Alcohol (and friends) While Pregnant

The simple fact that some debates are still happening is out of sheer ignorance.

I recently got into a tiff with a friend/colleague over the risks of consuming alcohol during pregnancy. I come from the point of view that the only safe amount of alcohol while pregnant (and while nursing) is no alcohol while this particular individual holds the belief that having sporadic drinks throughout the pregnancy is completely safe.

This all started up over yet another warning from the medical community stating my point of view: Zero is the only safe number and I think the debate could have been settled if there was a better understanding on both mine and my colleague's parts as to what FASD is and how it develops. Keep in mind that 20-30% of women have reported consuming alcohol at some point during their pregnancy.

To start, I want to get a few definitions straight:

• Fetal Alcohol Spectrum Disorder (FASD): Not unlike Autism Spectrum Disorder (ASD) in the sense that this term refers to a broad range of symptoms that, when combined, carry their own diagnostic terminologies. The symptoms range from physical (general stunted appearance, poor coordination, problems with seeing or hearing, distorted eye openings) to psychological (low intelligence, poor emotion control) to behavioural (school and legal troubles, high risk behaviours, drug and alcohol dependence). Within the FA spectrum:
  • Fetal Alcohol Syndrome (FAS): This is the most severe form of the spectrum. In order to be diagnosed there must be (1) A growth deficiency (pre- or post-natal height and/or weight at or below the 10th percentile; (2) FAS facial features (distorted eye openings, thin upper lip, smooth philtrum {the groove between the nose and upper lip}) must all be present; (3) Central nervous system (CNS) damage - basically meaning that there is structural, neurological or functional impairment of the brain; and, (4) Confirmed (or unknown) prenatal alcohol exposure).
  • Partial FAS (pFAS): The above symptoms are not as severe. (1) Growth or height ranges from normal to deficient; (2) Two or three of the FAS facial features are present; (3) CNS impairment in 3 or more of the 10 Brain Domains; and (4) Confirmed prenatal alcohol exposure.
    • 10 Brain Domains: Achievement, Adaptive Behaviour, Attention, Cognition, Executive Functioning, Language, Memory, Motor Skills, Multisensory Integration (aka Soft Neurological Problems), and Social Communication.
  • Alcohol-Related Neurodevelopmental Disorder (ARND): Focuses on neural (brain) development. (1) Growth or height may be normal or minimally deficient; (2) Minimal or no FAS facial features present; (3) Clinically significant structural, neurological, or functional impairment in 3 or more of the 10 Brain Domains; (4) Confirmed prenatal alcohol exposure.
  • Alcohol-Related Birth Defects (ARBD): Although this term is not commonly used, it refers to any congenital abnormalities linked to maternal alcohol use but without having any of the key features of FAS.
• Exposure: This is also a term of contention. Prenatal alcohol exposure is determined during an interview with the mother, her family members, and peers to confirm any level of alcohol use during pregnancy. There are 4 risk levels:
  • High Risk: Confirmed use of alcohol during pregnancy known to be at high blood alcohol levels (100 mg/dL or greater) delivered at least weekly at any point in pregnancy. This sounds pretty extreme until you consider that 100 mg/dL is equal to five beers with an alcohol content under 5% over the course of 3 hours OR two regular-sized Screw Drivers over the course of 3 hours in a 160 lb person. Splitting up your consumption does not matter.
  • Some Risk: Confirmed use of alcohol during pregnancy with use less than High Risk.
  • Unknown Risk: Self-explanatory, I think...
  • No Risk: Also, self-explanatory.

With the medical definitions out of the way it becomes quite clear that any amount of alcohol is considered to be some risk. Step 2 is understanding how FASD symptoms occur. The short explanation is that alcohol is a chemical that is not efficiently broken down by the body and ends up floating into various areas of our bodies (ie. blood, urine, breast milk). As soon as the blastocyst (early stage of pregnancy, around Week 3-4) attaches to the uterine wall it begins to receive nourishment from the mother. Chemical intrusion at this stage can already start to affect development. By Week 5 we are looking at the embryo developing its brain, spinal column, nerves, GI tract, and heart which puts the embryo at even higher risk from intrusions like some medications, drugs, alcohol, nicotine, and infections.

One of the areas prone to chemical intrusion is the blood-brain barrier. A lot of people have this image of the BBB being some kind of wall but the reality is much more complicated. It is a chemical membrane through which various chemicals within and outside the brain tissue can pass. One of those chemicals, to a degree, is alcohol when in adults and even more so during fetal development. Alcohol will also effect the development of other tissue groups (ie. skin, muscles, blood vessels, nerves) throughout pregnancy.

I have researched this issue quite heavily over the last few years and have found some folks promoting alcohol use during pregnancy (ie. Cosmo Magazine and author Emily Oster). Leaving aside the ones that have no citations (in particular, peer-reviewed citations) I found several who say that it is okay to have no more than one or two drinks periodically throughout the pregnancy as long as you are not going over the 100 mg/dL mark and not more than once over a 7-day period. Each seemed to cite the same notion that drinking a class of wine can help with stress reduction and blood flow which helps both mom and baby but as I followed the trail of links they provided as evidence they stopped at dead ends. Those 6 websites are so brutally outnumbered by everything else that even my colleague has since changed his tune.

The simple fact is that either way we are talking about generalizations based on large- and small-scale studies. Is it entirely possible that your minimal consumption throughout pregnancy will do no harm? Absolutely. We base our warning on the simple fact that FASD will be part of the lives of between 1 and 9 in 1000 births throughout Canada, even higher in rural and remote regions. Bearing in mind that blood alcohol levels (the 100 mg/dL I mentioned before) is dependent on many factors (strength of beverage, size of person, interval between drinks) I would rather be safe and recommend abstaining from alcohol.

The slightly more important part of this whole post idea is to help direct people you know and love to the supports they may need:

If your friend is thinking about becoming pregnant and is struggling with alcohol dependence please be gentle in how you approach! Be the change. If you are regularly drinking then anything you say to the contrary will likely be ignored regardless of the stage within the cycle of addiction that she is going through. Let them know that you are concerned about their behaviour could effect their pregnancy and their future children. I would go so far as to send this link or have the brochure available.

If your friend is currently pregnant and struggling with alcohol consumption at any degree please take care and help direct them toward their family doctor (if available) or a counsellor for a non-judgmental conversation on the issue. I know that I have my bias on the subject but when women who are pregnant come into my office who are struggling with alcohol use the conversation changes because they have already heard the warning. It's not my duty to put them under more stress. This is an opportunity to engage in the conversation around why alcohol is a part of that individual's life. Many larger communities have prenatal assistance directed at this exact issue.

Treatment options are available! Besides the dependence/addiction counselling that is readily available in many regions there are treatment options for families affected by FASD. In Renfrew County and the surrounding regions please check out this link, your local hospital, Community Care Access Centre (or similar organization), or private practitioners.

​Keep in mind that this posting is subject to regular updates.