The placenta that connects a mother with her gestating baby is remarkably permeable, meaning that almost everything a woman puts into her body moves directly into the body of the fetus.
As a result, most doctors warn their patients to limit their exposure to any kind of dangerous substance, including alcohol. Even so, the U.S. Centers for Disease Control suggests that one in 13 pregnant women drinks alcohol, and nearly one in five pregnant women admit to having four or more drinks during a two-hour time span.
It can be hard for medical professionals to understand why women might feel so comfortable with drinking during pregnancy, as the risks and outcomes have been so widely publicized. Unfortunately, it’s also remarkably common for women to see articles like this one from Slate that seem to suggest that drinking during pregnancy is not dangerous at all. In some cases, women might be reading these alternate articles and choosing to follow advice that seems more positive to them. In other cases, however, women might continue to drink simply because they have an addictive attachment to alcohol, and as a result, they may not be able to modulate their behavior at all.
It can be difficult for referring professionals to deal with these issues, particularly during routine checkup appointments that might last for 30 minutes or less, but learning more about the specifichazards women and their babies face during each trimester might make the conversations a little easier to start.
First Trimester Risk
Some women become aware of their pregnancies almost immediately, as they’re hit with waves of nausea and signs of pain in the weeks that follow fertilization. Unfortunately, there are some women who remain unaware of their pregnancies for long periods of time, and they may continue to drink simply because they’re unaware of the fact that they’re poisoning the developing baby they’re carrying. It’s a sad situation, as the first trimester is the most dangerous time in which a woman could drink. The baby’s facial features and other anatomical structures are developing at this time, as are the brain and spinal cord. By the end of this trimester, the baby is fully formed, albeit quite small. Not surprisingly, drinking during this time can be catastrophic for the long-term viability of the baby’s health.
In a study of the issue, in the journal Alcoholism: Clinical and Experimental Research, clinicians found that every drink a woman consumes during the first trimester results in serious consequences, including:
- A 25 percent increase in the risk of lip abnormalities
- A 12 percent increase in the risk of head size abnormalities
- A 16 percent increase in the risk of low birth weight
- An increased risk of related neurological problems
The researchers are quick to point out that not all babies born to mothers who drink develop these problems. Often, fetal alcohol syndrome symptoms develop due to the influence of genetics along with the introduction of alcohol. But studies like this do suggest that even small amounts of alcohol consumption during this crucial stage of pregnancy could have a deep impact on the way a baby looks, and the drinking might even influence the ability of the child to function at a reasonable level as an adult.
Women who choose to binge drink during this crucial time, however, may do a significant amount of damage to the underlying circuitry of the brain and nervous system, according to research published by the 168-174.htm” target=”_blank”>National Institute on Alcohol Abuse and Alcoholism. In the study, researchers suggest that heavy alcohol consumption during the first trimester results in small brain size, altered brain circuitry and loss of specific types of nerve cells. Some of thatdamage may not become evident until the child is older, but it’s also not the type of damage that can be simply ignored or worked through.
Second Trimester Risks
While the first trimester remains the most dangerous time in which pregnant women might choose to drink, the second trimester carries its own risks.
In a study conducted by doctors with the English Born in Bradford research project, researchers found that drinking a moderate amount of alcohol during the second trimester results in a 68 percent increased risk of giving birth to a smaller-than-average child. Babies that are born small like this have a harder time regulating their body temperature, and they might need to spend time in the hospital in order to receive care from a critical care team. Very small babies also have increased risks of breathing issues, as well as brain abnormalities.
During the second trimester, most women are aware of the fact that they are pregnant, and presumably, they would be much more willing to take steps to protect their developing children. During this time, however, women might begin to feel physical pain from long bone shifts and pelvic separations, and some might struggle to sleep through the night. Alcohol might seem like a solution for these problems, and women with addictions might maintain that they need alcohol in order to stay comfortable.
Third Trimester Risks
While a fetus has few developmental changes to make during the third trimester, it is a time during which the lungs mature and the baby puts on the weight that makes thermoregulation more accurate. Some babies born during this time can survive, but often they need to spend a significant amount of time in the hospital in order to stay alive, and they might be left with subtle forms of scarring that impede their success as adults.
