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AAP says no amount of alcohol should be considered safe during pregnancy

21 October, 2015
No Amount of Alcohol Safe During Pregnancy, Doctors Say.nlm.nih.gov. October 19, 2015- American Academy of Pediatrics issues new warning to women of childbearing age.While some studies have hinted that a little alcohol might be harmless during pregnancy, a leading U.S. pediatricians’ group has issued a new warning that no amount of drinking is safe while pregnant.Read also: Women who drink alcohol in the early stages of their pregnancy might damage their placenta & Even moderate amounts of alcohol in pregnancy can have an effect on future child intelligence
AAP says no amount of alcohol should be considered safe during pregnancy
"The only guarantee of having no effects from alcohol is no prenatal alcohol exposure," said Dr. Janet Williams, a professor of pediatrics at the University of Texas Health Science Center and co-author of the new statement and report from the American Academy of Pediatrics (AAP).
It’s likely, she added, that future research will continue to show that "alcohol has subtle yet important lasting effects on academic performance, attention, behavior, cognition, memory, language skills, and visual and motor development."
Physicians and researchers have been warning about the hazards of alcohol use during pregnancy for decades. Yet almost half of all women of childbearing age in the United States reported consuming alcohol within the past month, the researchers said, and nearly 8 percent of women continue to consume alcohol during pregnancy.
The AAP published its new statement in part to update health workers and the public, Williams said.
According to the new report, published online Oct. 19 in the journal Pediatrics, alcohol use during pregnancy can cause thinking and behavioral problems that last a lifetime. "No amount of alcohol intake should be considered safe," the report stated, and "there is no safe trimester to drink alcohol."
The report said that all forms of alcohol — beer, wine and liquor — pose similar risks. Getting quickly drunk, known as binge drinking, poses a higher risk in line with the extra amount of alcohol consumed, the report noted. According to Williams, binge drinking in women is defined as four or more standard drinks, typically within two hours.
Some studies published over the last few years have hinted that a small number of drinks during pregnancy could be safe. For example, research published in 2010 in the Journal of Epidemiology and Community Health found no extra behavioral or thinking risks from having one or two drinks a week.
However, "studies do not conclude that alcohol use is safe," Williams said. Instead, they only show "that in certain study populations under certain conditions, there is or is not sufficient evidence of effect that can be attributable to alcohol exposure."
Indeed, according to Janni Niclasen, an assistant professor of psychology at the University of Copenhagen who has studied alcohol and pregnancy, "With our current research methods, we will never be able to conclude from human studies whether there is a safe lower level below which drinking is not associated with any harm to the developing fetus."
Of course, many women inadvertently drink alcohol without realizing that they’re pregnant. And alcohol often plays a role in sexual encounters aimed at producing a baby, including those that may occur when a woman doesn’t know she’s pregnant. So, should women of childbearing age always avoid alcohol?
Williams isn’t willing to go that far, and would only say that alcohol and pregnancy don’t go together. She added that some women, despite the findings of research, "continue to rationalize that their own alcohol use during pregnancy is sufficiently low or infrequent to be safe."
Niclasen, the Denmark researcher, said women who are pregnant or trying to become pregnant should avoid all alcohol. "I am often called a moralist for having this perspective, but I think we need to focus on the development and future life of the unborn children," she said.
Christina Chambers, a professor of pediatrics at the Center for Better Beginnings at the University of California, San Diego, offers this advice: "Women of childbearing age who drink alcohol should consider their pattern of drinking. For example, avoid binge drinking and avoid pregnancy as long as they are drinking. If pregnancy is planned, then alcohol can be discontinued."
There may be no risk "if a woman has consumed small amounts of alcohol prior to knowing she is pregnant," she said, but "the best advice is to avoid pregnancy if drinking and to avoid drinking if pregnant."
According to both Williams and Chambers, alcohol use poses risks in all stages of pregnancy, and neither would say the risk is higher in certain stages.
Overall, Chambers said, the AAP’s statement "is an important stand to take, and hopefully it will lead to less stigma associated with [fetal alcohol spectrum disorders] and to more access to and uptake of prevention and treatment services."
