adversely affect your baby’s health and development after they have been born and into the longer term. These risks increase in relation to the amount of alcohol that is consumed, so the more women drink; the greater the risk of their baby being harmed.

Drinking too much is associated with babies developing learning difficulties and behavioural problems. Where a woman consumes more than six units of alcohol each day (higher-risk drinking) whilst pregnant; this has been shown to cause their baby to develop a very serious condition referred to as ‘Fetal Alcohol Syndrome’ (FAS). Babies born with FAS can have a number of distinct features:

Poor growth – babies exposed to too much alcohol tend to grow more slowly while they are in the uterus (womb) and are often born ‘small-for-dates’
Growth and development problems – these can affect the heart, stomach, intestines, limbs and joints which can cause health problems in the longer term
Facial abnormalities – smaller than normal eyes; a receding forehead and chin; cleft palate; short upturned (pug-like) nose
Learning difficulties (including problems with hearing or sight) and behavioural problems.

Less severe forms of FAS are associated with women who don’t drink as heavily during their pregnancy; however, studies show that women who drink heavily on single occasions are at increased risk of having babies’ born with lesser forms of FAS. These can include alcohol-related birth defects and individual birth defects that are known to occur at lower levels of drinking.

Studies that have looked at the longer term impact on children of excessive maternal drinking during pregnancy have found a number of adverse effects. These include babies being born with a poor sucking reflex which adversely impacts on feeding, especially breastfeeding; baby sleep problems; increased likelihood of behavioural problems such as, hyperactivity; attention deficit disorder (problems concentrating); as well as, difficulties with movement and coordination.

How do I assess how much alcohol I’m drinking?

Calculating how much alcohol you drink isn’t always easy because there are notable differences in the alcohol concentration of different drinks and because of the various sizes of wine, beer and shot glasses, and bottles and cans used in pubs and homes. Consequently, you could be drinking a lot more units of alcohol than you realise. ‘Drinkaware.co.uk’ has a ‘Unit & Calorie Calculator’ available at: http://www.drinkaware.co.uk/understand-your-drinking/unit-calculator

This tool can help you to work out how many units and calories you have consumed. Another useful resource if you have an Android smartphone, iPhone, iPad or iPod touch is the FREE app: Change4Life Drinks Tracker from Google Play or the iTunes App Store. This app allows you to keep a drinks diary and get feedback on your drinking. However, if you don’t have access to an Android or smartphone you can still complete a drinks diary by recording how much you drink and how often you drink in a note book.

What is a unit of alcohol?

Units are an easy way of conveying the quantity of pure alcohol that is present in a drink. One unit equals 10ml or 8g of pure alcohol; this is approximately the amount of alcohol that the average adult is able to process in one hour. On this basis, it is expected, in theory, that there should be little, if any, alcohol left in the blood stream of an adult one hour after consuming one unit of alcohol.

Using units is a much simpler way of conveying a drink’s alcohol content – this is normally expressed by the standard measure ‘alcohol by volume’ (ABV). The ABV is a measure of the amount of pure alcohol as a percentage of the total volume of liquid in a drink. The ABV may also be displayed as “vol” or “alcohol volume” on the side of wine and spirits bottles and cans.

The number of units in a drink is calculated using the size of the drink and its alcohol strength. For example, a pint of strong lager contains three units of alcohol, whereas, the same size drink of standard lager contains two units. The following section provides a basic guide to drinks and their strengths in relation to their alcohol unit measure and volume:

The following drinks each contain one unit of alcohol:

One small glass of wine
One small glass of sherry
½ pint of ordinary strength cider, lager or beer
¼ pint of strong cider, lager or beer
One single measure of spirits.

How much alcohol am I consuming?

At you first ‘Booking’ appointment with your midwife, you will be asked a number of medical, social and lifestyle questions which will include whether you drink alcohol; whether you are planning to continue drinking while pregnant, and, if so, how much. If you continue to consume alcohol during your pregnancy; it is probable that you will fall into one of the following three groups:

Lower-risk drinker
Increasing-risk drinker
Higher-risk drinker.

What are the potential implications of drinking while pregnant?

Apart from those women who choose to abstain from alcohol during pregnancy; most others will tend to fall into the category of being a ‘Lower-risk’ drinker (one to two units, once or twice a week).

Current advice from the DH is that pregnant women and those planning a pregnancy should not drink alcohol at.

However, where women’s alcohol intake is more than 2-3 units a day and they are drinking on a regular basis, they come into the category of ‘Increasing-risk’ drinker. Their midwife and doctor will be able to offer them support with this and can also refer them to local support agencies for more specialist support to stop drinking as needed.

