It is generally believed that taking some amount of alcohol, say a bottle of beer, occasionally might not harm both the baby and the mother. But experts warn that no amount of alcohol is safe during pregnancy, stressing that alcohol will tend to have ill effects on the growth and development of the child, reports Sade Oguntola.

There has been increasing interest in recent years about the possible health risks of drinking during pregnancy. In particular, there is considerable controversy about whether there is a safe threshold for alcohol consumption during pregnancy and whether international policy recommendations are based on evidence.

There are currently considerable international differences in policy recommendations about alcohol use in pregnancy— be it beer, wine or liquor. Some countries such as the United States of America, Canada and France have recommended complete abstinence. This appears to be based on a precautionary approach, given that no clear safe threshold for drinking has been established.

In contrast, until May 2007, guidelines in the United Kingdom were that pregnant women could safely drink one or two drinks per occasion up to between one and two times per week (that is, up to a total of four drinks/units of alcohol per week). This approach appears to be based on the lack of available evidence demonstrating that low levels of alcohol consumption are associated with later adverse outcomes.

These recommendations were recently revised to advice abstinence. However, this revision was based on the perceived greater clarity of a “no drinking” message rather than on the research evidence, and the guidelines remain ambiguous as they state that women who choose to drink can drink up to the previous limits.

But the controversy on no alcohol intake in pregnancy might have been laid to rest with a new study which tried to determine what are the windows of risk and the patterns in timing and quantity of alcohol use on a spectrum of abnormalities called “fetal alcohol spectrum disorders” (FASDs), whose effects range from mild to severe.

These effects include mental retardation; learning, emotional and behavioural problems; and defects involving the heart, face and other organs.

The most severe of these effects is fetal alcohol syndrome (FAS), a combination of physical and mental birth defects. People with the syndrome may have abnormal facial features, such as a smooth ridge between the nose and upper lip, small head size, unusually small-set eyes and shorter-than-average height.

Its result which was published online ahead the April print edition of Alcoholism: Clinical & Experimental Research found that there was no stage of pregnancy where drinking alcohol was safe. It found that higher prenatal alcohol consumption — no matter the timing in pregnancy — was associated with an increased risk of having an underweight infant or reduced birth length. However, the chance of the baby having problems was higher particularly between the sixth and 12th weeks of pregnancy, and with more alcohol.

The 992 women in the study were enrolled in the California Teratogen Information Service and Clinical Research Programme between 1978 and 2005, which provided confidential risk assessments for any potential toxin exposures during pregnancy. Every three months during the remainder of their pregnancies, they were asked about their use of alcohol and other substances, including specific dates of use, drinks per day, number of binge episodes and maximum number of drinks.

Information about their babies’ development was collected after birth, and each newborn was then examined by a dysmorphologist, a specialist in structural birth defects, to look for evidence of fetal alcohol syndrome as well as other conditions.

While higher levels of alcohol exposure were strongly linked to a greater risk of infants born smaller and lighter, with small heads and a smooth ridge between the nose and upper lip, the most significant associations were observed during the second half of the first trimester of pregnancy — defined as 43 to 84 days after conception.

For every one-drink increase in the daily average number of drinks consumed during this stage of pregnancy, there was a 25 per cent higher risk for having a smooth ridge between the nose and upper lip; 22 per cent for a thin upper lip, 12 per cent for microcephaly, 16 per cent for a low birth weight, and 18 per cent for a reduced birth length. The researchers found similar increases with each additional episode of binge drinking (consuming a high amount of alcohol at one time).

Unfortunately, Nigeria’s health Ministry does not have any guidelines on alcohol use in pregnancy and according to Dr Adebola Roberts, a consultant obstetrician and gyneacologist, University college Hospital (UCH), Ibadan, Oyo State, what women are told is abstain from alcohol in the first three months of pregnancy and afterwards never to exceed two units of alcohol per week.

“I think the critical period of development of the fetus, that is the first three months of pregnancy, is the period that alcohol should be avoided in totality. Subsequently, we expect that a pregnant woman would not take more than two units of alcohol. One unit of alcohol is equivalent to a shot of hot drink, a bottle of beer or stout.”

But cases of babies born with fetal alcohol spectrum disorders are still rare in Nigeria due to low consumption of alcohol among Nigerian women. According to Dr Roberts, “in my number of years of medical practice, I have not seen any baby born with fetal alcohol spectrum disorders and this is probably because there is low alcohol consumption in our women.”

“It is only now that incidence of alcohol use among women is on the rise with the advent of new age drinks which contains alcohol in them, he said.

Dr Roberts declared: “So women need to be advised to ensure they drink in moderation and never to exceed two units of alcohol even after the first trimester.”

Although many women are aware that heavy drinking during pregnancy can cause birth defects, many do not realise that moderate or even light drinking also may harm the fetus. In fact, the March of Dimes recommended that pregnant women should not drink any alcohol, including beer, wine and liquor, throughout their pregnancy and while nursing. In addition, because women often do not know they are pregnant for a few months, women who may be pregnant or those who are attempting to become pregnant should not drink alcohol.

When a pregnant woman drinks, alcohol passes through the placenta to her unborn baby. In the baby’s immature body, alcohol is broken down much more slowly than in an adult’s body. As a result, the alcohol level of the baby’s blood can be higher and remain elevated longer than the level in the mother’s blood. This, sometimes, causes the baby to suffer lifelong damage.

No doubt, not every child of women who drink even very heavily has all the features indicative of effects “fetal alcohol spectrum disorders” (FASDs), But there currently is no way to predict which babies will be damaged by alcohol, so the safest course is not to drink alcohol at all during pregnancy or while planning to get pregnant.

In fact, researchers theorised that alcohol exposure in the first six weeks of pregnancy — when many women don’t yet know they’re pregnant — may result in higher miscarriage rates, although the study did not include women who had miscarriages or stillbirths.

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