Pregnancy and Alcohol Consumption

• Introduction to pregnancy and alcohol consumption
• Guidelines for alcohol consumption during pregnancy
• Prevalence of alcohol consumption during pregnancy
• Predisposing factors
  • Unplanned pregnancy
  • Alcohol dependence
• Health risks associated with alcohol consumption during pregnancy
• What women should know about alcohol consumption during pregnancy

Introduction

When an individual consumes a drink containing alcohol, the alcohol enters their bloodstream. When a pregnant woman drinks alcohol, it also enters the bloodstream of her foetus, and when excessive amounts of alcohol are consumed they can have damaging effects on the foetus.

Many Australian women enjoy alcoholic beverages so being aware of the health effects of alcohol consumption during pregnancy, is important both for women who are pregnant and to those who may become pregnant. Knowing about the health effects of alcohol allows women to make informed decisions about their alcohol consumption during pregnancy, whilst also considering their social needs and desires.

The effects of alcohol consumption before and during pregnancy are not well understood. This is partly due to a lack of research about the effect, but also because when research is conducted, it is often difficult to separate the effects of alcohol, from the effects of other factors (e.g. smoking, poor nutrition) which contribute to poor pregnancy and infant health outcomes. There is substantial evidence that heavy alcohol consumption during pregnancy is associated with poor foetal development and also that poor foetal development can have ongoing health effects in infancy, childhood and adolescence. However there is not yet enough evidence from research studies to determine whether or not low to moderate alcohol consumption during pregnancy is associated with poor foetal development or infant health outcomes.

Guidelines for alcohol consumption during pregnancy

The lack of information and debate surrounding the effects of prenatal alcohol consumption is reflected in the varied and changing recommendations of Australia’s national, state and territory health departments.

For example, the National Health and Medical Research Council (NHMRC) released guidelines about alcohol consumption during pregnancy in 2009, which recommended that pregnant women abstain completely from alcohol during pregnancy. However an earlier version of the guideline, published by the NHMRC in 2001 recommended complete abstinence only as an option to be considered.

The 2001 guidelines stated that there is “no definite evidence that low-level drinking causes harm to the unborn child” and recommended that women who were pregnant or might become pregnant:

• “May consider not drinking at all;
• “Most importantly should never become intoxicated;
• “If they choose to drink, over a week, should have less than 7 standard drinks AND on any one day, no more than two standard drinks (spread over at least two hours);
• “Should note that the risk is highest in the earlier stages of pregnancy, including the time from conception to the first missed period.”

The NHMRC, in its 2009 review of alcohol consumption guidelines, changed this recommendation to state that complete abstinence from alcohol as the safest option during both pregnancy and breastfeeding. However, the guidelines noted that the changing recommendation was due to adoption of a more conservative public health approach rather than new evidence about the effects of alcohol consumption during pregnancy.

Prevalence of alcohol consumption during pregnancy

A national survey of alcohol consumption during pregnancy reported that 34% of women had consumed alcohol during a previous pregnancy and 24% would consume alcohol whilst pregnant if they became pregnant in the future. A Western Australian survey reported that more than half (59%) of women reported consuming alcohol during pregnancy and 14% reported binge drinking (consuming >5 standard drinks in a day) in the three months prior to conception. Twenty percent of respondents in a Queensland survey reported binge drinking (defined as >5 standard drinks) and 36% reported some alcohol consumption during pregnancy.

Predisposing factors

Some women may be more likely to consume alcohol during pregnancy, notably those who are unaware they are pregnant and those who are dependent on alcohol.

Unplanned pregnancy

As a woman does not know she is pregnant until her menstrual bleeding is absent, women who do not plan to become pregnant may consume alcohol, unaware that they are pregnant. As the effects of alcohol consumption on the foetus are most severe in the early stages of pregnancy, this may have particularly serious foetal effects.

Alcohol dependence

Women who are alcohol dependent(some 2.3% of Australian women) are those who regularly drink in excess of the NHMRC guidelines for safe alcohol consumption. Regular excessive alcohol consumption is associated with poor foetal outcomes. Women who are alcohol dependent crave alcohol and are unlikely to be able to stop drinking just because they discover they are pregnant. Young women (

Health risks associated with alcohol consumption during pregnancy

A number of health risks are associated with alcohol consumption either before or during pregnancy, including an increased risk of:

• Cognitive defects in the infant: are associated with drinking more than five standard drinks per day during pregnancy. This is particularly true for pregnant women who are >30 years old;
• Behavioural and learning difficulties in adolescence: have also been associated with maternal alcohol consumption. Adolescents whose mothers drank during pregnancy, particularly in the early stages or to the point of intoxication, are more likely to have behavioural and learning difficulties than those whose mothers did not;
• Foetal alcohol spectrum disorder: that is, a group of health and development issues seen in infants exposed to alcohol in utero. The syndrome is characterised by:
  • Abnormal facial features;
  • Retarded growth; and
  • Brain damage, which can manifest as learning or behavioural difficulties.

What women should know about alcohol consumption during pregnancy

It is very common for women in Australia, and particularly young women, to consume alcohol. Because drinking is common in Australia, some women may wish to continue consuming alcohol during pregnancy (for example at social gatherings). Women who are or plan to become pregnant should therefore access objective information about the effects of alcohol consumption during pregnancy, and some may wish to speak to their general practitioner or another health professional so that they can make an informed decision about if and how much they drink.

Obtaining objective information may also help to reduce the fear of women who have consumed alcohol in the early stages of pregnancy, before they even realised they were pregnant. Evidence suggests that many women consume alcohol in the period between conception and missing their menstrual period.

Women who are pregnant or considering becoming pregnant should also find out more about other factors which can affect their health and the health of their foetus, including:

• Nutritional intake;
• Tobacco consumption;
• Attending antenatal care;
• Stress.

More information

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For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy.

For more information on drinking alcohol, including drinking disorders and alcohol’s effect on the body, as well as some useful tools, see Alcohol.

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.

For more information about pregnancy planning, including importance of nutrition before pregnancy, being under-weight, being overweight, tobacco exposure and alcohol consumption, see Pregnancy Planning (Preconception Advice).

References

1. National Health and Medical Research Centre, Australian Alcohol Guidelines: Health risks and Benefits. 2001. [cited 2009, August 22]. Available from: URL Link
2. OLeary, C.M. Heuzenroder, L. Elliot, E.J. Bower, C. A review of policies on alcohol use during pregnancy in Australia and other English speaking countries, 2006. MJA. 2007;186:466-71.
3. National Health and Medical Research Centre. Australian Guidelines to reduce health risks from drinking. 2009. [cited 2009, August 22]. Available from: URL Link
4. Jacobson, J.L. Jacobson, S.W. Sokol, R.J. Ager, J.W. Relation of Maternal Age and Pattern of Pregnancy Drinking to Functionally Significant Cognitive Deficit in Infancy. Alcoholism- Clin Experiment Res. 2006;22(2):345-51.
5. Olson, H.C. Streissguth, A.P. Sampson, P.D. et al. Association of prenatal alcohol exposure with behavioural and learning problems in early adolescence. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1187-94.
6. Krulewitch, C.J. Alcohol consumption during pregnancy. Ann Rev Nurs Res; 2005;23:101-34.
7. Orleans, T. Barker, D.C. Kaufman, N.J. Marx, J.F. Helping pregnant smokers quit: meeting the challenge in the next decade. Tob Control. 2000;Supp3:iii6-11.