Where women find they are consuming more than 35 units of alcohol over a week (ie more than 6 units a day), they are considered to be a ‘Higher-risk’ drinker. The research evidence suggests that consuming alcohol at this level is likely to cause harm to both the woman and her developing baby. However, if you find that you are drinking this number of units each week and are struggling to control your drinking, or it is having a negative impact on your health and daily functioning, then you fall into the category of ‘Higher-risk’ drinker.

Trying to reduce your drinking when you have a history of excessive alcohol intake is however, not straightforward. Unsupervised withdrawal of alcohol (without a doctor’s supervision) can do more harm than good and in more severe cases can induce ‘withdrawal seizures’ which can harm your baby. This is because when a seizure happens, the oxygen supply to the baby inside the uterus diminishes. Therefore, reducing alcohol intake has to be carefully planned and monitored by health care professionals in order to safeguard the health and wellbeing of both the mother and her unborn baby. Also, to ensure that follow-up support and specialist referral is provided as necessary.

Binge drinking

This term refers to an episode of heavy drinking over a short period of time, such as over an hour or two, or over the course of an evening. The term is also used in association with drinking to the point of intoxication or drunkenness and is particularly associated with young men and women. However, if a woman is generally healthy, studies suggest that if they got drunk early-on in their pregnancy (eg before they knew they were pregnant), there is little risk that they will have harmed their baby.

Expectant mums and alcohol

Research has also found that pregnant women over the age of 30 years-of-age who drink excessively are more likely to give birth to a baby with alcohol-related damage. Additional risk factors for the mother are previous obstetric complications (pregnancy-related problems) and a history of miscarriage. Where women drink excessively during pregnancy, studies also show that the use of regional anaesthesia – such as epidurals (drugs that numb all sensation) can be less effective. This has been found to be more likely where the woman has been drinking heavily prior to her labour beginning.

Avoiding alcohol in pregnancy

The majority of women will take the decision to stop drinking alcohol as soon as they find out they are pregnant. It can be difficult when you are out socialising with friends or attending special celebrations to avoid alcoholic beverages; however, the hormonal changes associated with pregnancy tend to affect women’s tastes, so many women go off alcohol anyway. For those who don’t, there are many non-alcoholic options available which are just as enjoyable and a whole lot safer for their unborn baby.

Fathers and alcohol

Where fathers have a history of excessive drinking prior to their baby’s conception (pre-pregnancy); studies have shown that this is associated with an increased incidence of health problems in the baby. These include, an increased risk of the baby being born with cardiac defects (a hole in the heart); problems with the baby’s immune system (which makes it harder for them to fight-off infections) and babies being born ‘small-for-dates’ (smaller than would normally be expected).

Drinking following your baby’s birth

Studies that have looked at women who drink alcohol in the postnatal period have identified a number of worrying effects. Consuming alcohol while breastfeeding has been found to affect the taste and the smell of the mother’s breast milk; this can adversely interfere with their baby’s breastfeeding pattern.

Excessive alcohol consumption has also been found to be a significant risk factor in ‘Sudden Infant Death Syndrome’ (SIDS) – also commonly referred to as ‘Cot Death’. Research shows that drinking excessively, when also bed-sharing (co-sleeping) with your baby, increases the risk of cot death because alcohol often impairs parents’ responses and they are less likely to be alert to their baby’s needs, which can place the baby at risk.

Final thoughts…

Life happens and can be very hard at times, and alcohol can become part of a person’s coping mechanism. However, drinking during pregnancy can significantly damage both yours and your developing baby’s health.

We have written this article to help clarify the revised UK-wide recommendations on alcohol abstinance during pregnancy. We do however, also recommend that you discuss any concerns that you might have with your own midwife or doctor. They will want to support you, so it is important that you are open and honest with them. They can offer you and your partner advice about your drinking habits before you start trying for a baby and once pregnant, including strategies to reduce your alcohol intake where this is warranted. Your midwife and doctor can also put you in contact with specialist support services, if you have a history of heavy drinking or need some additional support to reduce your alcohol use.

Alcohol Support Services

Confidential help and specialist support is also available from a range of organisations:

Drinkline – this is the national alcohol helpline. Tel: 0300 123 1110. The helpline is free and available weekdays 9.00am – 8.00pm & weekends 11.00am – 4.00pm

Alcoholics Anonymous (AA) – this is a free self-help group. Their ’12-step’ programme involves getting sober with the help of attendance at regular support groups

Addaction – this is a UK-wide treatment agency supporting individuals, families and communities in helping them to manage the effects of alcohol and drug misuse.

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