Expectant Parents’ Guide: Answers to Your Top Questions About Alcohol and Pregnancy
Is a sip of champagne really that bad for your baby?
Even though most of us would say that drinking alcohol during pregnancy isn’t safe, I think many of us have thought, “OK, but how bad is one drink…?”
And I am not judging you – because I have definitely entertained this thought too.
The facts are that 10% of pregnant people report currently drinking alcohol. Organizations like the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the CDC all agree: avoiding alcohol during pregnancy is the safest choice. This is because alcohol is a teratogen—a substance that can cause birth defects, including the spectrum of disorders known as fetal alcohol syndrome disorder (FASD).
But let’s answer the questions I am sure you really want to ask your doctor or midwife. And let’s do it in a judgement free, evidence-based way.
I drank before I knew I was pregnant – how worried should I be?!
This is SUPER common, especially since about half of all pregnancies in the U.S. are unplanned. A large study from 1999 showed that almost half of all pregnant women in the U.S. drank before they knew they were pregnant — so you are certainly not alone.
If you had a few drinks before you realized you were expecting, I’d recommend not panicking and instead to chat with your healthcare provider, who can assess how much it was and when exactly in the pregnancy and guide you from there. For those who binge drank early on (and 1 in 22 pregnant people have), it’s also worth mentioning to your obstetric provider and pediatric team so they can be aware and monitor your baby’s development. I can’t stress enough, however, that there’s no reason to carry shame – we can’t change the past!
OK, but what counts as binge drinking?
Binge drinking is defined as having three or more drinks in one sitting. For reference, one drink is considered to be a 12-ounce beer, 5 ounces of wine, or 1.5 ounces of liquor.
Is any amount of alcohol safe during pregnancy?
The current advice doesn’t split hairs: no amount of alcohol is considered safe while pregnant. The reasoning is that even though there’s no specific study showing the exact amount of alcohol that causes harm, FASD can occur with varying levels of alcohol exposure. Alcohol can affect a baby’s developing brain, nerves, and organs at any stage of pregnancy.
Are you serious? You’re saying one sip of champagne is bad? Prove it.
I 100% hear you…and can see why you ask this. The thing is: I can’t point to any study that can tell you a safe amount, which is why leading organizations have the position to avoid all alcohol. We just don’t know at what point it causes an issue (and to be honest – it probably varies by your genetics, your baby’s genetics, your metabolism, the different stages of fetal development, etc.) and when it doesn’t.
So while the most conservative route is to avoid alcohol completely, I also understand your skepticism and frustration in that recommendation given the lack of data. I also trust you to take this information in and make the choice that feels right for you and your family.
I also suggest reading the next question for more perspective…
So if I drink more often, does that mean my baby will definitely be affected?
Not necessarily. A 2019 study on twins showed that even with the same level of alcohol exposure, some babies were more affected than others, indicating a genetic component. This means that while some babies may be more vulnerable to even small amounts of alcohol, others might not be as affected. This uncertainty (and other studies that have had conflicting results) is also one reason why the recommendation is to avoid alcohol altogether.
Will I get reported if I tell my doctor or midwife that I’ve been drinking?
I won’t lie: this depends on where you live. Some states do consider alcohol use during pregnancy a form of child neglect, which can lead to mandatory reporting. And if you’re thinking, “Won’t that mean some patients who need help will be too afraid to ask for it?” then you get the gold star. ACOG believes – and I agree –that using the legal system in these cases isn’t effective and can discourage pregnant patients from being honest with their healthcare providers. I’d love to see this changed.
If you have questions about the rules in your state (or are currently having a legal issue because of this), I definitely recommend contacting the amazing people at Pregnancy Justice.
I’m struggling to stop drinking. What should I do?
If you’re finding it hard to quit drinking, don’t hesitate to reach out to your doctor or midwife (sadly, with the caveats above). They can offer you the support and resources you need. Pregnant people with alcohol dependence need and deserve specialized care, including counseling and access to treatment.
Need help right now? You can check out AA and SAMHSA for more info.
Until next time,
Dr. Jen
References
1. The American College of Obstetricians and Gynecologists. Infographic: Alcohol and Pregnancy
2. The American College of Obstetricians and Gynecologists. FAQ: Tobacco, Alcohol, Drugs, and Pregnancy
3. Centers for Disease Control. Fetal alcohol spectrum disorders (FASDs): Data and statistics.
4. Advances in Pediatric Research. Twin study confirms virtually identical prenatal alcohol exposures can lead to markedly different fetal alcohol spectrum disorder outcomes – fetal genetics influences fetal vulnerability. January 2019.
5. Floyd RL, Decouflé P, Hungerford DW. Alcohol use prior to pregnancy recognition. Am J Prev Med. 1999 Aug;17(2):101-7. doi: 10.1016/s0749-3797(99)00059-8. PMID: 10490051.