Alcohol

(Date: July 2019. Version: 2.0)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

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Drinking alcohol during pregnancy

Alcohol consumed at any stage of pregnancy can reach the baby. In the earliest stages of pregnancy the developing embryo gets its nutrients from a structure called the yolk sac. Alcohol from the mother’s bloodstream can pass into the yolk sac. From around ten to twelve weeks of pregnancy the placenta starts to function. From this point, alcohol can cross the placenta and enter the bloodstream of the fetus. Babies in the womb cannot process alcohol in the same way as an adult and, as a result, alcohol remains in the baby’s brain and body for several hours after it has been cleared from the mother’s bloodstream.

Exposure to alcohol in the womb can cause lifelong problems with learning and behaviour, as well as some birth defects, miscarriage and stillbirth. While the strongest chance of these problems has been most clearly linked to heavy drinking, studies have not been able to prove that drinking any amount of alcohol whilst pregnant is safe. Additionally, some unborn babies are likely to be more susceptible to the effects of lower levels of alcohol exposure than others. It is for these reasons that the Department of Health in the UK recommends that alcohol should be avoided for the full nine months of pregnancy and, ideally, whilst trying to conceive. If you need help to do this you can ask your doctor or midwife for information on the support available.

What if I have already drunk alcohol during pregnancy?

It is not uncommon for a woman to drink alcohol before realising that she is pregnant. A very small number of studies do not raise concern that occasional binge drinking (5+ units) early in pregnancy poses a strong chance of problems in the baby. However, because so few pregnant women with this type of drinking pattern have been studied, more research is required to confirm this. Women who are worried about alcohol consumed during pregnancy can speak to their doctor or midwife. The chance of the baby being affected will largely depend upon the amount of alcohol consumed on each occasion and the number of drinking days (see the sections below for further details).

How can drinking in pregnancy harm my baby?

Drinking alcohol during pregnancy can cause a range of different problems in the baby, often referred to as Fetal Alcohol Spectrum Disorders (FASD). Some of the features of FASD may only become apparent when a child starts school, or later on in life. 
 
Features of FASD include:
• Learning and behavioural problems which can range from mild to severe (up to 9 out of every 10 children with FASD have these type of problems without any of the other issues listed below).
• Reduced growth in the womb and/or throughout life.
• A specific facial appearance (narrow eyes, thin upper lip, poorly defined groove between top lip and nose) – this can be quite hard to detect unless by a specially trained doctor.
• Abnormal brain formation or development, which can lead to the child having a very small skull and/or problems such as seizures.

The chance of a baby being born with FASD tends to be linked to the amount of alcohol they were exposed to in the womb (see below). Some children with FASD are affected by all of the problems listed above while others have only one or a few of these problems. Children who have all four of these types of problem are said to have Fetal Alcohol Syndrome (FAS).

How much alcohol causes FASD?

Heavy drinking during pregnancy, usually measured as repeatedly consuming more than around five units of alcohol (2 large glasses of wine) per day, carries the greatest risk of a baby being affected with FASD. Both daily heavy drinking and repeated heavy binge drinking have now been linked to FASD.

Other drinking patterns during pregnancy have not been well-researched. A small number of studies assessed children exposed in the womb to up to six drinks over a week (with some non-drinking days) at any stage of pregnancy. Some (but not all) identified possible adverse effects on learning and behaviour. Studies of small numbers of children exposed to low levels of alcohol at any stage of pregnancy (2 units up to twice a week) do not raise major concerns of adverse effects, but these cannot be ruled out due to the low numbers of children assessed.

As there is currently no level of alcohol that has been proved to be safe for an unborn baby, the Department of Health recommends complete abstinence from alcohol during pregnancy.

Can other factors influence the chance of FASD?

We can broadly say that across the population the chance of FASD is highest in children exposed in the womb repeatedly to large amounts of alcohol. However, other factors that naturally vary from person to person can influence each woman’s chance of having a baby with FASD. For some people this may mean that lower levels of alcohol have the potential to cause harm. These factors include:
• The ability of the mother and fetus to process alcohol (this is largely determined by their genes).
• The mother’s age, body weight, general health, nutritional status, and lifestyle.
• Exposure to additional prescription or recreational drugs.

Is there any stage of pregnancy where it is considered safe(r) to drink alcohol?

No. Alcohol consumed at any stage of pregnancy can reach the baby (see above).

Most of the baby’s body and organs are formed between weeks 3 and 8 of pregnancy and it is during this time that heavy drinking can potentially cause the characteristic facial malformations linked to FASD. A number of other structural birth defects (including heart, kidney and eye defects) have also been linked to alcohol exposure in early pregnancy.

A baby’s brain develops throughout the whole of pregnancy. Drinking alcohol at any time during pregnancy can therefore potentially damage the baby’s developing brain, leading to lifelong difficulties with thinking and learning, and behavioural problems such as ADHD or autism spectrum disorder.

Can drinking in pregnancy cause miscarriage or stillbirth?

A number of studies have linked drinking alcohol during pregnancy with miscarriage and stillbirth. One study showed that the chance of miscarriage was five times higher, and the chance of stillbirth three times higher, in women consuming more than five alcoholic drinks per week compared to women who drank one drink per week or less. Some studies have also shown that the more a woman drinks during pregnancy, the greater her risk of miscarriage or stillbirth.

Can drinking in pregnancy cause premature delivery?

Current scientific evidence shows that heavy drinking during pregnancy is linked to premature birth (before 37 weeks of pregnancy). The effects of moderate drinking (up to six drinks over a week with some non-drinking days) are unclear as the few studies that have been carried out report mixed findings. One large study of over 50,000 pregnant women who reported low levels of drinking (two units up to twice a week) found no link with premature delivery.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth. It is important to understand that scans are not able to pick up all birth defects and will not detect more subtle changes to the brain that might be linked to some learning and behavioural problems.

In pregnancies where exposure to high levels of alcohol has occurred, other specific monitoring or more detailed tests for the mother or baby may be offered.

Are there any risks to my baby if the father drank?

We would not expect any increased risk to the baby if the father drank alcohol around the time of conception.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.  If you are concerned that your child has been affected by alcohol exposure in the womb please speak to your GP or midwife and visit www.nofas-uk.org

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WE NEED YOUR HELP! Do you have 3 minutes to complete a short, quick and simple 12 question user feedback form about our bumps information leaflets? To have your say on how we can improve our website and the information we provide please visit www.surveymonkey.co.uk/r/uktis-bumps.

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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