For most women, pregnancy is a time of intense and often mixed, feelings. These feelings can range from anticipation, pride, excitement, and a sense of well-being, to worries, doubts, and fears. All of these feelings are normal.

Most women wonder: Can I handle the responsibility? Will I be a good mother? Can I afford this baby? Will it be a difficult birth? And perhaps most important of all—will the child be healthy and normal or have a physical or mental problem?

There are a number of things you can do to increase the chances of delivering a healthy baby. Regular checkups before the baby is born, a balanced diet, exercise, and the support and love of people close to you are important. There are also things you can avoid while you are pregnant that further help you to provide a good start for your unborn baby. Not smoking during pregnancy, and using extreme care about the kinds and amounts of drugs you take and about the amount of alcohol you drink are all steps you can take.

This article takes a close look at alcohol use and abuse during pregnancy. We look at how alcohol affects your unborn baby and discusses questions that still exist about alcohol use during pregnancy. Finally, it gives a few guidelines to help you make sure alcohol will not affect your unborn baby.

Alcohol Use vs. Alcohol Abuse

It is important to keep in mind that there is a difference between alcohol use and alcohol abuse. Some people may have one or two drinks on separate occasions—this is alcohol use. Others may drink heavily or in binges (drinking a large amount of alcohol in a short time)—this is alcohol abuse. The amount of alcohol that separates use from abuse is not clearly defined, however, even to health professionals.

Alcohol: A Powerful Drug

Alcohol is so taken for granted in our society that most of us don’t even think of it as a drug.

For any person, alcohol abuse over a period of time can lead to a number of serious problems. These can include muscle and heart disease, malnutrition, digestive problems, and liver cirrhosis (damaged liver cells). When alcohol is abused during pregnancy, it can also affect the delicate systems of the fetus (the unborn baby).

Fetal Alcohol Syndrome

In recent years, medical experts have done a number of studies on infants born to women who drank heavily during pregnancy. The results are disturbing. Many of the infants were born with a strong pattern of physical, mental, and behavioural problems. This group of problems is called the “fetal alcohol syndrome.”

Babies with this syndrome were shorter and lighter in weight than normal babies and didn’t “catch up,” even after special care was provided. They also had small heads; abnormal features of the face and head, joints, and limbs; heart defects; and poor control of movement. Most were also mentally retarded and showed a number of behavioural problems including hyperactivity, extreme nervousness, and poor attention span. Some of the infants were born with all of these problems; others showed signs of only some of them.

Other factors—cigarette smoking, use of other drugs, poor diet, problems handling stress—may well play a role in the development of the fetal alcohol syndrome. They do contribute to problems such as low birth weight. However, alcohol itself appears to be the one agent common to all fetal alcohol syndrome cases. Studies have ruled out the possibility that caffeine, other drugs, or malnutrition can alone account for the damaging actions of alcohol.

Only a relatively small percentage of children exposed to alcohol abuse before birth may be born with the severe group of problems called fetal alcohol syndrome. A fetus can still be at risk, however. Other birth defects that can be traced to alcohol abuse during pregnancy occur relatively often among infants born to women who drank heavily during pregnancy.

How Alcohol Affects the Fetus

It may be hard to believe that alcohol can do so much damage to the fetus. Knowing how alcohol interacts with the developing fetus may help. When a pregnant woman drinks alcohol it quickly reaches the fetus through the bloodstream. The same level of alcohol that goes through the mother’s bloodstream also goes through the fetus. Considering the bad effects this can have on the mother, it is not surprising that the fetus is vulnerable as well.

Genetic factors—the arrangement of genes that determine growth, development, and traits unique to each person—may also play a part in how the fetus is affected. This may explain, in part, why two women can drink the same amount of alcohol, yet one may be more affected than another.

Studies suggest that the more a mother drinks during pregnancy, the greater the danger to the fetus. The fetus is especially vulnerable early in pregnancy when all of the major body systems are being developed. Alcohol increases the risk of having a miscarriage at this time. The risk is about twice as high in pregnancies complicated by maternal drinking, though perhaps only among women who drink frequently.

How Much Alcohol Is Harmful?

One of the questions asked most often about alcohol and pregnancy is whether there is a safe level of alcohol intake and, if so, what it is.

Does the woman who drinks only once in a while put her baby in danger?

