Alcohol and pregnancy

Alcohol in pregnancy is the use of alcohol during gestation, including the time before the woman is aware of the pregnancy. Fetal alcohol spectrum disorders are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. The most severe form of the condition is known as fetal alcohol syndrome. Problems may include an abnormal appearance, short height, low body weight, small head size, poor coordination, low intelligence, behavioral problems, hearing loss, and vision problems.[1] Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and have trouble with alcohol and recreational drug use.[2] Alcohol use during pregnancy also can cause spontaneous abortion, stillbirth, low birthweight, and prematurity.[3] Not all infants exposed to alcohol in utero will have defects related to the alcohol consumption. Alcohol use during pregnancy can also result in the inability to care for an infant after the birth if the drinking continues. The use of alcohol during pregnancy is associated with domestic violence and potential harm to the infant.[3]

Fetal alcohol syndrome usually occurs when a pregnant woman has more than four drinks per day during the first trimester, with milder symptoms have been found with two drinks per day[4][5] Evidence of harm from less than two drinks per day or 10 drinks per week is not clear.[4][6] Most health organisations recommend complete abstinence from alcohol during the first three months of pregnancy, when the fetus is most susceptible to the mutative effects of alcohol, and recommend overall moderation throughout the entire pregnancy.[7][8][9]

Embryology

Different body systems in the infant grow, mature and develop at specific times during gestation. The consumption of alcohol during one or more of these developmental stages may only result in one or few conditions.[10]

From conception and to the third week, the most susceptible systems and organs are the brain, spinal cord, and heart. Though these body systems complete their development later in the pregnancy, the effects of alcohol consumption early in the pregnancy can result in defects to these systems and organs.[10]

During the fourth week of gestation, the limbs are being formed and it is at this point that alcohol can effect the development of arms, legs, fingers and toes. The eyes and ears also form during the fourth week and are more susceptible to the effects of alcohol.[10]

By the sixth week of gestation, the teeth and palate are forming and alcohol consumption at this time will affect these structures.[10] Alcohol use in this window is responsible for many of the facial characteristics of fetal alcohol syndrome.

By the 20th week of gestation the formation of organs and organ systems is well-developed. The infant is still susceptible to the damaging effects of alcohol.[10]

The baby’s brain, body, and organs are developing throughout pregnancy and can be affected by exposure to alcohol at any time. Because every pregnancy is different, drinking alcohol may hurt one baby more than another. A child that has been affected by alcohol before birth may be appear 'normal' at birth. Intellectual disabilities may not appear until the child begins school.[10]

After birth

When an infant is born and appears to be healthy, the baby may still have non-visible disorders and organ defects due to exposure to alcohol during the pregnancy.[10] Social problems in the child have been found to be associated with alcohol use during gestation.[3] Alcohol is a cause of microcephaly.[11]

Alcohol use during pregnancy does not effect the ability to breastfeed the infant. In addition, an infant may breastfeed even if the mother continues to consume alcohol after the birth. An infant born to a mother that has an alcohol dependency may go through alcohol withdrawal after the birth.[3]

Treatment

A woman may elect to discontinue alcohol once she knows that she is pregnant. A woman can have serious symptoms that accompany alcohol withdrawal during pregnancy. These symptoms can be treated during pregnancy with benzodiazepine.[3]

Epidemiology

One out of 67 women who drink alcohol during pregnancy will have a child with a birth defect. The five countries with the highest prevalence of alcohol use during pregnancy were Ireland (about 60%), Belarus (47%), Denmark (46%), the UK (41%) and the Russian Federation (37%). The lowest prevalence is in those nations whose religious beliefs govern their alcohol consumption. Birth defects caused by alcohol consumption may be up to 1% in many places. This may mean that FASD may be higher than anencephaly, Down syndrome, spina bifida and trisomy 18. Globally, one in 10 women drink alcohol during pregnancy. Out of this population, 20% binge drink and have four or more alcoholic drinks per single occasion.[12]

"Binge drinking is the direct cause of FAS or FASD. These findings are alarming because half of the pregnancies in developed countries and over 80% in developing countries are unplanned. That means that many women don’t realize they are pregnant during the early stages and that they continue drinking when pregnant."[12]

Public health recommendations

Starting in 1981, the surgeon general of the United States started releasing a warning asking pregnant women to abstain from alcohol for the remainder of gestation.[13] The American Academy of Pediatrics issued set of recommendations in 2015: "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."[7] The World Health Organization recommends that alcohol should be avoided entirely during pregnancy, given the relatively unknown effects of even small amounts of alcohol during pregnancy.[8] The National Institute for Health and Clinical Excellence has advised that women abstain from alcohol entirely during the first three months of gestation, and that if women do choose to drink they should drink no more than one or two drinks once or twice a week.[9]

