Alcohol and pregnancy

Alcohol in pregnancy is the use of alcohol (ethanol) during gestation. This also includes the time period between conception and awareness of the pregnancy. Alcohol use not only can result in Fetal Alcohol Spectrum Disorder (FASD), but it can result in only one or few disorders and conditions. Not all women who consume alcohol during pregnancy will have a baby with all of the features and characteristics of FASP. Alcohol use during pregnancy also can cause spontaneous abortion, stillbirth, low birthweight, and prematurity.[1] Alcohol consumption can begin in the later stages of pregnancy after the development of facial characteristics of an infant are almost fully developed.[2] Not all infants exposed to alcohol in utero will have defects related to the alcohol consumption. Alcohol use during pregnancy can also result in the inability to care for an infant after the birth if the drinking continues. The use of alcohol during pregnancy is associated with domestic violence and potential harm to the infant.[1]

Embryology

Different body systems in the infant grow, mature and develop at specific times during gestation. The consumption of alcohol during one or more of these developmental stages may only result in one or few conditions.[3]

From conception and to the third week, the most susceptible systems and organs are the brain, spinal cord, and heart. Though these body systems complete their development later in the pregnancy, the effects of alcohol consumption early in the pregnancy can result in defects to these systems and organs.[3]

During the fourth week of gestation, the limbs are being formed and it is at this point that alcohol can effect the development of arms, legs, fingers and toes. The eyes and ears also form during the fourth week and are more susceptible to the effects of alcohol.[3]

By the sixth week of gestation, the teeth and palate are forming and alcohol consumption at this time will effect these structures.[3]

By the 20th week of gestation the formation of organs and organ systems is well-developed. The infant is still susceptible to the damaging effects of alcohol.[3]

The baby’s brain, body, and organs are developing throughout pregnancy and can be affected by exposure to alcohol at any time. Because every pregnancy is different, drinking alcohol may hurt one baby more than another. A child that has been affected by alcohol before birth may be appear 'normal' at birth. Intellectual disabilities may not appear until the child begins school.[3]

After birth

When an infant is born and appears to be healthy, the baby may still have non-visible disorders and organ defects due to exposure to alcohol during the pregnancy.[3] Social problems in the child have been found to be associated with alcohol use during gestation.[1] Alcohol is a cause of microcephaly.[4]

Alcohol use during pregnancy is does not effect the ability to breastfeed the infant. In addition, an infant may breastfeed even if the mother continues to consume alcohol after the birth. An infant born to a mother that has an alcohol dependency may go through alcohol withdrawal after the birth.[1]

Treatment

A woman may elect to discontinue alcohol once she knows that she is pregnant. A woman can have serious symptoms that accompany alcohol withdrawal during pregnancy. These symptoms can be treated during pregnancy with benzodiazepine.[1]

Epidemiology

One out of 67 women who drink alcohol during pregnancy will have a child with a birth defect. The five countries with the highest prevalence of alcohol use during pregnancy were The highest prevalence of alcohol consumption by pregnant women is in Ireland (about 60%), Belarus (47%), Denmark (46%), the UK (41%) and the Russian Federation (37%). The lowest prevalence is in those nations whose religious beliefs govern their alcohol consumption. Birth defects caused by alcohol consumption may be up to 1% in many places. This may mean that FASD may be higher than anencephaly, Down syndrome, spina bifida and trisomy 18. Globally, one in 10 women drink alcohol during pregnancy. Out of this population, 20% binge drink and have four or more alcoholic drinks per single occasion.[5]

"Binge drinking is the direct cause of FAS or FASD. These findings are alarming because half of the pregnancies in developed countries and over 80% in developing countries are unplanned. That means that many women don’t realize they are pregnant during the early stages and that they continue drinking when pregnant."[5]

Public policy

In the United States, the surgeon general released a warning asking pregnant women to abstain from alcohol for the remainder of gestation.[6]

See also

References

  1. 1 2 3 4 5 "Guidelines for the identification and management of substance use and substance use disorders in pregnancy" (PDF). World Health Organization. 2014. Retrieved 11 August 2017.
  2. ↑ "Alcohol and Pregnancy". Retrieved 11 August 2017. This article incorporates text from this source, which is in the public domain.
  3. 1 2 3 4 5 6 7 "An Alcohol-free pregnAncy is the best choice for your baby" (PDF). Centers for Disease Control and Prevention. Retrieved 10 August 2017. This article incorporates text from this source, which is in the public domain.
  4. ↑ "Microcephaly". World Health Organization. Retrieved 11 August 2017.
  5. 1 2 "Counting the costs of drinking alcohol during pregnancy". World Health Organization. Retrieved 11 August 2017.
  6. ↑ Rankin, Lissa (23 August 2011). Fertility, Pregnancy, and Childbirth. St. Martin's Press. p. 14. ISBN 9781429959322. In 1981, the surgeon general put out the now-ubiquitous warning about alcohol and pregnancy.
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