Alcohol in Pregnancy Blog Post PDF

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Blog post for the topic of Alcohol Use during Pregnancy for the mandatory assignment. Received full marks for this assignment. ...

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The Healthy Pregnancy Blog

Kiahla Arnold

4 May 2018

WOULD YOU GIVE A NEWBORN A GLASS OF WINE? All your questions about alcohol in pregnancy answered… The question of whether it is ok to drink alcohol during pregnancy has been heavily debated for decades, so it can be difficult for expectant mothers to understand the risk of drinking during those precious months.

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What do the Australian guidelines say? Australia’s major health body - The National Health and Medical Research Council (NHMRC), firmly states that there is no safe level of alcohol to consume while pregnant,2 and this is the agreed stance across health agencies. Women who become pregnant or are planning for pregnancy should avoid alcohol all together as it can cause serious harm to the fetus as it is developing. As the chair of Foetal Alcohol Spectrum Disorders Task Force, Dr David Garry puts it:

60% OF EXPECTANT MOTHERS IN AUSTRALIA STILL DRINK AT SOME STAGE DURING THEIR PREGNANCY.1

“If you wouldn’t give a 2 month old a glass of wine, then why would you drink a glass of wine when you’re pregnant?” 3

Does a glass or two a week really do any damage? The answer is uncertain, and this is the problem - although there is overwhelming evidence that heavy drinking can cause birth abnormalities, the effects of light/moderate drinking is unclear, therefore cannot be declared as safe.4,5 Some studies including one by U.K National Institute for Health and Care Excellence reported that there was no evidence of risk when mothers consumed 1-2 drinks a week or on occasion throughout their pregnancy after following their children up until 5 years of age6. Despite these claims, the lack of accurate and long-term research means we still do not know if there is a safe threshold amount of alcohol to drink while expecting hence why the guidelines specify to avoid it entirely.

Why is alcohol harmful to babies? Alcohol contains ethanol, the chemical compound that causes the sometimes enjoyable and other times terrible effects we all associate with alcohol. Alcohol is a Teratogen, a toxic substance that can lead to structural abnormalities or miscarriage in the fetus. Once alcohol crosses the placenta it can impact the constantly developing brain cells particularly the glial cells, whose job it is to nourish and protect the all-important neurons of the brain which are responsible for sending messages within the brain and body. Impaired brain development can cause significant damage to the growing baby.

The Healthy Pregnancy Blog

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The Healthy Pregnancy Blog

Kiahla Arnold

4 May 2018

When a pregnant mother has a glass of wine, the alcohol crosses the placenta (seen in figure 3) which is the organ of exchange shared by the mother and the fetus that provides the much-needed nutrients needed for development. The amount of alcohol is shared in almost equal amounts between the mother and the fetus3, meaning your unborn baby receives just as much as wine as your fully developed adult body does. There is no safe period to drink - although studies have particularly identified the 1st trimester as a ‘Critical Period’. These first 3 months see organogenesis occur- the period where organs are formed, therefore alcohol consumption during this vital time in development has been especially linked to the onset of FAS7. Figure 3: The fetus inside placenta nutrients are passed from the maternal blood - this is how alcohol can be transferred

Alcohol-related neurodevelopmental disorder (ARND) This is a far more common condition that involves the range of developmental issues associated with FAS but without the characteristic facial deformities. ARND can result from far lower levels drinking, so it is important to refrain from even small amounts of alcohol to avoid putting your unborn child at any possible risk9.

Still not convinced? An Australian paediatrician likened drinking light amounts of alcohol to drinking ‘a little bit of thalidomide’ – a sedative given to pregnant women to relieve nausea in the 1950’s that turned out to cause catastrophic birth defects8.

FACT SHEET: FETAL ALCOHOL SPECTRUM DISORDERS FASD is a spectrum of conditions diagnosed by physical and behavioural abnormalities associated with high alcohol intake during pregnancy. The effects of these conditions can range from mild to extremely severe and include:3,5 Developmental delays and cardiac issues Characteristic facial defects including small head size and eye openings, wide set eyes and a thin upper lip (as seen in figure 4) IQ below 70, learning difficulties particularly language and speech development Fetal Alcohol Syndrome (FAS) is diagnosed when the impairment is at the most severe level and the baby suffers very serious levels of abnormalities. But before you panic it is important to remember that FAS is rare in mothers that consume less that 5 drinks per day. And is seen in 30% of children born to alcoholic mothers. 10

Take home message: FASD, ARND and any complications could cause an unborn child are 100% preventable Anything an expectant mother consumes is shared with the baby via the placenta There is no safe limit of alcohol to consume during pregnancy so abstaining is the safest option

The Healthy Pregnancy Blog

Figure 4: Identifying characteristics of FAS

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The Healthy Pregnancy Blog

Kiahla Arnold

4 May 2018

References 1. Muggli, E., O’Leary, C. et. Al., 2016 Did you ever drink more? A detailed description of pregnant women’s drinking patterns, BMC Public Health, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3354-9 2. National Health and Medical Research Council, 2009, Australian Guidelines to reduce health risks from drinking alcohol, Australian Government, pp. 67-81, Viewed 20th April, 2018 https://www.nhmrc.gov.au/_files_nhmrc/ publications/attachments/ds10-alcohol.pdf 3. Uscher, J. 2012, Alcohol and pregnancy: is ‘A Little Bit’ Safe? WebMD, viewed 28th 2018, 4. Australian Government Department of Health, 2018, Information you might not know about pregnancy and alcohol, Canberra, Viewed 30th April, 2018 5. Johnson, C., 2014, Alcohol in Pregnancy: Why the experts say no, ABC Health and Wellbeing, Viewed 28th April, < http://www.abc.net.au/health/thepulse/stories/2014/04/22/3986116.htm > 6. Kelly, Y., et al. 2010, Light drinking during pregnancy: Still no increased risk for socioemotional difficulties or cognitive deficits at 5 years of age? Journal of epidemiology and community health. Volume 66. 41-8. 7. Coles, C., 1994, Critical periods for Prenatal Alcohol Exposure, Alcohol Health & Research World, Vol 18, pp 22-29 8.

Colyer, S., 2017, Mixed messages sent about alcohol in pregnancy, MJA Insight, issue 24/26 June 2017, https:// www.doctorportal.com.au/mjainsight/2017/24/mixed-messages-sent-about-alcohol-in-pregnancy/

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Interagency Coordinating Committee on Fetal Alcohol Spectrum Disorders (ICCFASD), 2011, Recognizing ARND in Primary Health Care of Children Consensus Statement, Maryland, USA, viewed 28th April 2018,

10. May PA., 2001, Estimating the prevalence of fetal alcohol syndrome. A summary, Alcohol Research and Health, Vol 23, pp. 159-167 Images: 1: Lai, J., Pregnant, Flickr, Licensed under the Creative Commons Attribution-ShareAlike 2.0 Generic, viewed 9th May 2018, 2: Vchal, 2017, Drinking alcohol in pregnancy, istockphoto, viewed 28th April 2018, https://www.istockphoto.com/au/ photo/drinking-alcohol-in-pregnancy-pregnant-alcoholic-woman-is-drinking-wine-gm648844874-118267097 3: Zeldovich VB, Bakardjiev AI, 2012, Host Defense and Tolerance: Unique Challenges in the Placenta, Figure 1 PLoS Pathogens, viewed 10 May 2018, 4. NIH/National Institute on Alcohol Abuse and Alcoholism, 2005, Craniofacial features associated with fetal alcohol syndrome. Shared on Wikimedia Commons, viewed 9th May 2018, (Base image used- edited and transcribed by K.Arnold)

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