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Alcohol is one of the very first things to go once you see that positive pregnancy test. Trying to figure out guidelines for alcohol and pregnancy can be so confusing. Can you drink any alcohol during your pregnancy? Does it affect your baby? How much is okay? These are questions you may have asked your doctor or midwife and you usually get one of two answers. You hear, absolutely no alcohol, in any quantity, or, 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 episode is going to get into all of the details on alcohol and pregnancy, how it affects your baby, and what the research says about drinking when you are pregnant.

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How Your Body Processes Alcohol

Alcohol enters your blood stream once it is absorbed through your stomach and small intestines. Once it is in your blood stream 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. This means it gets passed to your baby through the umbilical cord. So yes, if you enjoy a beer or a glass of wine, your baby does too. Don’t fret yet, because we will get into drinking in moderation and whether a drink or two is okay, this is not a lecture on don’t drink or it will harm your baby.

Binge Drinking

I will not spend a lot of time on this but just to get it out there and out of the way, binge drinking, which is usually defined as 5 or more drinks or consumption of a lot of alcohol is a huge no-no.  I don’t have to tell you that. It is really common sense and you already know this.

Alcohol is a toxin, and a powerful one in high quantities. There is a whole range of problems known as fetal alcohol spectrum disorders that can include a long list of issues including; 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. I am not going to get into the research on high consumption of alcohol. There are a lot of studies out there and they will all tell you what you already know, which is consuming high amounts of alcohol when you are pregnant is a bad idea.

The Official Opinions on Alcohol During Pregnancy

Most major organizations advise against any alcohol in any amount. The Centers for Disease Control and Prevention state there is no known safe amount of alcohol to drink while pregnant.

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 similar risk; and binge drinking poses 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.

Alcohol and Trying to Conceive

If you are trying to conceive and not pregnant yet, first off kudos to you for getting a head start on learning about this stuff. There are a few studies worth mentioning about alcohol consumption and trying to conceive. A Danish study of 7,700 women found that alcohol consumption was associated with infertility in women over 30 when they drank more than 7 drinks per week. The researchers did not find the same correlation in younger women. Almost anyone in their 30s will tell you that do not bounce back quite as well after drinking, as they did in their 20s.

A Spanish study of 668 couples found no association between difficulty getting pregnant and alcohol consumption and this was measured by couples who consulted a physician for difficulty conceiving. More studies are needed to adequately determine the effects of alcohol consumption on fertility.

Also worth mentioning, is a review that evaluated studies on whether alcohol consumption effects 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. This is common sense right? Binge drinking and tying one on are probably not going to help with your health. With that being said, I did not find research showing low to moderate drinking had a major impact on fertility.

Drinking Alcohol Before You Find Out You Are Pregnant

A big question many expecting moms ask is, “I went out and had a party night, or a couple party nights, before I knew I was pregnant and I was drinking.  Is my baby going to be okay?” As soon as you know or suspect that you are pregnant, you need to be watching your alcohol consumption. There is no sense is stressing out over the party night you had before you realized you were pregnant. A lot of women have been in that same situation and went on to have 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.

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 your pregnancy and their professional opinion carries a lot of weight.

Most care providers make their recommendation on alcohol consumption a black and white issue and recommend you abstain from alcohol entirely. This is the easiest, safest, and probably the most common answer. Perhaps this is what you have heard from your doctor or midwife. Or your care provider may have told you, go ahead and enjoy a glass of wine. Obviously, 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 tell me it was okay to have a drink here and there. Getting mixed messages makes this issue even more confusing. Hopefully, by diving into some of the research, it will be an easier decision for you.

Measuring and Comparing Different Types of Alcohol

All alcoholic drinks are not equal. You cannot compare any glass of wine, to any beer, or to any cocktail.  You need to be looking at the alcohol content and the size of the drink. If you are out and a bartender makes you a drink, you aren’t going to know exactly how much is in there.  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 that is usually mixed in with other non-alcoholic ingredients. I don’t imagine anyone who is pregnant is doing shots.

In the U.K. alcohol is measured, at least in research, by units. If you don’t live in the U.K., or haven’t read through a ton of research from the U.K. on this topic, you are probably wondering what a unit of alcohol is. 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 volume of the drink (in ml) by the ABV or percentage of alcohol, then divide the result by 1,000. For a quick reference, a normal size bottle of wine is 750 ml, if the wine is 13.5% alcohol; the whole bottle is just over 10 units.

