Pregnancy is often presented in culture and society as a wondrous time for giving new life, but as most new parents know, the reality involves a huge amount of stress, anxiety and worry about, well, pretty much everything. Nothing is a source of greater terror than worrying if you actions are impacting your baby, especially when it comes to drugs such as caffeine, medications and … you guessed it, alcohol. Drinking during pregnancy is highly politicised, and messages can seem mixed, so it’s easy to see how confusion and fear can take hold. With 13% of women continuing to consume some alcohol during pregnancy, what’s the lowdown on its impact? We answer some common questions below.

How does alcohol affect my baby?

Whilst your baby is growing it receives nutrients from the mother’s bloodstream via the placenta. Unfortunately this life giving process also transfers consumed alcohol from mother to baby. In adults alcohol can be detoxified and processed in the liver, but in the early stages of pregnancy the underdeveloped liver in a foetus can struggle to break it down, allowing toxic effects on the heart, eyes, brain and other tissues, as well as slowing growth. Excess alcohol intake can increase the risk of miscarriage, stillbirth, very low birth weight, sudden infant death syndrome (SIDS) and premature birth.

What is Foetal Alcohol Syndrome?

Whilst research into the impact of very low level alcohol consumption in expectant mothers is inconclusive, there is no debate about the danger of regular heavy and binge drinking throughout pregnancy (as well as in general). This can lead to the very serious foetal alcohol syndrome (FAS) – one of a group of “foetal alcohol spectrum disorders”, which also includes alcohol related birth defects and neurodevelopmental disorders. Foetal alcohol syndrome can cause facial abnormalities such as small eye openings, stunted growth and learning or behavioural difficulties including low IQ.

Not all women who drink heavily in pregnancy have children with FAS. Genetics, general health, diet, stress, age and smoking status can all have an impact on risk.

What are the Guidelines, and should I go tee-total during pregnancy?

It is unknown exactly how much alcohol is safe in pregnancy. Whilst historically a very small amount of alcohol has been overlooked, recent guidelines suggest that it is safest to cut out alcohol completely. This guidance is based on limiting any risk whilst investigations continue, as well as providing clear advice that is simple to follow. Unfortunately this can lead to unnecessary panic about accidental alcohol intake or an occasional small glass of wine or cider. Whilst seriously limiting your alcohol is most definitely advisable, there is no evidence that one or two units (about one small glass of wine) a few times a month has any noticeable impact on your child’s health.

How much alcohol can impact my baby?

The NHS suggests that drinking more than two units of alcohol a week (the equivalent of around one pint) can be a risk factor for miscarriage, though it’s important to note that drinking two mugs of instant coffee a day is also classed as an equivalent risk. Unfortunately definitive evidence is lacking and there is likely to be variation between women as to how much can be tolerated.

Recent headlines have focused on research showing that low level alcohol consumption (no more than 7 units a week) during pregnancy can cause subtle changes to facial features, including a slightly shorter and upturned nose, in one year old children of drinkers vs tee-totalers. These effects  are extremely mild, may not be lasting and had no discernible impact on brain development, but do indicate that even low level drinking will have some impact on growth.

Help, I drank “normally” before I knew I was pregnant?!

Many women may unknowingly continue to drink for one to two months before discovering they are to become a parent, and nothing is more worrying than fear that your lifestyle may have impacted your baby’s health. If you drank moderately and were within the 14 unit per week guideline range in early pregnancy then there’s no need to panic, the risk of any negative impact is very low. Avoid further drinking and limit your intake from here on – try these “cocktail” recipes if you still want to spice up Friday night!

Around 1 in 5 women report binge drinking before recognising they were pregnant, so if that sounds familiar to you, you aren’t alone. The risk of health effects is increased with heavy or binge drinking but is still low if drinking stops in early pregnancy. A visit to your local doctor or midwife can provide more information to ease your mind, and an early discussion of your concerns can help them to check for any adverse developmental effects when you head in for your scans.

For help in calculating your weekly alcohol unit intake head to drink aware.

What should I do if I’m trying for a Baby?

If you’re trying for a baby then it’s best to severely limit your intake. The male partner doesn’t get a free pass here either – research shows the risk of “spontaneous abortion” is doubled for both female and male alcohol intake at the time of conception. “Spontaneous abortion” or miscarriage may sound scary but in this case will likely apply to pregnancies which wouldn’t ever be detected, where menstruation would occur as normal. Even so, alcohol intake could be unintentionally hindering your attempts to get pregnant.

In summary whilst its best to avoid alcohol completely, don’t panic if you fall off the wagon once or twice, one glass here and there is unlikely to have an impact if consumed infrequently. If you’re still concerned then your GP or midwife can give you more information.

Charlie Rose Howard, Dietetic Student

Charlie is a BSc Nutrition and Dietetics student at King’s College London. She’s interested in all things public health, child health, and evidence based. Tweet her @charlieroseRD2B


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