Drinking Alcohol in Pregnancy

by E
(New York)

I had been drinking alcohol in early pregnancy.
What would be the effects of alcohol on the developing embryo?
Fetal Alcohol Syndrome?

It was before I realized I was pregnant. I am now about 4 weeks pregnant. I have had a few drinks after my last menstrual period (LMP), which was on 25 Jan 2018. On 3 Feb I had one beer, on 4 Feb I had 2 beers, on 7 Feb I had a cocktail drink, on 9 Feb I had a glass of wine. But none after that.

How likely is it that I have caused damage to my baby?
I believe I conceived on 2 Feb, though it’s hard to be certain. This means all of the drinks, except the last one, were taken during the second week after my LMP.

Oh, I have made a terrible mistake, and wish I could take it back. I am worried sick. Please tell me how worried I should be.
Thank you for your time.

The Expert, Ren Chats Answers

Worried?
But of course!
Wish I could say, “Don’t.

Drinking alcohol

Indulging in alcoholic drinks has unfortunately become a norm of modern society, also among sexually active young ladies. Even though the potential ill effects of alcohol on embryo and fetus are well known. However, the proof from prospective studies in human is not possible - for the obvious reasons.

Most studies in humans on the subject are retrospective, which usually focus on distinct abnormalities caused by prenatal exposure to alcohol. It is also difficult to quantify the amount of alcohol a developing fetus is actually exposed to, and at what stages of development.

Moreover, the ladies who happen to drink alcohol in early pregnancy, are into drinking alcohol, along with their partner, for some years before that. Studies on mice show that alcohol drinking even before falling pregnant may have a negative impact on placental development and fetal health.

Another study done on couples undergoing IVF showed that drinking alcohol, as few as four drinks per week, significantly decreased the chances of fertilization and healthy fetal development.

This points out that the toxic effects of alcohol (chemically known as Ethanol) and acetaldehyde (the intermediate breakdown product of Ethanol) can jeopardize the genetic information stored in both sperms and ova alike. But the exact mechanism is not yet known. Secondly, how severely a person’s germ cells are affected depends on inherited differences in the metabolism of ethanol and the intensity of lifestyle related external influences, like drinking alcohol, tobacco consumption, and drug abuse.

You have successfully passed this stage. Because without fertilization of the egg healthy implantation of the embryo is not possible, and the pregnancy is usually diagnosed after implantation has taken place.

Alcohol in Pregnancy

There exists a general misconception that drinking some alcohol during pregnancy is harmless.
It is not.
The belief helps people deny the risks associated with drinking alcohol in pregnancy.

Alcohol effects on the unborn baby vary according to the stage of its development. 1 in 3 pregnant women reports binge drinking in early pregnancy, usually for the first 2–3 weeks between conception and pregnancy recognition.

The commonest negative outcome noted at this stage is miscarriage.
2 out of 10 clinically confirmed pregnancies end in spontaneous abortion within 3 months of conception. A fair number of these spontaneous early abortions are due to chromosomal abnormality in the fertilized egg, the developing embryo.

All chromosomal abnormalities in an embryo are not always those that are inherited from the parents. Some are the result of genetic reprogramming that the embryo undergoes to survive the toxic environment. One of the mechanisms being “epigenetic imprinting”, wherein one of the two inherited genes is turned off. This alters growth and multiplication of the cells.

Secondly, all cells are highly responsive to the chemicals in its environment, more so actively multiplying embryo cells. Ethanol, the alcohol we drink, is a toxic chemical. It can therefore, disturb the sensing and processing of cell signals, thereby the gene expression. Gene expression regulates cell differentiation, which determines the appropriate functioning of the cells.

Nevertheless, many of the babies who are exposed to a low quantity of alcohol and during the very early stage of development, escape damage. But all don’t.

The altered gene expressions in babies influence their development and functions throughout life. Several subtle changes of gene expression are difficult to recognize, especially during the early stages. They become apparent only when child’s developmental milestones are found to lag behind the expected normal for the age.

Fetal Alcohol Syndrome (FAS)

Almost 50% of pregnant women drink alcohol during pregnancy; the stage of pregnancy, quantity, and frequency of drinking alcohol of course vary. However, only a very small number of babies, who are exposed to alcohol before birth, are diagnosed to be suffering from the classical “Fetal Alcohol Syndrome”.

Does it mean alcohol does not harm every baby?
No!
It does.
Alcohol hampers fetal development.
The degree and the presentation varies.
Commonly only some ill effects of alcohol are seen in each child. The domain of childhood development affected also differs from individual to individual.

The most affected is the growth of the child. These children do not attain their optimal growth and height. Odd facial features and birth defects are also common. Neuro-development suffers a serious setback.

Neuro-developmental problems include a variety of peer relationship issues, and poor cognitive development.

Both together determine child’s behaviour, ability to meet social demands, emotional control, and learning abilities like paying attention, thinking, reasoning, applying and remembering.

All problems are not seen in every child. The severity and presentation of the problems differ in each child exposed to alcohol in the mother’s womb. Furthermore, because of the isolated nature of the developmental delays, prenatal exposure to alcohol being the underlying cause often gets overlooked.

What to do?

Nothing once the damage is done, but it can be prevented.
Indeed, Fetal alcohol spectrum disorders are entirely preventable - only if women, planning to have a baby, avail preconception counseling, and abstain from drinking alcohol totally and not only when they are pregnant.

Related article of interest - Mothers Who Drink Alcohol Beware

For more information on the subject read Alcohol Use in Pregnancy

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