Heavy drinking during pregnancy can harm the fetus, leading to fetal alcohol syndrome (FAS) or other prenatal alcohol-related conditions such as alcohol-related neurodevelopmental disorder (ARND). In the June issue of Alcoholism: Clinical & Experimental Research, an examination of the most recent data on alcohol consumption among women of child-bearing age (18 to 44 years) reveals that drinking remains at levels of concern among women who are younger than 30 years of age.
"There are a considerable number of women of childbearing age who are drinking excessively, especially the younger women," said Raul Caetano, professor of epidemiology and regional dean at The University of Texas School of Public Health as well as the study's corresponding author. "These may not necessarily be the women of child-bearing age who are pregnant, but because about 45 percent of pregnancies in the United States are unplanned, and because we don't know what the cutoff point for damaging alcohol consumption during pregnancy is, by the time a woman in this group realizes that she is pregnant, the fetus may already be damaged."
"The diagnosis of FAS involves facial anomalies plus abnormalities of the brain which lead to mental retardation," noted Lee Ann Kaskutas, a research scientist with the Alcohol Research Group at Berkeley. "It is an extremely serious condition. However, full-blown FAS is not widespread, and is not associated with moderate drinking. Furthermore, it is important that women who drank lightly or even moderately before they understood they were pregnant, but who immediately cut down or quit altogether once they find out they are pregnant, not feel guilty or become over-concerned about the risk of FAS."
Caetano and his coauthors examined data taken from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions that was conducted by the National Institute on Alcohol Abuse and Alcoholism. Of the total number of women of child-bearing age (n=12,374), there were 451 women (4%) who were pregnant at the time of the interview, and 1,517 (12.4%) who reported being pregnant some time during the previous year.
"Results indicate that drinking and heavy drinking remain at high levels among women of child-bearing age," said Caetano. "Binge drinking, alcohol abuse and dependence are more common among younger pregnant and nonpregnant women less than 30 years of age." Binge drinking was defined as having had four or more drinks per occasion at least once in the preceding year.
Among women who reported being pregnant at any point in the previous 12 months and also drinking, 88 percent said that "they had not drank during pregnancy."
"The moment a women becomes pregnant," noted Caetano, "she will most often immediately respond by cutting back on her drinking because she is aware of the risks. However, the unplanned aspect of becoming pregnant is a huge part of the problem. If we did not have this enormous number of unplanned pregnancies, the risk would be much less, but that is not the fact."
"This brings us to another issue," said Kaskutas, "what was these women's drinking like before they knew they were pregnant? We can't answer that from this paper. Furthermore, given that 88 percent of the drinkers said they had abstained during pregnancy, this means that 12 percent had not abstained during pregnancy. What did their drinking look like? I would like to have known more about these women."
Caetano admitted that there continues to be a small number of women who are alcohol dependent who cannot control their drinking, no matter what. "This is a small number of women, yes, but they are responsible for a considerable number of FAS children," he said. "One of the significant factors of a woman being at risk of having a child with FAS is a woman who has had a FAS child before. So what we have here are two fundamental problems: the issue of unplanned pregnancies, and the inability of women with addictions to control their drinking."
Kaskutas had several recommendations for information campaigns targeting alcohol consumption among women of child-bearing age. "The concern I have with our current health information campaigns is that they do not provide any information -- or offer any help whatsoever -- for women who are not going to abstain. And we know that not all women abstain from alcohol during pregnancy. In Dr. Caetano's study, 12 percent did not abstain, for instance. Campaigns that tell these women to abstain are not really offering them any help. I ask myself this: 'If a woman is not going to abstain, then what information can we give her that will help her have a healthier baby?' For example, we could provide information about the benefit of cutting down, and provide tips on how to do that."