MUSC experts weigh in on discussion about alcohol and pregnancy

Helen Adams

November 04, 2015

Woman's pregnant belly, beer bottle — The American Association of Pediatrics recommends that pregnant women avoid alcohol.

When Scott Sullivan, M.D., heard the latest recommendation about drinking while pregnant, he said, “I smiled a little bit, because this is one of those controversies that never really goes away. It just cycles through.”

The word from the American Academy of Pediatrics to pregnant women: Avoid alcohol completely. It’s just too risky.

Some women quickly shot back on social media and news reports, saying pregnancy can be stressful, and a glass of wine every now and then won’t hurt anything.

Sullivan, a maternal fetal medicine specialist at the Medical University of South Carolina, said the AAP is absolutely right to point out that avoiding alcohol removes the risk of fetal alcohol spectrum disorder. FASD causes problems that range from subtle to severe. They include behavior problems, abnormal facial features, a small head, poor coordination and heart, kidney and bone issues. FASD is also one of the more common causes of intellectual disability, and alcohol use can lead to miscarriage, stillbirth and premature birth.

Part of the problem fueling the debate over drinking during pregnancy is a lack of comprehensive data, Sullivan said. “We’re never going to do a controlled, randomized study on this. We’re never going to take pregnant women and give them a glass of wine – it would take thousands of women – and see how that works out. Without that kind of data, we’re going to keep arguing about it.”

That’s not to say there’s been no research on low, moderate alcohol use during pregnancy. MUSC psychiatrist Connie Guille, M.D., specializes in helping pregnant women who have mental health issues, including alcohol dependency. “There’s a small subset of studies that have looked at low, moderate use of alcohol and have demonstrated that there isn’t risk,” she said. “The problem with those studies is they only looked at a couple of outcomes, when we know that fetal alcohol spectrum disorder encompasses a myriad of poor outcomes, including physical, intellectual and emotional problems for children.

"The other issue the studies haven’t really addressed is timing, really characterizing the timing of alcohol exposure and when there might be a differential risk.”

Her conclusion: “For now, I think there are very clear risks and probably very little benefit from any alcohol use during pregnancy.”

Sullivan said an unintended consequence of the AAP recommendation is that it may scare some women who really don’t need to worry. “I hate to see patients who have alcohol before they know they’re pregnant or choose to have a rare sip of wine or glass of wine, think they damaged the baby. It’s not really true.”

Sullivan said the people he worries about are problem drinkers who hide their alcohol use from doctors. “It’s long, long chronic use through the pregnancy that causes the harm. If you can intervene early, you really can save the baby.”

He hopes a new screening tool at MUSC will lead to more early interventions. When a pregnant woman comes to MUSC, she’ll be asked in private about alcohol, drugs, smoking and domestic violence. “If there’s a hit, we help people. We don’t get judgmental. We don’t shame them. We really try to help them and their babies.”

Guille said in some cases, pregnancy causes women to make changes they weren’t able to make before. “It can be a time when there’s enhanced motivation to meet that challenge and engage in more healthy behaviors. They want what’s best for their babies.”

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Helen Adams