Key Takeaways:
- Current guidelines recommend that women who are pregnant or those who are trying to become pregnant avoid alcohol.
- There is no safe amount of alcohol use during pregnancy.
- Fetal exposure to high amounts of alcohol is associated with birth defects, stillbirth, premature birth, and fetal alcohol spectrum disorders.
- Alcohol exposure during pregnancy is associated with cognitive delays, cognitive problems, attention deficit, behavioral problems, social issues, and learning disabilities in children.
- Many women drink while pregnant because they didn't know they were pregnant. If you find yourself in this situation, some studies have indicated that exercise, healthy diet, reduced stress, taking daily wellness supplements, and getting quality prenatal care might be able to mitigate these effects.
- Despite the known risks, many women continue to drink while pregnant or while trying to become pregnant. This may be due to cultural attitudes around drinking, studies that have been misinterpreted widely, and long-held beliefs in the past that didn’t equate alcohol with risk to pregnancy.
Trying to get pregnant can be stressful enough, especially if you’re been struggling to conceive. Not only are you and your partner taking a big step in your lives and relationship, but you may find yourselves immersed in a whole new (and stressful) world of tracking cycles, taking pregnancy tests, and worrying about how you’ll pay for diapers and college. It’s no wonder then that the Centers for Disease Control reports that as many as three in four women who want to get pregnant continue to drink alcohol despite CDC recommendations that they stop drinking if they’re trying to get pregnant.
The thought that you might need to renounce your glass of wine with dinner, pass up on the occasional happy hour with friends, or reject date night cocktails—not only while you’re pregnant, but also during the time you and your partner are trying to get in the mood to make a baby can sound downright draconian. According to the American Pregnancy Association only 30 percent of couples will get pregnant during their first cycle of trying, and only 60 percent of couples will get pregnant after about three months of trying. For most couples (80 percent), it will take about six months of trying to get pregnant. And for the other 20 percent, it can take much longer and even require assisted reproductive technology. For the vast majority of couples, trying to have a baby can mean a lot of missed happy hours.
Yet, there are very good reasons to pass up on the glass of wine or cocktail while you’re trying to conceive. For one, it can take anywhere from four to six weeks before you find out you’re pregnant. If you’re been drinking, this is four to six weeks where your unborn baby could have been exposed to alcohol in the womb. Alcohol crosses the placenta, and fetal alcohol levels can reach maternal alcohol levels within 2 hours of your first drink. Fetal metabolism is much slower than that of the mother, and the fetus can have higher levels of blood alcohol concentration than the mother.
According to What to Expect, the whole process of conception, from sex to implantation takes between two and three weeks. Most women don’t take a pregnancy test until their first missed period (and most pregnancy tests are too sensitive to detect pregnancy before the first missed period). At this point, it’s possible you might have been pregnant for weeks. And if you’re drinking, that’s weeks of drinking during pregnancy.
According to the journal Obstetrics and Gynecology, as many as 50% of women continue to consume alcohol during pregnancy, mostly in moderate amounts. Some of these women may have consumed alcohol before they knew they were pregnant, a strong reason to stop drinking if you are trying to conceive. If you drank before you knew you were pregnant, the key is to stop drinking as soon as possible, and to seek prenatal care to assess the risks and take steps to mitigate the impact. As we’ll explore below, some studies have indicated that exercise, reduced stress, healthy diet, daily wellness supplements, and quality prenatal care can potentially mitigate the impact that accidental drinking can have on your pregnancy.
Unfortunately, many women find themselves in the stressful position of having this conversation with their doctors. The CDC reports that as many as three million women drink and have unprotected sex, putting them at risk of exposing their unborn baby to alcohol without intending to do so.
The risks of using alcohol during pregnancy include fetal alcohol spectrum disorders, which can include low birth weight, developmental problems, heart problems, kidney problems, or other organ issues. Babies exposed to alcohol in the womb can suffer brain damage or have low IQ. Others may go on to develop learning disabilities, attention deficit disorder, difficulty communicating in social situations, poor reasoning, and poor judgement. Other complications can include the risk of preterm birth and stillbirth.
Yet, as many as 50% of women may continue to drink during pregnancy, some even after they learn they are pregnant. In order to understand why, we’ll need to delve into cultural beliefs about alcohol use, the history of recommendations regarding alcohol use and pregnancy, and some confusing recent research about alcohol use and pregnancy.
