When confronted with so many different types of infections and viruses that can threaten the health of an unborn baby, it’s unfortunate that drinking during pregnancy is still the leading cause of birth defects in this country and abroad. Without knowledge of the devastating effects, it’s easy to have a casual attitude toward drinking but when a fetus is exposed to any amount of alcohol it can lead to a number of permanent and debilitating conditions. These are known as fetal alcohol spectrum disorders (FASD) and can include anything from severe brain damage and growth deficits to lifelong learning and behavioral problems in children. September is designated as FASD Awareness Month but my hope is that at some point in the near future there is no longer a need to observe it because the fact is—FASD is 100 percent preventable.
For some women, alcohol is an occasional indulgence – a glass of wine with dinner, a cocktail at a special event. For other women, drinking is a much more frequent and dangerous activity. Thirteen percent of women in the US consume more than seven drinks per week, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). And according to the Centers for Disease Control and Prevention (CDC), about 1 in 8 women and 1 in 5 high school girls report binge drinking.
I love sushi—living in California this is no surprise. Lucky for me my office is across the street from one of the best local sushi restaurants in town. It’s a favorite destination for me, my staff, and my patients. I recommend it to everyone—EXCEPT my pregnant patients. Why? Because I am inherently cautious.
We know raw fish is more likely to contain parasites or bacteria than cooked fish is. Sushi-related infections are rare, but this doesn’t erase my concern about the risk of adverse outcomes, mercury exposure, and the potential complications of treating an infection should one occur. As an ob-gyn, this is my job. It’s my business to consider potential problems, make my patients aware of them, and advise them to avoid unnecessary risks. If you really want to have some sushi, it’s a good idea to eat only cooked or vegetable sushi.
My goal is not to worry or alarm my patients, but to make suggestions based on solid, high-quality research. I use evidence to guide my recommendations, support my practice, and help my patients make healthy decisions for themselves and their fetuses. That’s why a recent essay by an economist and mom, who asserts that many common pregnancy recommendations are not fully supported by evidence, caught my attention.
Ob-gyns understand there’s often conflicting data and that the changes we suggest during pregnancy can sometimes be overwhelming: nine months can seem like an eternity when you have to give up your favorite things. Sometimes we even look back and realize our advice missed the mark. I remember a time when bed rest was prescribed for many patients with preterm labor, which we now realize accomplished little. But as doctors, we’re continuously learning. Advising patients to avoid things that we KNOW can cause harm is a good practice. Why take the risk of drinking alcohol when you know it could cause a problem? Given the risks, most patients don’t want to use their own child as a test subject.
In other areas, the evidence is very clear. For example, obesity and its impact on pregnancy, the fetus, and a woman’s long term health. Research has shown that excess weight gain increases the risk of maternal and neonatal complications. Obese women have a higher risk of having children born with birth defects. Excess pregnancy weight also increases the risk of maternal obesity eight to 10 years after delivery, especially if women do not lose their pregnancy weight within six months. I would argue that we have not focused enough on weight gain. Ob-gyns could go even further to support women on appropriate weight gain and exercise during pregnancy and healthy weight loss and exercise after delivery.
Certainly it is up to women to make their own decisions during their pregnancy. It’s also important for ob-gyns to remember not to lecture patients, but to partner with them to help them achieve the healthiest pregnancy possible. We must stay tuned in to the recommendations put forth by ACOG and the dedicated practicing physicians who spend countless hours reviewing the latest literature and developing guidance and best practices for ob-gyn care. And it’s also OK to listen to that precautionary voice in the back of your head. Evidence first, but better safe than sorry.
Subscribe to the ACOG President’s Blog to receive an email alert every time a new blog is posted.
As an ob-gyn taking care of women every day, it’s not uncommon for one of my patients to tell me, “I just have some shots and beers on the weekend—what’s the harm in that? All my friends do it.” However, what a patient may consider “normal” drinking could put her health at great risk now and in the future.
Women who drink too much often end up losing out. Judgment becomes clouded. They may have accidents and car crashes. If the drinking continues, they may lose their job, their friends, their family, and other things they hold dear. Women who drink and have sex without using birth control are at risk for becoming pregnant and having an alcohol-exposed infant. Sunday, September 9, is International Fetal Alcohol Spectrum Disorders (FASDs) Awareness Day. Alcohol use during pregnancy is the greatest preventable cause of mental retardation in children. Children exposed to alcohol during pregnancy may also have problems with coordination, controlling emotions, socialization, decision-making, understanding consequences of their actions, and more.
The amount of alcohol in a drink can vary widely. A 12-ounce can of beer, 5-ounce glass of wine and 1 ½-ounces of hard liquor (rum, tequila, vodka, etc.) all contain the same amount of alcohol. But, just one martini or margarita could actually have three servings of alcohol in it. Risky drinking for women is defined as more than three drinks per occasion or more than seven drinks a week.
If it takes a woman more than two drinks in one hour to feel tipsy, she may be developing a tolerance to alcohol, a strong sign of problem drinking. Other signs include:
- Friends and family telling her that she drinks too much
- Her own personal feelings that she needs to cut down on drinking
- Her needing or wanting a drink the morning after a night out to relieve a hangover
Do not drink any alcohol if you are pregnant, trying to become pregnant, taking medications that warn of alcohol use on the label, or have medical conditions in which alcohol use can cause further harm. If you drink, use birth control exactly as prescribed, and if you miss a pill, use condoms until your next period. Be smart and learn your safe limits.
David J. Garry, DO, is co-director of obstetrics and maternal-fetal medicine and associate professor of clinical ob-gyn, Montefiore Medical Center/Einstein College of Medicine, Bronx, NY.