There are many common questions about alcohol when trying to conceive, during pregnancy, and breastfeeding. Does drinking alcohol make it more challenging to get pregnant? Can you drink any alcohol during your pregnancy? Does it affect your baby? How much is okay? Can you pump and dump if you drink while breastfeeding? Doctors and midwives usually give you one of two answers. You hear, absolutely no alcohol, in any quantity. Or they may tell you it’s okay to enjoy a glass of wine from time to time with a meal. You already know that drinking high amounts of alcohol is a bad idea. What about an occasional drink? This article will examine the evidence on everything from the party night you had before you realized you were pregnant, enjoying a drink or two during pregnancy, and why you may not need to pump and dump if you drink while breastfeeding.
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How Your Body Processes Alcohol
Alcoholic drinks contain ethanol, produced by fermenting grains, fruits, or other sources of sugar. When you drink alcohol, it is absorbed through your stomach and small intestines and enters your bloodstream. Once in your bloodstream, it goes everywhere to your heart, brain, muscles, and other tissues. If you are pregnant, it is also going to your placenta, which it crosses to pass to your baby through the umbilical cord. If you enjoy a beer or a glass of wine, your baby does too. Keep reading; this is not a lecture on the dangers of drinking. This article will examine the evidence on everything from the party night you had before you realized you were pregnant, enjoying a drink or two during pregnancy, and why you may not need to pump and dump if you drink when you are breastfeeding.
Before we dive into the evidence on alcohol, we have to cover binge drinking quickly. Alcohol is a toxin and a powerful one in high quantities. I don’t have to tell you that consuming a lot of alcohol or binge drinking is off-limits when you are pregnant.
A whole range of problems known as fetal alcohol spectrum disorders can include a long list of issues. FASD includes abnormal facial features, small head size, shorter-than-average height, low body weight, poor coordination, hyperactive behavior, difficulty with attention, poor memory, learning disabilities, speech and language delays, intellectual disability or low IQ, poor reasoning and judgment skills, sleep and sucking problems as a baby, vision or hearing problems, and problems with the heart, kidney, or bones. Some of these issues carry on well into the adult life of your baby. This article does not scrutinize the research on high alcohol consumption. There are a lot of studies that will all tell you what you already know, which is consuming high amounts of alcohol when you are pregnant is a terrible idea.
Experts estimate that the full range of fetal alcohol spectrum disorders in the United States and some Western European countries might number as high as 1% to 5% of the population. If you have difficulty quitting drinking, please talk to your doctor or midwife about getting help. You can also visit the Alcoholics Anonymous website or call the Substance Abuse and Mental Health Services Administration’s treatment referral line at (800)622-HELP (4357).
Measuring and Comparing Different Types of Alcohol
All alcoholic drinks are not equal. You cannot compare any glass of wine to any beer or cocktail. You need to look at the alcohol content and the size of the drink. If a bartender makes you a drink, you aren’t going to know precisely how much alcohol it contains. Beer can range from 3% alcohol up to 10% or more. Wine usually ranges from 12-14%. Hard liquor is the highest, at 35-40%, although most people mix liquor with other non-alcoholic ingredients.
In the United States, one drink typically contains about 14 grams of pure alcohol. This is about the amount in 12 ounces of regular beer (5% alcohol), 5 ounces of wine (12% alcohol), or 1.5 ounces of distilled spirits (40% alcohol).
In the U.K., alcohol is measured, at least in research, by units. A unit of alcohol is 10 milliliters or 8 grams of pure alcohol. A standard drink will have between 1-3 units of alcohol. To calculate the units of alcohol in a drink, you multiply the drink volume (in ml) by the ABV (alcohol beverage volume) or percentage of alcohol, then divide the result by 1,000. For a quick reference, a standard bottle of wine is 750 ml. If the wine is 13.5% alcohol, the whole bottle is just over ten units.
((volume in milliliters)(ABV or % of alcohol))/1000 = units of alcohol
The units of alcohol in the U.K. make it much easier to compare one alcoholic drink to another. In the U.S., comparing a 5-ounce glass of 12% wine and a pint of beer with 5.5% alcohol is more challenging. When you add cocktails to the mix, it can be even more confusing. Factors like size and weight or whether you are having a drink with a meal or on an empty stomach will impact how your body metabolizes alcohol. If you decide to enjoy a drink, you must use your judgment and common sense. You can always choose to err on the side of caution and abstain from alcohol.
The Official Opinions on Alcohol During Pregnancy
All major medical organizations advise against alcohol in any amount. The Centers for Disease Control and Prevention state there is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time for alcohol use during pregnancy. All types of alcohol are equally harmful, including all wines and beer.