Controversy

There is some controversy surrounding the "zero-tolerance" approach taken by many countries when it comes to alcohol consumption during pregnancy. The assertion that moderate drinking causes FAS is said to lack strong evidence and, in fact, the practice of equating a responsible level of drinking with potential harm to the fetus may have negative social, legal, and health impacts.[14]

In February 2016 an infographic created by the CDC caused controversy because it recommended that women of child-bearing age abstain from alcohol if they were not on birth control.[15] This is because the window for developing fetal alcohol syndrome is very early, before women may know they're pregnant. However, the recommendation was seen as onerous or overly broad with some sources claiming it "shamed women." [16][17][18][19][20]

See also

References

  1. ↑ "Facts about FASDs". 16 April 2015. Archived from the original on 23 May 2015. Retrieved 10 June 2015.
  2. ↑ Coriale, G; Fiorentino, D; Di Lauro, F; Marchitelli, R; Scalese, B; Fiore, M; Maviglia, M; Ceccanti, M (2013). "Fetal Alcohol Spectrum Disorder (FASD): neurobehavioral profile, indications for diagnosis and treatment". Rivista di psichiatria. 48 (5): 359–369. doi:10.1708/1356.15062. PMID 24326748.
  3. 1 2 3 4 5 "Guidelines for the identification and management of substance use and substance use disorders in pregnancy" (PDF). World Health Organization. 2014. Retrieved 11 August 2017.
  4. 1 2 Yaffe, Sumner J. (2011). Drugs in pregnancy and lactation : a reference guide to fetal and neonatal risk (9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 527. ISBN 9781608317080. Archived from the original on 10 September 2017.
  5. ↑ "Pregnancy and alcohol: occasional, light drinking may be safe". Prescrire Int. 21 (124): 44–50. Feb 2012. PMID 22413723.
  6. ↑ Henderson, J; Gray, R; Brocklehurst, P (March 2007). "Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome". BJOG : an international journal of obstetrics and gynaecology. 114 (3): 243–252. doi:10.1111/j.1471-0528.2006.01163.x. PMID 17233797.
  7. 1 2 Williams JF, Smith VC (2015). "Fetal Alcohol Spectrum Disorders". Pediatrics. 136 (5): e1395–e1406. doi:10.1542/peds.2015-3113. PMID 26482673.
  8. 1 2 "Framework for alcohol policy in the WHO European Region" (PDF). World Health Organisation.
  9. 1 2 "Drinking in pregnancy guidance". nhs.uk. Retrieved 2018-04-06.
  10. 1 2 3 4 5 6 7 "An Alcohol-free pregnAncy is the best choice for your baby" (PDF). Centers for Disease Control and Prevention. Retrieved 10 August 2017. This article incorporates text from this source, which is in the public domain.
  11. ↑ "Microcephaly". World Health Organization. Retrieved 11 August 2017.
  12. 1 2 "Counting the costs of drinking alcohol during pregnancy". World Health Organization. Retrieved 11 August 2017.
  13. ↑ Rankin, Lissa (23 August 2011). Fertility, Pregnancy, and Childbirth. St. Martin's Press. p. 14. ISBN 9781429959322. In 1981, the surgeon general put out the now-ubiquitous warning about alcohol and pregnancy.
  14. ↑ ARMSTRONG, E. M. (2000-05-01). "FETAL ALCOHOL SYNDROME: THE ORIGINS OF A MORAL PANIC". Alcohol and Alcoholism. 35 (3): 276–282. doi:10.1093/alcalc/35.3.276. ISSN 0735-0414. Archived from the original on 2015-03-31.
  15. ↑ "Alcohol and Pregnancy | VitalSigns | CDC". www.cdc.gov. 2017-03-20. Retrieved 2018-04-06.
  16. ↑ "The CDC's Alcohol and Pregnancy Warning Shames Women". Time. Retrieved 2018-04-06.
  17. ↑ "CDC faces backlash over alcohol warning to women". Retrieved 2018-04-06.
  18. ↑ Schumaker, Erin (2016-02-04). "No, The CDC Did Not Tell Women To Stop Drinking". Huffington Post. Retrieved 2018-04-06.
  19. ↑ "Women Blast CDC's Advice To Use Birth Control If Drinking Alcohol". NPR.org. Retrieved 2018-04-06.
  20. ↑ "Women Blast CDC's Advice To Use Birth Control If Drinking Alcohol". NPR.org. Retrieved 2018-04-06.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.