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Pregnancy and Childbirth: The answers

 

Alcohol in Pregnancy

The effects of alcohol on pregnancy are quite different from those of smoking. There is current debate whether alcohol in moderation is safe in pregnancy. In early 2008, The National Institute for Clinical Excellence (NICE) in the UK released a recommendation stating that alcohol consumption at any rate may not be safe in pregnancy therefore advising pregnant women to abstain from alcohol consumption altogether during the course of the pregnancy.  This in fact followed a similar advice given by the Royal College of Obstetricians and Gynaecologists (RCOG)  a year earlier. This has been a cause of a lot of debate since. A simila r advice has been in place from the Surgeon General in the United States since 2005 echoeing the NOFAS  slogan in place for almost two decades (see below).

 

Whilst the above, seemingly extreme advice might be a cause for legitimate debate, there is no argument regarding heavy and sustained drinking in pregnancy. Here, the risk of serious adverse effects, which may include a profoundly disabled child is not in any doubt.

 

The issue of alcohol use and abuse is a broad one and is not confined to the narrow question of whether the baby will be affected or not. There are other relevant facts: that an alcohol-dependent mother is more prone to physical trauma and life-threatening infections such as Hepatitis B, HIV etc. There are also other ramifications.

 

Degree of alcohol drinking that is safe in pregnancy

There is still a fair degree of debate on this as discussed above. The conventional advice for some years now has been that an average consumption of fifteen units of alcohol per week is safe. This message has always been given with a note of caution. Since bio­logical phenomena hardly ever obey strict rules, it is probably wiser to stick well below this level.

The revised advise to abstain from alcohol altogether was largely based on the fact that, some cases of Fetal Alcohol Syndrome (see below) have been reported among mothers where there was credible evidence that their consumption fell well within the ‘recommended’ 15 units per week.

This RCOG recommendation is in fact not new. In the United States, this has been the recommendation for almost 20 years, since 1989. The National Organization on Fetal Alcohol Syndrome (NOFAS) states: "No safe time. No safe amount. No safe alcohol. Period."

Adverse effects of alcohol during pregnancy

A moderately heavy drinker (18 to 20 units per week) runs the risk of ending up with a low birth-weight baby. Smaller babies are more likely to suffer illness in the immediate post-delivery period.

 

A heavy drinker imbibing more than twenty units of alcohol per week runs a far more serious risk. This is in the form of what is known as "fetal alcohol syndrome". The effects of this are life-long for the individual. This syndrome is characterized by:

Ø Fetal growth restriction (worse than that seen in moderate drinking),

Ø Neurological abnor­malities,

Ø Developmental delay,

Ø Intellectual impairment and

Ø Facial deformities.

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