Armed with a long list of “no nos,” from crunchy crab rolls to Pinot Noir, it’s normal for pregnant women to feel like they’re suddenly deprived of many of their favorite things. Not to mention, pregnancy can be a time when a healthy pour would be most appreciated, especially if you feel like you’re in a constant state of PMS. But some women enjoy the occasional pint of Guinness or sip(s) of wine. You may have a friend who indulged in a few glasses throughout pregnancy and delivered a healthy baby. But when you ask your waiter for the wine list, she (along with the couple at the next table) stare at you like you’re the craziest and most irresponsible person on the planet.
There’s undoubtedly an enormous amount of pressure on women to do everything perfectly during their pregnancy. However, on the other end of the spectrum, there can be pressure from friends or the media to take a more “chill” or less paranoid approach to things like drinking.
Damned if you do — damned if you don’t, huh? Damn. So, can you actually have that glass of wine during pregnancy? Since this week is Alcohol and Other Drug-Related Birth Defects Week (and because we just really want an answer to this question), we investigated these two schools of thought by consulting an expert to help you make the best decision for you.
Remind me: Why is booze on the ‘no no’ list again?
“Drinking alcohol while pregnant causes a spectrum of abnormalities, referred to as fetal alcohol syndrome, which can vary in severity,” explains Dr. Kristin Daniel, an OB-GYN at Women Obstetrics & Gynecology in Nashville. “Infants with fetal alcohol syndrome may have small eye openings, a smooth philtrum (the vertical groove between the base of the nose and upper lip), a thin upper lip, a small head size, a short stature, or low body weight.”
In addition to these physical features, Daniel says that poor coordination, late achievement of developmental milestones, poor vision or hearing, behavioral issues, and low intelligence are also symptoms of fetal alcohol syndrome. But again, it’s important to remember that fetal alcohol syndrome occurs on a spectrum, as Daniel notes. While some babies may not show physical signs (like a thin upper lip), they may meet criteria for fetal alcohol syndrome diagnosis based on neurological delay or behavior problems. “All of this is preventable by not consuming alcohol during pregnancy,” adds Daniel.
Here’s another way of thinking about all this: alcohol is a known depressant — it’s a “downer” rather than an “upper.” So, it makes some sense that when a pregnant person drinks, the infant might have a similar, “slowed down” experience which impacts their development.
But how does this actually happen in the body?
According to Daniel, all birth defects (fetal alcohol syndrome is classified as a birth defect) are caused by chemicals that can cross the placenta, including alcohol. (Quick anatomy refresh: The placenta is a temporary organ that is attached to the mother’s uterine wall and the fetus’ umbilical cord. It transfers oxygen and nutrients from the mother’s body to the fetus via the umbilical cord, and permits the release of carbon dioxide and waste products from the fetus.) In other words, if a mother consumes alcohol, it then get transferred to her baby via the placenta.
“The developing fetal brain appears to be especially sensitive to alcohol — it interrupts nearly all of the processes involved in development and practically all central nervous system functions are compromised,” says Daniel. “In addition, a baby’s liver cannot detox the alcohol like the adult liver, so the fetus ends up being exposed to higher amounts of alcohol long after the mother’s blood alcohol level has decreased or resolved completely.” (AKA a fetus’ hangover lasts way longer than yours.)
But can just a single glass or sip really cause it?
While there’s plenty of research on fetal alcohol syndrome and the medical community is confident that a mother’s consumption of alcohol is the culprit, there’s one factor they unfortunately haven’t quite quite figured out yet: dosage.
“There are reports of fetal alcohol syndrome in women who had only had a few drinks their entire pregnancy and infants born to chronic alcoholics,” says Daniel. “No one has been able to pinpoint the amount of alcohol or the most dangerous time of pregnancy to ingest it, but it is the combination of amount, frequency, and possibly the time during pregnancy when consumed.”
Here’s what The American College of Gynecologists and Obstetricians (ACOG) has to say about this: “Fetal alcohol syndrome is most likely to occur in babies born to women who drink heavily throughout pregnancy. But alcohol-related problems can occur with lesser amounts of alcohol use. It is best not to drink at all while you are pregnant.” This is why ACOG and other leading health organizations like The Mayo Clinic say that no amount of alcohol is deemed safe for pregnant women.
Is there any research suggesting limited drinking may be OK?
This 2012 Danish study published in the International Journal of Obstetrics and Gynecology, for example, observed 1628 women who reported low to moderate alcohol consumption during pregnancy and their five-year-old children. The researchers write, “This study did not observe significant effects of low to moderate alcohol consumption during pregnancy on executive functioning at the age of 5 years.”
Another 2013 study observed 5,628 women who were pregnant for the first time between 2004 and 2011, with a goal of determining how dosage and frequency impacts birth outcomes during the first 15 weeks of pregnancy. Researchers defined intake as “occasional” (1–2 units per week), “low” (3–7 units per week), “moderate” (8–14 units per week), “heavy” (greater than 14 units per week), and “binge” (6 or more alcohol units in one session).
19 percent of women reported occasional alcohol consumption, 25 percent low, 11 percent moderate, and five percent heavy. 23 reported a binge.
Here’s what they discovered: Participants who consumed occasional to heavy amounts of alcohol in early pregnancy did not have altered odds of their infant being born preterm, at a smaller size, or at a low birth weight (all of which can be signs of fetal alcohol syndrome). Those who binge drank did not have altered odds of these adverse outcomes, either.
This Harvard Health article, which summarizes the findings of the study, notes, “While not drinking any alcohol during pregnancy is the safest choice, small amounts of alcohol early in pregnancy may be less risky to the mother’s health and the health of their baby than previously believed.” However, the article points out that it’s still not totally clear how much alcohol it takes to cause problems — more research is needed (again, it comes back to the whole issue of dosage). Therefore, the best advice is to avoid alcohol.
We should add that it’s tough (and in some cases unethical) to run randomized control trials (RCTs) on topics like pregnancy and birth. We have a hunch that few pregnant women would want to risk being randomly assigned to the test group that’s asked to drink multiple glasses of wine a day, in order ultimately determine if this amount is the dosage that causes fetal alcohol syndrome. “Ethically, we cannot study these things in pregnant women, so will never be able to nail this down,” adds Daniel.
Um...but what if I find out I’m pregnant right after a weekend of drinking?
Great question. After all, most women don’t find out they are pregnant until they are four to six weeks along — it’s understandable that alcohol may be consumed during this time frame. In this case, the previously cited studies should be reassuring.
Daniel also adds that this frequently happens with patients in her practice. “By far, these babies all turn out to be fine, assuming the drinking stops there,” she says. “I reassure my patients that the drinking they did before they knew they were pregnant is unlikely to have caused any harm.” However, if you are actively trying to conceive, Daniel recommends not drinking to avoid this scenario and stress all together.
So does this mean it’s likely OK for me to just have that one glass of rosé?
Maybe — but maybe not. Here’s how Daniel puts it to her patients: “If your one, two, or however many glasses of wine in this pregnancy were to be blamed for your child’s physical and developmental defects, would you be able to live with that? Conversely, if you did not consume any alcohol or drugs in this pregnancy, then you know there is nothing that you did to put your child at risk. For most of us, alcohol is a small thing to give up a few months for our child's future welfare. But for some, it is more difficult.”
We wish we could give you a clear “yes” or “no,” but ultimately this is a call that can only be made by you. So, before you reach for the corkscrew, chat with your provider, review the previously cited links from ACOG, and consider answering Daniel’s question for yourself.