According to the American Academy of Pediatrics, prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. The Academy states that during pregnancy, no amount of alcohol intake should be considered safe; there is no safe trimester to drink alcohol; all forms of alcohol, such as beer, wine, and liquor, pose a similar risk; and binge drinking poses a dose-related risk to the developing fetus.
The American College of Obstetricians and Gynecologists strongly advises against any amount of alcohol during pregnancy and states that there is no safe amount or type of alcohol use during pregnancy. These organizations are adamantly against alcohol consumption during pregnancy because alcohol-related birth defects are entirely preventable.
Alcohol and Trying to Conceive
In recent years organizations like the CDC and ACOG have updated their recommendation to advise against alcohol consumption for anyone trying to become pregnant. If you are trying to conceive and not pregnant yet, there are a few studies worth mentioning about alcohol consumption and trying to conceive.
A study of 7,700 women found that alcohol consumption was associated with infertility in women over 30 when they drank more than seven drinks per week. The researchers did not find the same correlation in younger women.
A study of 668 couples found no association between difficulty getting pregnant and alcohol consumption. The participants in this study consulted a physician for difficulty conceiving. Of course, you hear this a lot; more studies are needed to adequately determine the effects of alcohol consumption on fertility.
One review evaluated studies on whether alcohol consumption affects male reproductive function. They found that alcohol consumption is associated with a deterioration of sperm parameters which may be partially reversible upon alcohol consumption discontinuation. I will note that they did not find an association between alcohol consumption and fertility, just that there were abnormalities in the sperm.
If you are trying to get pregnant, the healthier you and your partner are, the better. Drinking alcohol, especially heavy drinking, is not optimal for your health. That said, I did not find research showing low to moderate drinking significantly impacted fertility.
Drinking Alcohol Before You Find Out You Are Pregnant
Many expecting moms ask, “I went out and had a party night or a couple of party nights before I knew I was pregnant. Is my baby going to be okay?” As soon as you know or suspect you are pregnant, you must watch your alcohol consumption. There is no sense in stressing out over the party night you had before you realized you were pregnant. Many women have been in that same situation and had perfectly healthy babies. There is no point in stressing out about the past. All you can do is make sure you are mindful of alcohol moving forward.
Even the American College of Obstetricians and Gynecologists acknowledges serious harm is unlikely if you drank before you knew you were pregnant. The most important thing is to stop drinking alcohol when you find out you are pregnant.
Occasional Alcohol During Pregnancy
We covered binge drinking, obviously a bad idea, alcohol consumption when trying to conceive, and drinking before you knew you were pregnant. Next, let’s examine the evidence on whether an occasional drink is safe during pregnancy.
Talking to Your Doctor or Midwife
Please ask your doctor or midwife about their recommendation for alcohol during pregnancy. They are your trusted partner during pregnancy, and their professional opinion carries considerable weight. Most care providers make their guidance on alcohol consumption a black-and-white issue and recommend you abstain from alcohol entirely. This is the easiest, safest, and most common answer. Perhaps this is what you have heard from your doctor or midwife. Or your care provider may have told you to go ahead and enjoy an occasional glass of wine. Their priority is your health and the health of your baby. Chances are they are going to play it safe.
I had one care provider tell me absolutely no alcohol in any amount. Then another told me it was okay to have a drink here and there. Getting mixed messages makes this issue even more confusing. Hopefully, diving into the research will make this an easier decision for you.
The Research on Alcohol and Pregnancy
All of the studies discussed below focus on low to moderate alcohol consumption. The terms low or moderate alcohol consumption are not universally defined. Generally, we are talking about a drink or a few drinks per week. To clarify, a few drinks per week on different days of the week, not all at once.
A review by the University of Oxford looked at 46 studies on low to moderate alcohol consumption and the outcomes of miscarriage, stillbirth, intrauterine growth restriction, prematurity, birth weight, small for gestational age at birth, and birth defects, including fetal alcohol syndrome. This review was in the U.K., and the researchers defined low to moderate levels of alcohol as up to 10.4 units of alcohol. Using the example earlier, a 750 ml bottle of wine at 13.5% alcohol is just over ten units. This study considered low to moderate drinking as about a bottle of wine or less per week. The researchers found no convincing evidence of adverse effects of prenatal alcohol exposure at low-moderate exposure levels. However, there were some weaknesses in the evidence, and they did not come out and say that drinking at these levels during pregnancy is safe.