Alcohol Use and Pregnancy: A Brief History of Bad Advice
According to Alcoholism: Clinical and Experimental Research, it wasn’t until the 1970s that the government first started advising women in America to avoid alcohol during pregnancy. In 1973, published reports found a link between drinking during pregnancy and fetal alcohol syndrome, and in 1977, the first public health advisories were issued by the Surgeon General. Yet, the belief that alcohol was safe during pregnancy continued well into the late 1970s, and beyond. In order to understand why, it helps to understand the long history of drinking during pregnancy prevalent in the west, and also to understand the politics of prohibition.
There is a long history of written records detailing the risk of alcohol use and pregnancy, but these warnings were not always heeded. In the late 1600s, inexpensive gin was widely available in England and consumed by pregnant women (and also by the population at large). Back then, much of the water available to drink contained bacteria, and gin had the added benefit of killing potentially deadly bacteria, making gin safer than water, at least when it came to preventing disease. Yet, by 1724, the London College of Physicians had noticed a connection between alcohol consumption during pregnancy and problems with babies, leading the organization to write the following note to the House of Commons: “Spirituous Liquors… (are) too often the cause of weak, feeble, and distempered children who must be instead of an advantage and strength a charge to their country.” Yet entrenched beliefs about alcohol were hard to change.
By the end of the 19th century, several studies indicated that there were risks of using alcohol during pregnancy. In 1899, one study linked alcohol use to higher mortality rates, and another study in 1904 linked alcohol use to structural abnormalities in children. Yet, these studies were used as propaganda to support prohibition. Those arguing for temperance often exaggerated claims about the dangers of alcohol use. These studies and claims were finally rejected wholesale in 1933 to support the repeal of prohibition. By the 1930s widespread belief was that alcohol use during pregnancy was safe. The baby was literally thrown out with the bathwater.
In Europe, things were not much better. According to the Smithsonian, in the 1920s Guinness introduced its “Guinness is good for you” slogan, even recommending Guinness to pregnant women (supported only by the fact that Guinness contains iron). We now know that there are better ways to get iron, prenatal vitamins and spinach being among them.
Yet, by the early 1970s the abundance of studies linking maternal alcohol use to fetal alcohol syndrome and other risks couldn’t be ignored. Early advisories in the late 1970s recommended no more than a two drink a day limit for pregnant women, but the modesty of these early advisories was largely to not alarm women who were already pregnant and drinking. By 1981, the surgeon general would advise women to avoid all alcohol use during pregnancy.
European warnings have lagged far behind the U.S., largely due to entrenched cultural attitudes about drinking. It wasn’t until the early 2000s that France started putting warnings for pregnant women on its drink labels. According the European Journal of Clinical Nutrition, in Italy gynecologists don’t recommend that women avoid alcohol during pregnancy. And until only 2016, women in the United Kingdom were advised not to consume more than “two units” of alcohol a week (National Institute for Health Research). The Royal College of Obstetricians and Gynecologists recommended the avoidance of alcohol during pregnancy, but only in the first trimester, with light drinking permitted in the second and third trimester. The United Kingdom finally revised these recommendations to indicate that no amount of alcohol consumption is safe during pregnancy.
The key takeaway is this: until only very recently, most people believed that drinking was safe during pregnancy. And only until very recently, have European nations started serious campaigns to warn women that no alcohol use is safe during pregnancy. The World Health Organization Europe notes that “statistics show that social drinking among western women during pregnancy is relatively common” and official recommendations about alcohol intake have varied widely for some time.
For women in America who may look to European standards to make their decisions, the observation that European women drink during pregnancy may lead them to believe it is safe. It is not. Yet, entrenched cultural beliefs (“my mother drank when she was pregnant and I turned out fine,” or “an occasional drink won’t hurt anyone”) along with some recent limited studies about alcohol use and pregnancy have led to more confusion. We’ll explore these studies next.
The “Mixed” Research on the Effects of Alcohol Use and Early Pregnancy
The World Health Organization Europe notes that “little is known about the impact of low to moderate (1-4 glasses of alcohol per week) alcohol consumption during pregnancy on children’s later cognitive and socioemotional development.” Studies about moderate alcohol use during pregnancy have produced mixed results, with some studies showing no impact on the fetus and some showing impact. Yet, as we’ll explore, the studies that show “no impact” are often very limited in scope and could be potentially open to significant confounding factors. Given these limitations, the World Health Organization recommends that the safest course is that women abstain from alcohol use during pregnancy.
When evaluating studies about the risks of alcohol use during pregnancy, it is important to keep in mind that different studies may define what “one drink” means differently. According to Clinical Obstetrics and Gynecology, one drink is often defined as a 12 oz beer or wine cooler (5% alcohol), 5 oz of table wine (12% alcohol), 8 to 9 oz malt liquor, 1.5 oz of 40% spirits. But different drinks can have different alcohol percentages, so it is important to take that into account. Studies regarding alcohol use during pregnancy involve self-report, making it particularly difficult for researchers to link drinking to a specific trimester.