Although the effects of heavy drinking on infant development have been well documented, it is unclear what the effects of moderate drinking are and how drinking affects fetal development at various stages of pregnancy. To date, there is no evidence that an occasional drink is harmful. Women who drink heavily throughout pregnancy may have smaller babies with physical and mental handicaps, but women who drink moderately may have babies with no more problems than those women who drink rarely or not at all.

It’s hard to determine the amount and timing of alcohol consumption that puts the fetus at risk. One study shows that women who drank only occasionally and moderately (described in this particular study as between 1 and 45 drinks spaced out over a month) had babies with no more problems than those women who drank rarely or not at all. There were no differences either in size or number of babies’ handicaps between the women who drank moderately and those who abstained or drank lightly.

Medical experts cannot state exactly how much or what kind of alcohol may harm the developing fetus. Each individual fetus may be affected differently. Since there are no risks from alcohol if a woman abstains, the safest course is not to drink alcohol at all during pregnancy.

What You Can Do

As guidelines for alcohol use during pregnancy, you may find the following suggestions useful.

Know the Risks.

The exact level at which alcohol begins to harm the developing fetus is not known. At the lowest levels, the risks from alcohol are probably very small or nonexistent, but, as alcohol consumption increases, so does the risk. If you’re not sure how much is too much, talk with your doctor: “tolerance” (how much a person can drink without being affected) is different for different people. Not drinking at all will not damage your baby.

Don’t Depend on Alcohol.

If you feel that you need alcohol to get through the day, or to keep up a certain appearance during a social or business situation, or for whatever reason, you may want to talk with your doctor about how to cut down or cut out the need—it will help not only you but also your fetus.

Avoid Other Drugs Too.

Some people find it difficult to handle daily problems or stress and will use other drugs like tranquillizers to calm their nerves or help them forget. These mood-changing drugs may also enter your bloodstream and reach the fetus just like alcohol. Many of these drugs can harm the baby. Always consult your doctor before taking any drug—even those you can buy without a prescription. Your doctor can tell you which drugs are safe and which are harmful.

Find Alternatives to Alcohol.

Pregnancy changes your life in some important ways. You’re bound to feel some stress during this time. Some women feel more anxious and depressed than usual during pregnancy. Pregnancy is a good time to learn to cope with such changing feelings without alcohol or other drugs. If you can learn to do this now, it may help you to handle the normal stresses of motherhood later.

Start by making sure you are clear about just what is bothering you. Is there anything you could do to improve the situation? Or would simply talking about your feelings to someone close to you help? Sometimes a long walk, relaxing music, or being with people you like can do a lot to relieve stress. Exercise that you are used to doing can sometimes work off stress.

Getting Help.

If you find that you are too depressed to do any of these things, nothing seems to help, or you can’t cut down or stop drinking, try getting help from people who are specially trained to offer counseling with this type of problem. First talk to your obstetrician as early as possible in the pregnancy or when you’re thinking of having a baby. It is the best thing you can do for yourself and your baby.

Your doctor will help you decide if you need special care and, if necessary, refer you to specialists who help other women who have the same types of problems. These may include a psychologist, a local women’s centre, a counselling program, or other support groups. In particular, if you are drinking more than you can handle, you can find help through your local NGOs on alcoholism, mental health agency, or Alcoholics Anonymous chapter. If you are reluctant to contact them directly, talk with your doctor about it.

Finally ..

You will hear a lot of “dos” and “don’ts” during pregnancy and sometimes you may feel a bit confused. Your doctor, your family, and many other groups can help. But others can only make suggestions. You are the one who is most important in taking care of your unborn baby’s needs. It can’t take care of itself.

The best alternative to drinking alcohol is to abstain or drink very lightly. But the key is moderation—even if you believe your drinking is moderate, try to cut down—it’s just one more way of modifying your lifestyle, along with eating healthy foods, getting more sleep, and exercising. Talk with your doctor if cutting down on drinking is difficult for you. Sometimes just talking about it with your doctor can help encourage you to limit alcohol use.

What you do makes a big difference to the health of your baby. Know the facts about alcohol and drugs during pregnancy. Remember—alcohol can be harmful, so why take the risk? By making informed, intelligent choices about using alcohol during pregnancy, you can increase your chances of having a healthy, normal baby.

If you need advice regarding the health of your unborn baby, please feel free to schedule an appointment to see Dr.Gan.
— Dr.Gan Kam Ling

Consultant Obstetrician And Gynaecology

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