Alcohol and pregnancy 

The topic of alcohol and pregnancy is an emotive one and has attracted media attention because of concerns of the negative health impacts on the developing baby. For this reason if you are pregnant you are advised not to  drink excessively. But what does that actually mean?

• Is it safe to drink moderately during pregnancy?
• What is best for my baby’s health  – total abstinence or is the occasional small glass of wine okay?
• How much is too much?

What we do know is that experts are still unsure exactly how much, if any, alcohol is completely safe for you to drink whilst pregnant. For this reason, the safest approach is thought to be that you shouldn’t drink any alcohol while you are pregnant or trying to become pregnant.

The effects of alcohol during your first trimester

It is especially important to listen to advice on alcohol consumption during  your first trimester (the first 12 weeks of pregnancy). This is because your baby’s  major body organs – brain, spinal cord and nervous system, heart and kidneys – are developing; as are their facial features.

If  you drink during  your first trimester and continue to drink heavily throughout your pregnancy it can  cause irreversible damage to your baby’s growth and development. However, if you reduce your alcohol consumption or stop drinking entirely, any further damage to your baby’s health and development can be avoided. This is why reducing alcohol consumption at any stage of your pregnancy can still benefit  your baby’s health and wellbeing – even late in pregnancy.

NICE Guidelines advise  that you  should not to drink during the first three months’ of pregnancy due to the increased risk of miscarriage associated with excessive alcohol use. In addition, studies have found that drinking heavily, particularly during the first three months’ of pregnancy also increases the risk of premature birth and low birth weight.

What does the Department of Health recommend?

• That if you are pregnant or trying to become pregnant, you should not drink any alcohol at all
• However, if you do decide to drink, you should limit this to one or two units of alcohol, once or twice a week – the equivalent to one or two small glasses of wine.

This recommendation is based on research and evidence that has looked at the effects of low-to-moderate alcohol intake on the developing baby. This research has failed to find any strong evidence of harm to the developing baby where alcohol intake is kept at this level. However, it is important to note that: no evidence does not mean that it’s safe.

How could alcohol affect my baby?

When you consume alcoholic drinks the alcohol passes directly into your blood stream, and if you are pregnant, will then cross the placenta and enter your baby’s blood stream. Your baby is unable to process the alcohol in its body because its liver is one of the last major organs to develop and it doesn’t mature until late pregnancy. This is why when they are exposed to too much alcohol it can significantly impact their health and development.

Studies show that excessive drinking in your third trimester can have long term adverse effects on your baby’s health and development after they have been born. Drinking too much is associated with babies developing learning difficulties and behavioural problems. These risks increase in relation to the amount of alcohol you drink.

Fetal Alcohol Syndrome

Studies show that drinking more than six units of alcohol each day  whilst pregnant can cause  babies to develop a very serious condition referred to as ‘Fetal Alcohol Syndrome’ (FAS). Babies born with FAS can have a number of distinct features:

• Poor growth: babies exposed to too much alcohol tend to grow more slowly while they are in the uterus (womb) and are often born ‘small-for-dates’
• Growth and development problems: these can affect the heart, stomach, intestines, limbs and joints which can cause life-long health problems
• Facial abnormalities
  • Smaller than normal eyes
  • A receding forehead and chin
  • A cleft palate
  • A short upturned (pug-like) nose
• Learning difficulties, including problems with hearing or sight
• Behavioural problems.

Studies show that women who drink heavily on single occasions are at an increased risk of having babies’ born with lesser forms of FAS which can include birth defects.

Long term effects of drinking when pregnant

Studies that have looked at the longer term impact on children whose mums drank excessively during pregnancy have found a number of adverse effects, including:

• Babies being born with a poor sucking reflex which adversely impacts on feeding, especially breastfeeding
• Baby sleep problems
• Increased likelihood of hyperactivity
• Attention deficit disorder (problems concentrating)
• Difficulties with movement and coordination.

How much am I drinking?

Calculating how much alcohol you drink isn’t always easy because there are significant differences in the amount of alcohol in different drinks, as well as, the various glass, bottle and can sizes used in pubs and homes. You could be drinking a lot more than you realise.

