The Real Risk of Drinking Before You Know You're Pregnant

Many people drink alcohol without knowing they’re pregnant—and it often ends up fine. Here's what you need to know about your risk of fetal alcohol syndrome while expecting.

Friends Toasting alcohol with Wine glasses In Restaurant
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Not every pregnancy is planned, and those that are can take time—so it's not surprising that you may have enjoyed a few adult beverages at some point after sperm meets egg, completely unaware that you're expecting. Cue panic, and an attempt to remember how much (and what) you imbibed.

Why the concern? The Centers for Disease Control and Prevention (CDC) has a clear stance: There's no known safe amount of alcohol use during pregnancy. Because alcohol passes directly from the parent's bloodstream to the fetus through the umbilical cord, alcohol use during any point in the pregnancy can result in miscarriage, stillbirth, and a range of issues known as fetal alcohol spectrum disorders (FASD).

Fetal alcohol syndrome (FAS), one of the most complex disorders under the FASD umbrella, can result in serious issues with the central nervous system, developmental problems, and specific physical characteristics. Some kids may have subtle damage that isn't even noticed until they begin school, when learning and behavior problems become apparent.

Whether you enjoyed a single ballpark brew or a crazy night out before your first positive pregnancy test, it's normal to wonder—and worry—whether you've put your future child's health at risk. You might be asking, "I drank before I knew I was pregnant—now what?"

Accidents like these happen more often than you may think, and you shouldn't add stress and misery to your pregnancy because of an early slip-up. Instead, talk to your doctor about your concerns, and follow the advice below to understand your risks of fetal alcohol syndrome.

Try Not to Worry About Drinking Before Knowing You Were Pregnant

Although having a couple of drinks before you knew you were pregnant isn't ideal, it's somewhat common. "Half the women in the U.S. drink alcohol and half of all pregnancies are unplanned, so there are many cases of women realizing they drank before discovering they're expecting," says Robert Sokol, M.D., professor of obstetrics and gynecology at Wayne State University School of Medicine in Detroit.

Indeed, according to the National Institute on Alcohol Abuse and Alcoholism, about 20-30% of pregnant people reported drinking during pregnancy, and more than 8% reported binge drinking. Both instances happened most often during the first trimester.

It may be difficult not to worry, but do your best not dwell on the past. "Once you're pregnant, stop drinking," says Dr. Sokol. The AAP notes that if the pregnant person stops drinking, the baby will likely do better.

Remember Every Pregnancy is Different

Not every person who drinks during pregnancy will bear a child with fetal alcohol syndrome. In fact, some people may have a genetic predisposition that decreases the vulnerability of their fetus to alcohol damage, and others may experience the opposite (certain people may have genes that increase the risk of an FAS-related birth). Those of advanced maternal age are in the latter category: "Older women tend to be heavier, so the more body fat one has, the faster the blood alcohol content rises because fat doesn't absorb alcohol like muscle does," says Dr. Sokol.

Other factors—like your environment, nutrition, and smoking habits—can affect your odds of fetal alcohol syndrome. Another important influence is how much and how often you drank alcohol. "The more alcohol a woman drinks the higher the risk is for the developing fetus to have alcohol-related brain and organ damage," according to the American Academy of Pediatrics (AAP). Binge drinking (having four or more drinks in two hours) and regular heavy drinking is the most risky behavior.

Follow Doctor's Orders

Ideally, you should assess your health before becoming pregnant so you can start your pregnancy on the best foot possible. This means taking preconception folic acid (400 mcg) for at least a month to reduce the chance of a neural tube defect, as well as cutting out smoking and drinking.

Some studies suggest the most severe damage happens while drinking in the first three months of pregnancy, so abstinence is recommended when trying to conceive, says David Garry, D.O., a spokesperson for the American Congress of Obstetricians and Gynecologists (ACOG) and a maternal fetal medicine specialist at Montefiore Medical Center in Bronx, NY.

And if you did drink while pregnant? Don't hesitate to talk openly with your health care provider so you can understand your real risks—and hopefully put your mind at ease. Depending on your circumstances, it may be helpful to know that FASDs include a range of disabilities—both physical and intellectual—that may not even be visible when your child is born. While there is no known cure for FASDs, research shows that early intervention therapies may help improve a child's development.

Also, don't hesitate to ask for help if you're having trouble eliminating alcohol from your diet. Your health care provider can direct you to support and resources.

The Bottom Line

Some organizations estimate 40,000 babies are born with a FASD each year—and anywhere from 800 and 8,000 babies might have FAS, according to the AAP. That said, drinking during pregnancy isn't a guarantee that your child will be affected. The best advice is also the simplest: For the healthiest baby, stop drinking the moment you decide you'd like to get pregnant.

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