Yet, in 2012 and 2013, several studies came out that indicated that moderate drinking during early pregnancy may not have a negative effect on low birth weight, the risk for preeclampsia, and preterm birth. These studies were then picked up by the media and widely cited in the press. Visit NPR around 2012 and you’d find this article: “A Few Drinks While Pregnancy May Be OK.” MSNBC and other media outlets also widely reported on the study using similar language. Yet, doctors and scientists were quick to note that the study only looked at how alcohol affected the IQs of 5-year-olds, and other studies only looked at effects of alcohol on infants, and not children throughout the course of their development. The European Journal of Clinical Nutrition also found no increased risk of preterm birth when women drank moderately during pregnancy. This was an Italian study. Red wine was consumed. And it isn’t clear exactly how much alcohol each woman may have been measuring when making these self-reports. Anyone who has poured herself a glass of wine knows that she isn’t often measuring by the ounce.
Two doctors at the University of Washington critiqued the media response to these studies, noting that many of these studies fail to adequately address the impact that maternal drinking can really have on cognitive and mental development later in life. The researchers noted that a child’s brain at five years old is “not developed enough to perform complex tasks like remembering and following multiple instructions, writing a report, communicating abstract ideas effectively, exercising good judgement” and that alcohol has its greatest impact on complex brain functions. The researchers also noted that the full impact of maternal alcohol use wouldn’t be known until a child reached adolescence, and there are no studies on the long-term impact of maternal alcohol use and adolescent cognition, mood, and development. The researchers at the University of Washington also cited another study that found that 1 out of 7 children diagnosed with FAS involved a mother who drank 1-8 drinks per week, suggesting that even one drink is enough in some cases to get a FAS diagnosis. In other words, mothers who drink might be playing “Russian Roulette” with their child’s future development. Genetics plays a role in development, and metabolism of alcohol also plays a role. In the same research, only 10% of children with FAS had intellectual difficulties by age 5, but by age 10, 60% were found to be affected. 100% of the children with FAS showed severe dysfunctions in language, memory, and activity levels.
Another study published in Obstetrics and Gynecology in 2013 found that women who drank moderately or occasionally didn’t have increased risks for low birth weight, preeclampsia, and preterm birth. Yet, the study only looked at women in the first 15 weeks of pregnancy and didn’t evaluate the association between similar moderate drinking and long-term cognitive outcomes in children. The risk of neurocognitive dysfunction remains one of the strongest reasons why women should avoid moderate alcohol use during early pregnancy.
Other epidemiological studies have produced mixed results when they looked at whether moderate maternal drinking affected pregnancy. Epidemiological studies on groups of British, Australian, and Danish children found that light to moderate drinking showed no change in cognitive development, behavioral issues, attention, and motor function.
Yet, in a fascinating article published in the International Journal of Epidemiology, researchers found a potential confound (or potential flaw) in these results. Researchers noted that affluent women from higher socioeconomic and social statuses may be more likely to drink during pregnancy, and that affluence could potentially skew the results of these studies. Children born to parents from higher socioeconomic and social statuses tend to have higher cognitive outcomes and better test results in a range of measurements. The reasons for this may have to do with lower stress, better nutrition, greater compliance in taking prenatal vitamins, better prenatal care, and access to better educational opportunities. Ultimately, when the issues were accounted for, researchers found that when the IQ of children was tested at 8 years of age, moderate drinking was shown to have a negative effect.
Beliefs about control may play a role in alcohol use and academic performance, and may also play a role in whether women choose to drink during pregnancy. Psychologists refer to beliefs about control as locus of control. People with internal locus of control believe that they can influence their lives by making good choices while people with external locus of control believe that life is controlled by fate, chance, or luck. High internal locus of control is associated with healthy life decisions that include eating healthy food, not smoking, and following medical advice. Internal locus of control is also associated with higher socioeconomic status and higher academic achievement. According to an article published in Frontiers in Psychology, high internal locus of control was associated with higher achievement in math and science. Furthermore, the researchers found that parental internal locus of control was associated with higher-achieving children.
You would think that higher locus of control would also mean that individuals would be less likely to drink moderately or regularly, but a fascinating Dutch study by the IZA Institute of Labor Economics found that higher internal locus of control was actually associated with moderate, regular drinking, and binge drinking. While heavy drinking is generally associated with negative health and economic outcomes, moderate drinking is also not generally associated with serious health consequences.