Handy tools:

• Drink Aware Unit and Calorie Calculator
• Change4Life Drinks Tracker App (free)

What is a unit of alcohol?

Units are an easy way of conveying the quantity of pure alcohol that is present in a drink. One unit equals 10ml or 8g of pure alcohol; this is approximately the amount of alcohol that the average adult is able to process in one hour.

• 76 ml of standard 13% wine (a small glass is 125 ml, or 1.6 units)
• 250 ml of standard 4.5% beer (half a pint is 284 ml, or 1.1 units; and a pint is 568 ml, or 2.2 units)
• 218 ml of standard 4.5% cider (half a pint is 284 ml, or 1.3 units; and a pint is 568 ml or 2.6 units)
• 250 ml of standard 4% alcopop (a standard sized bottle is 275 ml, or 1.1 unit)
• 25 ml of standard 40% spirits (this is a single shot of spirits)

Booking appointment

At you first meeting with your midwife (booking appointment) you will be asked a number of medical, social and lifestyle questions which will include:

• Whether you drink alcohol
• Whether you are continuing to drink while pregnant
• And, if so, how much you plan to drink

If you continue to drink alcohol during your pregnancy you will fall into one of the following groups:

• Lower-risk drinker: Drinks one to two units, once or twice a week. Applies to most pregnant women
• Increasing-risk drinker: Drinks more than 2-3 units a day, drinking on a regular basis
• Higher-risk drinker: Drinking more than 35 units in a week, or more than 6 units a day

As mentioned above, the advice from the Department of Health is to not drink alcohol, or keep drinking within the ‘Lower-risk’ drinker category. Therefore, if you fall into one of the higher risk categories, you will be encouraged to limit your drinking to this level whilst pregnant. Your midwife and doctor will be able to offer support with this and refer on to local support agencies,

It is important to note, that trying to reduce your drinking when you have a history of excessive alcohol intake is not straightforward.

Unsupervised withdrawal of alcohol (without a doctor’s supervision) can do more harm than good and in more severe cases can induce ‘withdrawal seizures’ which can harm your baby. This is because when a seizure happens, the oxygen supply to your baby diminishes.

Therefore, reducing your alcohol intake has to be carefully planned and monitored by health care professionals to safeguard both the health of you and your baby – and to ensure that follow-up support and specialist referral is available, if necessary.

Additional risk factors for mums

• Research has found that pregnant women over the age of 30 who drink excessively are more likely to give birth to a baby with alcohol-related damage
• Previous obstetric complications (pregnancy-related problems) and a history of miscarriage
• Studies also show that excessive drinking in pregnancy can make regional anaesthesia – such as epidurals less effective. Especially, if you have been drinking heavily prior to labour beginning.

Dads drinking habits can impact your childs health too

Studies have shown an increased number of health problems in babies whose Dads have a history of excessive drinking prior to their baby’s conception (pre-pregnancy), including:

• An increased risk of the baby being born with cardiac defects (a hole in the heart)
• Problems with the baby’s immune system (which makes it harder for them to fight-off infections)
• Babies being born ‘small-for-dates’ (smaller than would normally be expected).

Drinking following your baby’s birth

Studies that have looked at women who drink alcohol in the postnatal period have identified a number of worrying effects.

• Consuming alcohol while breastfeeding has been found to affect the taste and the smell of the mother’s breast milk; this can adversely interfere with their baby’s breastfeeding pattern
• Excessive alcohol consumption has also been found to be a significant risk factor in ‘Sudden Infant Death Syndrome’ (SIDS) – also commonly referred to as ‘Cot Death’. Research shows that drinking excessively, when also sharing a bed (co-sleeping) with your baby increases the risk of cot death because alcohol can impair parents’ responses and they are less likely to be alert to their baby’s needs

Final thoughts…

We recommend that you discuss any concerns you might have about your drinking habits with your midwife or doctor. They will want to support you, so it is important that you are open and honest with them.

They can offer you and your partner advice about your drinking habits before you start trying for a baby, as well as when you are pregnant, including strategies to help reduce your alcohol intake if needed. Your midwife and doctor can also put you in contact with specialist support services, if you have a history of heavy drinking or need some additional help to reduce your alcohol use.