Mothers who drink alcohol during pregnancy expose their fetuses to a known “teratogen.” A teratogen is something that causes birth defects. It has been well-recognized since at least 1973, if not since biblical times, that babies can be born with serious problems if their mothers drank. What is less clear is whether alcohol in small amounts is okay.
The short answer? None.
If you’re looking for the long answer, let me explain a little more…
What we really need is some rock-solid, gold-standard research on the subject. To do this, we need to find a group of women who are newly-pregnant who would be willing to enroll in a study where we give them measured amounts of alcohol at specific points of gestation, then examine their babies as they age.
So, let’s say that I have you in my office for your first prenatal visit. I ask you if you would sign this consent form for participation in a study that would randomly assign you to take either a placebo, or a little bit of a drug we know can cause serious harm to your fetus. I reassure you that we are only going to give you a tiny amount of this dangerous substance, and that the effects, if any, would likely be very little. Perhaps a tiny reduction in your child’s cognitive ability, or ability to listen to instruction, or control his own impulses. Would you agree to participate? Most women would decline.
There are other substances we know cause harm in small doses, such as lead, mercury, Thalidomide, Accutane, radiation. Would a woman in her right mind be willing to be given just a tiny dose of one of those for the purposes of scientific research?
What happens if a woman does drink during pregnancy?
At high doses, or at doses at the wrong times, or repeated doses, alcohol can change the way a person appears. A computer program is under development that could analyze a head shot of your child to see if you drank during pregnancy. The signature characteristics are a smaller eyes relative to the distance between, a thin upper lip and most easily recognizable, an upper lip that lacks a well-defined “philtrum” groove above it and below the nose. This child’s image was given as an example in the Pediatrics article:
The brain and other organs can be harmed, even if nothing shows on the face. A fetus can even die from exposure to alcohol. The brain changes can result in a long and frightening list of permanent limitations and risk factors for the child. According to this week’s article in “Pediatrics,” these include:
Learning problems, subtle to severe
Other mood disorders, including anxiety
Trouble with the law
Inappropriate sexual behaviors
The estimated lifetime cost of care, including health and social services are estimated to be $2.44 million for each effected child.
According to this new article, approximately half of all U.S. women of childbearing age have reported consuming alcohol in the past month. About 15% report drinking 4 or more drinks in a 2-hour period, which meets the latest definition of “binge drinking.” And 7.6% of pregnant women report continued alcohol use, with 1.4% reporting binge drinking during pregnancy.
Researchers in academic institutions must follow, by law, a procedure before doing research on humans. The proposal must be approved their Institutional Review Board, which weighs risks and benefits, and takes into consideration whether all participates can give informed consent. As you can imagine, IRB’s rarely approve research on pregnant women. The standards are not met when the fetus would be exposed to a known teratogen, with well-identified serious, permanent potential impacts. So what this means is that no prospective, randomized controlled trials of alcohol in pregnancy will EVER come out of a authoritative academic institution. So we are forced to act on the basis of the knowledge gained from observational, retrospective studies, which are clearly demonstrating that drinking alcohol in any form is not completely safe for babies in any trimester in any amount. What mother in her right mind would give her baby a little bit of a known teratogen?
What should you do if you are pregnant and have consumed alcohol?
If you drank before you found out you were pregnant, stop. If you cannot stop, find a health care provider who can help you quit. There is help available. And if your baby may be alcohol-exposed, early intervention and treatment programs have shown to help. You can contact me at my office: 734-655-8250, or via email at firstname.lastname@example.org.