((volume in milliliters)(ABV or % of alcohol))/1000 = units of alcohol

I like the units of alcohol put in place in the U.K. because it makes 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 that has 5.5% alcohol is a little bit more of a challenge. When you add cocktails to the mix it can be even more confusing. If you do decide to enjoy a drink, you have to use your judgment and common sense. Also your size and weight, whether you are having a drink with a meal or on an empty stomach is all going to impact how your body metabolizes alcohol and it will be different for everyone. There really is a grey area on what is considered low to moderate alcohol consumption. You can always choose to err on the side of caution.

The Research on Alcohol and Pregnancy

All of the studies discussed from this point on are focused on low to moderate alcohol consumption. We are talking about a drink, or a few drinks a week. To clarify, a few drinks on different days, not all at once.

A review done by the University of Oxford looked at 46 different 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 done in the U.K. and considered low to moderate levels of alcohol as up to 10.4 units of alcohol. Using the example we discussed, terms of this study they considered low to moderate drinking as about a bottle of wine or less, per week. The review concluded that no convincing evidence of adverse effects of prenatal alcohol exposure at low-moderate levels of exposure were found. 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 trimester. This study found that a lot of women reported some alcohol consumption during their pregnancy. 29% consumed alcohol during the first month. It is likely many people in this group did not know they were pregnant in month one. This dropped to 9% in the second month, and 7% in the third month. The median was that women in their first trimester had about 1 drink per week. In month 7, 11% of women in this study had some exposure to alcohol, and increasing to 29% over the course of the entire third trimester.

A big takeaway from this study is even though expecting moms are often told by care providers to abstain from alcohol completely, a good number of pregnant women do enjoy a drink here and there. The results of this study suggest low-to-moderate alcohol exposure during early and late gestation is not associated with increased risk of low birthweight, 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 isn’t the most accurate way to collect data because it isn’t measured exactly.

A meta analysis of 34 different studies looked at alcohol consumption during pregnancy and child neurodevelopment. This included things like academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The overall conclusion 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.

I am going to stop here. I could literally be sifting through data and studies for weeks on this topic. There is a lot of research out there. Low to moderate alcohol consumption does not appear to be associated with adverse outcomes. Keep in mind this is just from the research I have seen and we are talking about one to five drinks per week, not all in the same night. Unfortunately, “Low to moderate” isn’t universally or clearly defined. Staying healthy during your pregnancy is obviously a priority. Best-case scenario is probably that you abstain from alcohol, that would be the safest thing to do.

One thing I was hoping to find included in at least one study was the mention of a possible benefit of relaxing with an alcoholic beverage. Unfortunately, I did not find any study that addressed this. If you do see that as a benefit, it could be one thing to weigh against the potential harmful effects of consuming alcohol.

The Bottom Line

I want to remain neutral here. I’m not going to tell you to having a drink is perfectly okay. I am not going to judge you for enjoying a drink either, and neither should anyone else. You know what your doctor or midwife thinks about it, if you don’t, ask them what their recommendation is. 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 a mimosa with brunch you certainly can do that. If you feel better not drinking at all you can do that. Ultimately it is up to you.

Navigating Social Situations

A couple things I want to add about social drinking and how to handle some different scenarios. The first is, what if you are not ready to tell you friends that you are pregnant? But, you have that wedding or party to attend and everyone will know you are pregnant if you don’t drink. If you are not ready to tell people that you are pregnant, don’t.

If you think you need to fake that you are drinking to keep your cover, then 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 just say you are the designated driver for the night or hang out with a glass of club soda on the rocks with lemon wedge in it. 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 the alcohol. If you are missing your Friday happy hour mules or margaritas, make a virgin one.

You may be adjusting to some changes in your social circles since you found out you are pregnant. I have been there and I feel you. It can be strange when you are used to wine night every Thursday and suddenly you are the designated driver every time 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 is going to be over before you know it.  If you are having a tough time dealing with some changes in your social life, which may be happening even if your group of friends does not drink, hang in there. This is such a major adjustment period for you and it can be challenging at times.

 

Thank you to Zahler for their support of this episode.

Zahler makes a high quality prenatal vitamin that has the active form of folate plus omega 3s and DHA. This is my favorite prenatal vitamin, the one I take everyday and the one I recommend to all expecting moms. Zahler is offering an exclusive discount to listeners of the Pregnancy Podcast. To check out the vitamin and find out how you can save 40% in the month of August 2019 when you buy a one month supply on Amazon click this link Zahler Prenatal + DHA.

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