Women who binge drink during the third trimester may inadvertently condemn their children to this fate, according to a study in the American Journal of Epidemiology, as researchers found that binging during the third trimester results in the highest boost in risk of preterm delivery. Women who have been drinking throughout their pregnancies may deliver theirchildren much too early, and those babies might have all sorts of intense difficulties when they come into the world.
In addition to the risks already mentioned, babies born to mothers who drink can also experience:
- Heart defects
- Low vision
- Hearing deficiencies
- Organ failure
- Learning disabilities
- Behavioral difficulties
- Failure to thrive
These babies can be difficult to parent, as they can be fussy and easily upset, and they might be impossible to soothe. They might also struggle to grow and stay warm, demanding a significant amount of attention from their caregivers in order to stay alive. Women with alcoholism, who are presented with these chronically difficult children, might be driven back to drinking problems simply because they’re under an enormous amount of stress and have few coping skills that enable them to handle the pressure with grace.
Often, it’s best to stop the cycle by addressing the addiction before the birth takes place. By stopping the alcohol intake, the amount of damage the baby faces mightbe reduced, and the mother might be more capable of providing appropriate parenting.
An article published in The American Journal of Medicinesuggests that primary care doctors are in a perfect position in which to help their alcoholic patients, as they’re often involved in long-term care over the lifespan.
In some cases, so-called “brief interventions” have been helpful in addressing an alcoholism issue. Here, providers outline the symptoms of alcoholism they see, and they provide some straightforward advice about how users can stop drinking. If this talk is repeated, and clients are also encouraged to participate in Alcoholics Anonymous or another support group, it could quite effective for some.
Unfortunately, there are some addicted people who are too deeply entrenched in their habits and who cannot stop drinking, even though they might want to do so. Pregnancy might also be a difficult time for some women to make changes in their behaviors, as they might feel as though they’re under far too much pressure as it is, due to the alterations their bodies are going through on a regular basis. Adding in alcohol reduction might seem much too difficult for these people.
An interventionist might be a worthwhile ally, if the alcoholic woman will not change and her family wants assistance in bringing a change to life. In an intervention, the family has the opportunity to air their concerns publically, and they have the chance to lean on the expertise of someone trained in the field of addiction recovery. Conversations held by these professionals can be profoundly persuasive, and they can sometimes push an alcoholic person into treatment, even if that person has previously resisted all attempts to gain assistance for an addiction issue.
Once a successful intervention has been held, the person is encouraged to enter into a formal treatment program for addiction. Those programs might be provided on an inpatient basis, allowing the woman the opportunity to escape the pressures of her everyday life, but some women find it more palatable to participate in outpatient care, so they can continue to live at home with their families and provide care for any children who might already be living in a home.
No matter which setting provides the woman care, counseling is likely to play a major role. This counseling can take many forms. Some counseling is designed to use a problem-solving approach, in which the woman has the opportunity to think about the triggers that spark a drinking episode and develop new skills that could help her to handle those triggers. Some counseling involves boosting a woman’s motivation to change. This Motivational Interviewing technique has been proven effective in pregnant women, according to a study in the journal Pediatrics, as just four sessions resulted in remarkable results. Of the participants, 68.5 percent were no longer at risk for an alcohol-impacted pregnancy. It’s easy to see how longer sessions might be even more effective.
Pregnant women might also benefit from additional wraparound care. For example, some women need assistance from social workers, so they can find safe places in which to live and raise children. Some benefit from parenting classes, so they can learn how to raise their children in a supportive and nonviolent manner. Others need legal assistance, possibly due to difficulties with the birth father. Some even need assistance with the food stamp enrollment process. Programs that provide this level of care might be ideal for women with very complex cases of alcoholism.
It’s common for providers to respond with alarm when their pregnant clients admit to drinking. It can be difficult to know where to turn for help or what to do when the concept comes to light. It’s important to remember, however, that these problems rarely disappear on their own. Those doctors who do take action may be saving the health of their patients, as well as the health of the babies who haven’t yet been born.
If you have specific questions about how treatment might help a loved one, or you’d like to know more about specific treatment facilities that might be appropriate for your patients, please call us. Foundations Recovery Network is a professional group of facilities that stretch from coast to coast, and we’re happy to link you with the facility that might provide the right care for your situation. Call to find out more.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.