Why would people with higher internal locus of control be more likely to drink (moderately)? Dutch researchers believe that these individuals may be more socially connected and more likely to participate in social and cultural events where drinking takes place. They also may be more able to afford regular drinking. Individuals with high locus of control may place a lower emphasis on risk and higher emphasis on their own ability to cope with the negative outcomes of their behavior. Studies have found that people with internal locus of control tend to believe they have a lower risk of having a heart attack, getting cancer, getting AIDS, or underestimate their chances of having a drinking problem.
Finally, people with a high locus of control can still be influenced by peers. So, if your friends think drinking moderately during pregnancy is safe, then you might be more likely to engage in the behavior. This is why dispelling myths around drinking and pregnancy is so important.
In fact, studies indicate that women who drink moderately may be skewing the results of epidemiological assessments about pregnancy and alcohol use because these women may also be more likely to exercise, eat healthy food, and take multivitamins. Another study published in the Annals of Epidemiology, found that women who exercise, work, and take multivitamins were also more likely to report drinking in the first month of pregnancy. Researchers found no link between moderate alcohol use and low birth weight, preterm birth, or congenital malformations. However, the researchers noted that the lower odds for these women may have had more to do with their exercise, healthy lifestyle, and taking multivitamins. The study also didn’t evaluate whether moderate drinking had an effect on cognition.
In other words, women who drink occasionally in early pregnancy may be able to counter the negative effects by taking multivitamins, eating healthy food, reducing stress, and exercising. But then again, for women looking to give their children the best possible start, not drinking during pregnancy is shown time and time again to be the best course of action.
Drinking and Infertility, ART, IVF, and IUI
According to Clinical Obstetrics and Gynecology, women who chronically abuse alcohol have reduced fertility. Heavy alcohol use is associated with diminished ovarian reserve. While there’s no link between moderate alcohol use and reduced fertility, if you are at risk of infertility, or are older and trying to get pregnant, stopping drinking while trying to get pregnant appears to have the added benefit of increasing your chances of success with assisted reproductive technology (ART). These benefits also apply to men, too. Long-term heavy alcohol use in men is associated with testicular atrophy, decreased testosterone, and lower sperm production. Intoxication is also associated with erectile dysfunction, ejaculation dysfunction, and issues with arousal and desire in men. All of this is to say that if you’ve been having trouble conceiving, quitting drinking might be able to increase your chances of getting pregnant. A study published in Fertility and Sterility linked resveratrol, which is found in red wine, with increased fertility, but you can also find resveratrol in cranberries, dark chocolate, peanuts, pistachios, grapes, and blueberries, or by taking a daily wellness supplement that contains it.
Drinking can also affect your hormones, which can affect your ability to get pregnant. According to the American Diabetes Association, lifestyle changes which can include reducing alcohol intake are considered first-line treatments for polycystic ovary syndrome, a condition which can impact fertility.
Quitting drinking before IVF could potentially increase your chances of success. According to the journal, Obstetrics and Gynecology, couples where both partners consumed more than 4 drinks per week were shown to have 20% worse odds of giving birth to a live baby. Even one drink a day was associated with 13% fewer eggs retrieved. So, while it is unclear which mechanism alcohol may be affecting to result in these lower success rates, the research consistently shows that drinking can impact IVF success. Researchers speculate that alcohol may affect hormonal levels or may affect the way certain reproductive hormones are cleared by the liver.
So, if you and your partner are investing in expensive assisted reproductive technology procedures like IVF, there is a great deal of evidence to show that even moderate drinking can reduce your chances of success. Even just one drink a day can increase the risk of fertilization failure with IVF. Women who plan to undergo IVF or ART may want to stop drinking at least a month before their first treatment cycle. Research has also found that when men drink in the week before sperm retrieval, this can also affect the success of IVF. Male partners are encouraged to avoid drinking at least the week before sperm retrieval.
Key Takeaways
The American College of Obstetricians and Gynecologists notes that there is no safe amount of alcohol use during pregnancy. The organization notes that even one drink can cause problems including birth defects, coordination problems, attention deficit, behavioral problems, and learning disabilities. While more research needs to be done on moderate drinking and pregnancy, women are wise to assume that there may be a risk, given the available research. The truth is that we still need to do a lot more research to better understand the cognitive effects of maternal drinking on babies and the children they become. We live in a culture where fine-grained cognitive abilities are important and confer significant advantages in society. Only recently have we gained the tools to make these assessments, and when we take these tools into account, early indications suggest that even moderate alcohol use can have negative cognitive effects on the fetus and on children. Basically, if you want to give your child the best possible start, the research points to taking multivitamins, eating healthy foods, exercising, and not drinking at all while trying to conceive, and during pregnancy.