No safe level of alcohol consumption during pregnancy: Study

Evelyn Lewin

29/09/2020 1:41:36 PM

New research shows ‘any’ alcohol use in pregnancy is associated with psychological and behavioural effects in children.

Young pregnant woman holding a glass of wine
Around one in four Australian women continue to drink after finding out they are pregnant.

‘This confirms for me what I’ve long suspected: that there isn’t a safe level of alcohol in pregnancy.’
That is Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal/Postnatal Care network.
She is talking to newsGP about new research from The University of Sydney, published recently in the American Journal of Psychiatry.
The retrospective observational study examined the parent reports of 9719 children aged 9—10.9 years, looking at prenatal alcohol exposure and its association with psychological, behavioural and cognitive outcomes in offspring.
The research also explored whether differences in brain structure and resting-state functional connectivity partially explained these associations at baseline and at follow-up one year later, after controlling for possible confounding factors.
For the study – considered the largest to investigate the impacts of low-level alcohol use during pregnancy to date – low levels of drinking were considered one to two drinks per occasion, with a maximum of six drinks per week.
Compared to children who were not exposed to alcohol during pregnancy, the study found those exposed to low levels of alcohol in utero at any time in pregnancy experienced more psychological/emotional problems, including anxiety and depression, and behavioural problems, such as poor attention and being impulsive.
There was also a 25% increased likelihood of attention deficit hyperactivity disorder (ADHD) in children exposed to heavier alcohol levels (approximately 36 drinks) in the first six to seven weeks of pregnancy.
The authors therefore conclude ‘any’ alcohol use in pregnancy is associated with psychological and behavioural effects in children, and that women should continue to be advised to abstain from alcohol consumption for the entirety of their pregnancy from conception onwards.
Lead author Ms Briana Lees says previous research showed that very heavy alcohol use, such as binge drinking, during pregnancy can cause harm to the baby.
‘However, this study shows that any alcohol use during pregnancy, even low levels, is associated with subtle, yet significant behavioural and psychological effects in children including anxiety, depression and poor attention,’ she said.
‘This study is so important because in Australia, around 50% of women drink alcohol before they know they are pregnant, and 25% do so after they know.
‘The vast majority consume one or two standard drinks per occasion which this study shows is enough to impact the baby’s brain.’
Ms Lees says that in general, the more alcohol a child is exposed to in utero, the more severe the outcomes. However, even children exposed to low levels of alcohol in the first six to seven weeks still experienced negative effects.
‘The data indicates that there is no completely safe level of alcohol consumption during pregnancy,’ Ms Lees said.
Dr Burton agrees with that conclusion.
‘I usually tell women that we know alcohol damages brain cells, we know that it crosses the placenta, so the best advice is to not expose a developing child to alcohol,’ she said.
‘My advice to pregnant women is the best option is not to drink when they’re trying to fall pregnant and then throughout the pregnancy; the second best option is not to drink as soon as they know they’re pregnant.’
Dr Burton believes partners should also support pregnant women in this endeavour to make abstaining from drinking easier.
‘I ask the partner to consider supporting their pregnant partner by not drinking, or not drinking as much,’ she said.
If a pregnant woman is struggling to stop drinking, Dr Burton encourages them to see her about that issue, to explore it further and discuss whether more help is needed.

Dr Wendy Burton says the message to steer clear of alcohol during pregnancy does not always get through to patients.

While this research paints a worrying picture of alcohol intake in pregnancy, Dr Burton says women who consumed alcohol before finding out they were only just pregnant do not need to panic.
She says women who are trying to conceive sometimes do not know they should not be drinking and may even have a ‘big night out’, only to discover a couple of weeks later that they are pregnant.
‘That’s most likely less of a concern in an ongoing pregnancy because of the implications of very early stage exposure,’ she said.
‘While we don’t recommend drinking alcohol while trying to conceive, if alcohol damages cells so early it is likely to be catastrophic and hence the fetus is unlikely to survive.
‘If the pregnancy is ongoing past the first two weeks since conception – four weeks from the last period – it is likely that the baby is okay.’
Dr Burton says this is an assumption made on first principles.
‘It would be interesting to look at the research to see if it holds up,’ she said.
While there may be confounding factors in the study that could have influenced the findings, Dr Burton believes this research should act as another reminder for GPs to be proactive in starting the conversation about alcohol in pregnancy, even before a woman is expecting.
This is especially important Dr Burton says, because even though the message to steer clear of alcohol during pregnancy is not new ‘it doesn’t always get through’.
‘There’s nothing like a face-to-face person who you hopefully have a relationship with saying, “When it is time to start trying to fall pregnant, let’s talk about that ahead of time”,’ she said.
‘“Can I check, are you still smoking, how much are you drinking?” These are good conversations for us to be having anyway, even if women aren’t trying to fall pregnant.’
Dr Burton says there have been ‘lingering concerns’ regarding alcohol use in pregnancy, and hopes this research is the final nail in the coffin on discussions regarding whether it is okay for pregnant women to have ‘one or two’ drinks occasionally.
‘We’ve got definite levels of alcohol consumption that is known to cause harm,’ she said.
‘This is just more evidence to say any level of drinking in pregnancy is not recommended.’ 
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