A study of almost 4,500 women looked at low to moderate alcohol consumption during the first and third trimesters. This study found that many women reported some alcohol consumption during their pregnancy. 29% consumed alcohol during the first month. Many people in this group likely did not know they were pregnant. This dropped to 9% in the second and 7% in the third months. Women in their first trimester had about one drink per week. In month 7, 11% of women in this study had some exposure to alcohol, increasing to 29% over the course of the entire third trimester.
A big takeaway from this study is that although care providers often tell expecting moms to abstain from alcohol completely, many pregnant women enjoy a drink here and there. The results of this study suggest that low-to-moderate alcohol exposure during early and late gestation is not associated with an increased risk of low birth weight, preterm delivery, intrauterine growth restriction, and most selected perinatal outcomes. The researchers noted that second-trimester exposure was not assessed but is unlikely to have deviated in a meaningful way from the first and third-trimester assessments. This study relied on participants reporting their alcohol consumption. This was not measured precisely and isn’t the most accurate way to collect data.
A meta-analysis of 34 studies examined alcohol consumption during pregnancy and child neurodevelopment. This included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The overall conclusion was the results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant.
Summarizing the Research
Many studies on this topic have a lot of data to analyze. Overall there are recurring themes in the studies we covered and others on this topic. Low to moderate alcohol consumption does not appear to be associated with adverse outcomes. “Low to moderate” isn’t universally defined and usually refers to one to five drinks per week, not all on the same night. There is no amount of alcohol that is proven to be safe during pregnancy. The safest course of action is to abstain from alcohol.
You should ask your doctor or midwife for their recommendation. They can also be a resource for more information or to answer your questions.
Alcohol and Breastfeeding
If you enjoyed wine or alcohol before you got pregnant, you might be looking forward to enjoying a glass after pregnancy. Many moms are disappointed to learn that you can transfer alcohol to your baby in breast milk. There is nuance to drinking alcohol and breastfeeding; it is not 100% off-limits.
Alcohol in your breast milk follows your blood alcohol level. When breastfeeding, you can enjoy a drink, and you do not have to pump and dump. You only need to be mindful about when you are consuming alcohol and when you feed your baby. Pumping and disposing of the milk does not remove alcohol from your system. You may want to pump and dump if your breasts are uncomfortably full.
According to ACOG, if you want to have an occasional alcoholic drink, wait at least 2 hours after a single drink before you breastfeed. The alcohol will leave your milk as it leaves your bloodstream—there is no need to express and discard your milk. Drinking more than two drinks per day regularly may be harmful to your baby and may cause drowsiness, weakness, and abnormal weight gain.
See this Kelly Mom article for more in-depth information on alcohol and breastfeeding.
Navigating Social Situations
There are a few scenarios you may run into with social situations that can be challenging to navigate. Let’s look at a few scenarios and some ideas to handle them.
You may be early in your pregnancy and not ready to announce the news. This can be tricky if you have an event, like a wedding or other celebration, where your friends will be drinking. If you don’t drink, people may speculate that you are pregnant.
Don’t feel obligated to tell people you are pregnant if you are not ready. If you think you need to fake that you are drinking to keep your cover, fake it. Most people will focusing other things and will not even notice if you aren’t drinking. There can be a lot of social pressure to join the party and have drinks with your friends. You could always say you are the designated driver for the night or hang out with a glass of club soda on the rocks with a lemon wedge. You can tell your friends you are on a 30-day no-drinking cleanse. Whatever you need to do to feel comfortable in your social circles.
Another scenario is that you might be feeling left out. There are some great alternatives to drinking if you are hanging out with friends who are having alcoholic beverages and you are not. Go for something like a ginger beer that doesn’t have alcohol or a sparkling soda. Mocktails are delicious and are just like a cocktail but without alcohol. If you miss your Friday happy hour mules or margaritas, make a virgin one.
You may be adjusting to changes in your social circles since you found out you are pregnant. It can be strange when you are used to wine night every Thursday, and now you are the designated driver whenever you hang out with your friends. Giving up things, like wine, for a short time is all so worth it. The time you are pregnant will be over before you know it. If you are having a tough time dealing with changes in your social life, which may be happening even if your group of friends does not drink, hang in there.
The Bottom Line
I want to remain neutral, and I will not tell you a drink is perfectly okay. On the same note, I will not judge you for it, nor should anyone else. If you don’t already know what your doctor or midwife thinks about it, ask for their recommendation. You have read through a lot of information in this article. It is your call. If you are comfortable enjoying a glass of wine with dinner or mimosa with brunch, you certainly can do that. If you feel better not drinking at all, you can also abstain. Ultimately it is up to you.
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