Alcohol Use in Pregnancy²

Abuse of alcohol is a significant societal problem in the United States; approximately 18 million Americans are chronic consumers of alcohol. Current estimates indicate that between 8 and 11 percent of women of childbearing age are either problem drinkers or alcoholics. Alcohol abuse exists within all socioeconomic levels of society. Review of drinking habits during pregnancy should form an essential part of perinatal history taking.

No safe level of alcohol consumption during pregnancy has been determined. Alcohol exposure in utero may result in a spectrum of abnormalities of fetal growth and development. Maternal consumption of 2 to 3 ounces of alcohol daily, often in association with "binge drinking," is frequently associated with fetal alcohol syndrome (FAS). Lesser intake of alcohol may produce subcombinations of signs of FAS; these lesser signs have been called fetal alcohol effects (FAE).

The effects of alcohol abuse during pregnancy can be summarized as follows:

1. Adverse Pregnancy Outcome, including an increased risk of spontaneous abortion.
2. FAS - The worldwide incidence of FAS is 1-3 births per 1,000 live births. To make the diagnosis of FAS, one abnormality from each of the following categories must be present:
   1. Prenatal or postnatal growth retardation; failure to thrive (weight, length, and / or head circumference less than the 10th percentile).
   2. Central nervous system dysfunction, including intellectual, neurologic, and behavioral deficits manifested as mild to moderate mental retardation, hypotonia (poor muscle tone), irritability in infancy, and later hyperactivity in childhood. Mental abnormality occurs in 85 percent of FAS children, and although IQ scores vary, affected children rarely show normal mental ability.
   3. Facial dysmorphology (structural abnormalities) including at least two of three characteristics:
      1. Microcephaly (head circumference less than the 10th percentile).
      2. Microphthalmia (abnormal smallness of the eye) or short palpebral fissures, ptosis (dropping eyelid), strabismus (imbalance of the eye muscles), or epicanthal folds (folds of the skin of the upper eyelid over the eye).
      3. Poorly developed philtrum, thin upper lip (vermilion border), short upturned nose, or flattening or absence of the maxilla (upper jaw).
3. FAE - Lesser degree of effect.