WHAT'S UP DOC? Alcohol and pregnancy don't mix

Q: I just found out I am pregnant. How much alcohol is safe for me to drink?

A: The simple answer is none.Alcohol freely passes through the placenta to the fetus, so any alcohol a pregnant woman drinks, her fetus drinks as well. Alcohol is a teratogenic substance; it is known to cause birth defects.

The more alcohol the mother drinks during pregnancy, the bigger the risk for the fetus. However, since even a small amount of alcohol carries some risk, the recommendation is to avoid alcohol completely during pregnancy. In fact, in 2005 Surgeon General Dr. Richard Carmona issued an advisory on alcohol use in pregnancy. This noted that even women who may become pregnant (such as any woman of child-bearing age who is having unprotected intercourse) should avoid all alcohol, since alcohol consumption may have negative effects even in the earliest weeks after conception - even before a woman knows she is pregnant.

Alcohol affects the growth and development of many of the organs of the developing fetus, so there is a broad range of problems that alcohol can cause (termed Fetal Alcohol Spectrum Disorder), the most severe of which is called Fetal Alcohol Syndrome.

The earliest clinical effects of FAS start during pregnancy and cause poor growth of the fetus,, abnormal brain growth, as well as abnormal development of the baby's face and possibly other organ systems. The damage done to the fetus is not reversible, so once the baby is born the organ problems eventually become evident. The diagnosis of FAS is made by noting specific facial features of the baby, growth retardation and abnormalities in the central nervous system (from abnormal brain development).

At birth, kids with FAS will have characteristic faces (although these can be seen in kids without FAS as well), which can include a smooth philtrum (the vertical groove under the nose and over the upper lip is flat), smooth upper vermillion borders (thin upper lip with very little red part) and short palpebral fissures (narrow total width of the eyes from side to side). Other abnormalities can occur as well.

For babies born with FAS, the poor growth that started while the mother was pregnant, continues in infancy and throughout childhood. The abnormal brain development from FAS may manifest as developmental delay (not meeting normal times for baby's milestones such as walking, talking, etc.) during infancy and subsequently with mental retardation. As children, these kids do poorly in school and often have behavioral problems. They also have high rates of mental health disorders (affecting up to 95 percent of FAS kids by the time they become adults) and social troubles (82 percent are not able to live independently, over 50 percent end up in jail, over 70 percent have trouble getting or keeping a job and over 50 percent have alcohol or drug problems).

There are many other organs that can be involved in FAS, including the baby's heart, kidneys, bones, eyes, ears and others.

Some babies exposed to alcohol while in utero have some, but not all, of the sequelae of FAS. For example, some may have mental retardation but not have the characteristic facial features. In fact, alcohol exposure during pregnancy is one of the leading identifiable causes of mental retardation. This is even more tragic since it is 100 percent preventable.

Estimates are that as many as 1 in 750 babies born in the U.S. - around 40,000 per year - suffer negative effects from fetal alcohol exposure. The National Survey on Drug Abuse done in the late 1990s found that almost 15 percent of women drank at least some alcohol during pregnancy, and this likely underestimated fetal alcohol exposure by missing exposure very early in pregnancy (before the woman knew she was pregnant).

The Perinatal Substance Exposure Study Group tested urine samples in women at the time of delivery and found alcohol in almost 7 percent of women. This is also likely to have underestimated the prevalence of the problem since it tested women only at the time of delivery and used urine samples, which are not the most sensitive test of fetal alcohol exposure.

Heavier alcohol exposure, whether chronic or from binge drinking, places the fetus at even greater risk. In fact, babies regularly exposed to high alcohol levels can actually go through alcohol withdrawal (with symptoms such as irritability, tremors or even seizures), usually three to 12 hours or so after birth.

Babies exposed to alcohol in utero also have a higher risk of having been exposed to other drugs (including heroin and cocaine), as well as to other diseases (including sexually transmitted diseases such as HIV and syphilis). Furthermore, mothers who drink during pregnancy are less likely to get regular prenatal care.

Improved education about the problems that can occur from alcohol exposure during pregnancy has the potential to benefit many children. Since younger, poorer, unmarried and less educated women are at higher risk for drinking during pregnancy, as is any woman with a history of alcohol dependence, these should be target groups for educational programs.

Alcohol should be completely avoided during pregnancy, and this should include women who may become pregnant in order to avoid fetal alcohol exposure very early in the pregnancy.

Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.