Pregnant Drinking and Fetal Alcohol Syndrome Disorder

By Temma Ehrenfeld  @temmaehrenfeld
October 30, 2023
Pregnant Drinking and Fetal Alcohol Syndrome Disorder

Children born with the worst kind of brain damage from fetal alcohol syndrome disorder have characteristic symptoms: small heads and eyes and a thin upper lip. 

Alcohol in the womb has affected many more children than experts once thought. 

Children born with the worst kind of brain damage from alcohol exposure in the womb have characteristic symptoms: small heads and eyes and a thin upper lip. They suffer from fetal alcohol syndrome disorder and can end up with intellectual disabilities.


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The long-term effects of alcohol on children

But children can lack the signs of the disorder and still suffer as they grow up from the effects of an early alcohol bath. They may be impulsive and distractible and have a hard time doing tasks in order. They may fall behind in language skills and make bad judgment calls. 

Those symptoms sound similar to attention deficit hyperactivity disorder or simply be labeled with having behavioral problems. But many of them may be diagnosed with fetal alcohol spectrum disorder, which means that they’ve been affected by alcohol but fall short of the diagnosis of fetal alcohol syndrome.     

A seminal study showed that 2 to 5 percent of first-graders in a mainly white, middle-class Midwestern city had fetal alcohol spectrum disorder, falling somewhere along a curve from the worst cases to the least. Children with symptoms of the disorder are often diagnosed with other psychiatric issues and put in special education classes.

Previous estimates had been lower, and other experts say that the problem may be even more common. Doctors are still working out the best ways to diagnose fetal alcohol spectrum disorder, and they may disagree about any one child. Sometimes a child is incorrectly labeled with fetal alcohol syndrome when she has another disorder. 

When psychiatrist Carl Bell, MD, conducted a study of 611 of his patients in a low-income African American community on Chicago’s South Side, he concluded that almost 40 percent had some form of fetal alcohol spectrum disorder, including some with fetal alcohol syndrome. 

Ira Chasnoff, MD, a pediatrician treating Chicago kids and teens with serious behavioral problems who were adopted or in foster care, concluded that nearly 30 percent suffered from fetal alcohol spectrum. He put the patients through a full day or more of testing. For 80 percent of them, it was the first time they’d been diagnosed, he reported

How many pregnant women drink?

The Centers for Disease Control and Prevention estimates that about 10 percent of pregnant women in the United States drink alcohol, but those numbers may also be too low. 

One reason is that the damage begins as early as three weeks after conception — before a mother will even know she’s pregnant. Consuming four or five drinks around that time can interfere with brain development in the fetus.

Every major medical organization in the United States agrees that the best advice is for women not to drink alcohol when they’re pregnant or when there is a possibility of trying to become pregnant.

Can you drink even just a little?

In the United States, nearly half of pregnancies are unplanned. If you’re having unprotected sex and are of child-bearing age, you should not drink either.

Some women think that their children are safe as long as they stop drinking once they know they’re pregnant. Yet by one well-respected estimate, drinking during the first trimester (versus no drinking) produces 12 times the odds of giving birth to a child with symptoms somewhere along the spectrum that ends in fetal alcohol syndrome.   

Other women think that having a glass of wine or a beer or two occasionally during pregnancy doesn’t count. It’s true that heavy drinking will do more damage. But drinking any alcohol increases the chance of bearing a child with behavioral problems. Red wine is no safer than white wine, beer, or mixed drinks.

Some women realize that they drank in the first trimester and assume the damage is done — so they keep drinking. Drinking in both the first and second trimester increases the odds of hurting your child 61 times, and drinking in all trimesters increases the odds 65 times.

If you drank during your pregnancy, you should tell your child’s pediatrician or mental health counselor about your drinking habits at the time. The same goes with your obstetrician if you’re pregnant now.

A doctor can help mothers who are pregnant and drank early on or after. There’s some evidence that taking vitamin A, choline, folate, and iron prior to conception and during pregnancy may help your future baby’s brain development, as will taking prenatal vitamins.

Another reason to be honest is that targeted coaching can make a big difference. “You have to raise these kids differently than other children,” Bell says.

Public programs may help. If your child is younger than three, contact your local early intervention system. The local elementary school or board of education can steer you towards help even before your child enrolls. 

Medical care can possibly help a child with the right diagnosis. Supplements might be worth a try. Bell gives patients vitamin A, folate, choline, and omega-3 supplements. Choline supplements may help children with symptoms of fetal alcohol spectrum disorder.

Look for resources and support through the American Academy of Pediatrics


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October 30, 2023

Reviewed By:  

Christopher Nystuen, MD, MBA