SOURCES: Janet Williams, M.D., professor, pediatrics, University of Texas Health Science Center, San Antonio; Janni Niclasen, Ph.D., assistant professor, psychology, University of Copenhagen, Denmark; Christina Chambers, Ph.D., M.P.H., professor, pediatrics, Center for Better Beginnings, University of California, San Diego; November 2015, Pediatrics
HealthDay___________________________________________________________________________________________________Read aslo: AAP Says No Amount of Alcohol Should be Considered Safe During Pregnancy.aap.org. October 19, 2015. A new clinical report from the American Academy of Pediatrics (AAP) identifies prenatal exposure to alcohol as the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities in children. The report, "Fetal Alcohol Spectrum Disorders," in the November 2015 issue of Pediatrics (published online Oct. 19) stresses that no amount of alcohol should be considered safe to drink during any trimester of pregnancy. 
Fetal alcohol spectrum disorders (FASDs) is an all-encompassing term for the range of effects that can occur in someone whose mother drank alcohol during pregnancy. Neurocognitive and behavioral problems from prenatal alcohol exposure are lifelong, but early recognition, diagnosis and therapy for any FASD condition can improve a child’s health. 
Unfortunately, a lack of uniformly accepted diagnostic criteria for fetal alcohol-related disorders has critically limited efforts that could lessen the impact of FASDs, says Janet F. Williams, MD, FAAP, one of the report’s lead authors. 
"Even though fetal alcohol spectrum disorders are the most commonly identifiable causes of developmental delays and intellectual disabilities, they remain significantly under-recognized," said Dr. Williams. 
Prenatal alcohol exposure is a frequent cause of structural or functional effects on the brain, heart, bones and spine, kidneys, vision and hearing. It’s associated with a higher incidence of attention-deficit/hyperactivity disorder and specific learning disabilities such as difficulties with mathematics and language, visual-spatial functioning, impaired impulse control, information processing, memory skills, problem solving, abstract reasoning and auditory comprehension. 
In surveys, about half of all childbearing age women in the United States report consuming alcohol within the past month, and nearly 8 percent of women said they continued to consume alcohol during pregnancy. A recent study found increased risk of infant growth retardation even when a pregnant woman’s consumption was limited to 1 alcoholic drink per day (a 1.5-ounce shot of distilled spirits, 5 ounces of wine, or 12 ounces of beer).  
First-trimester drinking, compared to no drinking, results in 12 times the odds of giving birth to a child with FASDs. First- and second-trimester drinking increased FASDs odds 61 times, and women who drink during all trimesters increased the likelihood of FASD odds by a factor of 65. 
"The research suggests that the smartest choice for women who are pregnant is to just abstain from alcohol completely," said Dr. Williams. 
The AAP offers several resources for on prenatal alcohol exposure, including an FASD Toolkit for physicians (http://www.aap.org/fasd) and a set of frequently asked questions for parents on Fetal Alcohol Syndrome Disorders (https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders-FAQs-of-Parents-and-Families.aspx),  
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The American Academy of Pediatrics is an organization of 64,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. (www.aap.org)
____________________________________________________________________________________________________Read also: Fetal Alcohol Spectrum Disorders.pediatrics.aappublications.org.Janet F. Williams, MD, FAAP, Vincent C. Smith, MD, MPH, FAAP, the COMMITTEE ON SUBSTANCE ABUSEABSTRACT:  Prenatal exposure to alcohol can damage the developing fetus and is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. Subsequently, research unequivocally revealed that prenatal alcohol exposure causes a broad range of adverse developmental effects. Fetal alcohol spectrum disorder (FASD) is the general term that encompasses the range of adverse effects associated with prenatal alcohol exposure. The diagnostic criteria for fetal alcohol syndrome are specific, and comprehensive efforts are ongoing to establish definitive criteria for diagnosing the other FASDs. A large and growing body of research has led to evidence-based FASD education of professionals and the public, broader prevention initiatives, and recommended treatment approaches based on the following premises:
Alcohol-related birth defects and developmental disabilities are completely preventable when pregnant women abstain from alcohol use.
▪ Neurocognitive and behavioral problems resulting from prenatal alcohol exposure are lifelong.
▪ Early recognition, diagnosis, and therapy for any condition along the FASD continuum can result in improved outcomes.
▪ During pregnancy:
◦no amount of alcohol intake should be considered safe;
◦there is no safe trimester to drink alcohol;
◦all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and
◦binge drinking poses dose-related risk to the developing fetus.

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