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Experts say no amount of alcohol is OK during pregnancy. Abraham Gonzalez Fernandez/Getty Images
  • A new report states that heavy alcohol consumption increased among pregnant women between 2011 and 2020.
  • Experts say this is a worrisome trend because any amount of alcohol during pregnancy poses risks for an unborn child.
  • They say stress, anxiety, and depression can lead to alcohol use during pregnancy, but they add that there also appears to be a general relaxation about drinking while pregnant.

Look, here’s the deal. If you drink alcohol while you’re pregnant, you may be ruining your baby’s chances of ever having a normal life. All forms of alcohol are dangerous, even beer and wine. Play it smart. Alcohol and pregnancy don’t mix.”

That’s the message from a public service announcement the federal government released in 2015. Even before that, the warnings have been out there for decades.

Despite these warnings, however, a new study published in JAMA Network reports that over a decade’s time, binge drinking increased by nearly 9% per year and heavy alcohol consumption increased by more than 11% per year among pregnant women.

The team of public health researchers looked at data for pregnant women ages 18 to 44 from the Behavioral Risk Factor Surveillance System (BRFSS) from January 2011 to the end of 2020. The BRFSS is a national cross-sectional sample of U.S. adults that measures alcohol consumption. The information comes from the participants’ own 30-day recall.

“Binge drinking” was defined as 4 or more drinks on a single occasion. “Heavy alcohol consumption” was defined as 8 or more drinks per week.

Jeffrey T. Howard, PhD, an associate professor of public health at the University of Texas at San Antonio and lead author of the study, says his team was looking at causes of maternal deaths and came across the unexpected numbers involving alcohol.

“What really surprised me the most was what showed up in maternal mortality. We really weren’t expecting to see this large increase in drug and alcohol poisoning among this group,” he told Healthline.

“It was disheartening to see that both binge drinking and heavy alcohol consumption did increase in pregnant women In the last decade. I’m not particularly surprised by it, unfortunately,” said Dr. Vanessa Parisi, OB-GYN, the president of the New Jersey OBGYN Society and a team member of the American College of Obstetricians and Gynecologists (ACOG) Fetal Alcohol Spectrum Disorder (FASD) Prevention Program.

“The work has to start with the education of the medical provider,” she told Healthline. “How to ask open-ended questions without stigma. To tell our patients there is no safe amount, type, or timing of alcohol in pregnancy.”

“Providers need to screen and intervene when we have at-risk or high risk patients and refer them to treatment,” she added.

The study did not go into the possible reasons behind the increase in numbers.

That’s something Dr. G. Thomas Ruiz, an OB-GYN at MemorialCare Orange Coast Medical Center in California, would like to have seen.

“The study doesn’t really expand on why we’re seeing more of this type of behavior. It leaves it up to us to come up with our own conclusions,” he told Healthline.

“What we know is that in terms of mental health, high anxiety, depression, and social stressors, people will often turn to alcohol or drugs to self-medicate to make them feel better,” Ruiz said. “That’s part of one of the things within the human condition. Stressors like the inability to buy a house, high student debt, making ends meet, trying to decide if you’re going to have a family, all of these social stressors can create an anxiety state.“

Howard says that’s what the research team is working on now.

“We’re currently engaged in a larger study to understand their stressors and other kinds of factors,” he explained. “Financial hardships, potential exposure to intimate partner violence, access to healthcare, things that put a lot of stress on pregnant women in particular.”

Besides the socioeconomic factors, experts say there is a growing phenomenon they’ve noted that may also be at work.

“I think there is a counter-narrative out there, not necessarily in the scientific literature, but in the popular self-help kind of literature out there,” Howard said. “There are some folks out there who trivialize this and you know, ‘it’s not a big deal.’ They don’t necessarily say it’s OK to binge drink… but it’s more of a message of just kind of accepting alcohol consumption generally as something that’s OK and not a big deal.”

“I don’t know how prominent it is and I’m not trying to attribute it all to that. I’m just saying there is a kind of a counter-narrative out there,” he added.

“We want our patients to have autonomy and to ask many questions,” said Parisi. “Patients are reading more than ever and are being influenced by the media, friends, and family, and not all of those sources are created equal nor evidence-based.”

“A lot has changed in medicine. It used to be ‘Yes, Doctor, whatever you say.’ I’m not saying it should go back to that” Parisi said. “But we as physicians have to gain a rapport with our patients, destigmatize care, and patients need to find providers they can work with and rebuild trust.”

“We as providers need to combat recommendations that are not evidence-based and still promote shared decision making,” she added.

Ruiz says he believes one of the most important ways to hammer the message home is through one-on-one relationships.

“A lot of it has to do with the relationship between the provider and the patient,” he said. “In my practice, everybody at the beginning of the pregnancy, we do kind of general counseling and we try to get to them before pregnancy.”

“When that patient is in the office, we go through and discuss, as part of the counseling of a newly pregnant woman, what is safe behavior during pregnancy. We also discuss smoking and THC use in those initial early prenatal care visits” he explained.

Ruiz says they also provide patients with a web app so they can access the information they need to guide them through their pregnancy.

“Our FASD work group at ACOG works to educate patients on the risks of prenatal alcohol exposure,” Parisi said. “There have been studies showing that not all providers instruct their patients to completely abstain and that is unfortunate.”

But she says finding the time to get the information out can be a problem.

“We are all strapped for time, particularly those in private practice. I was in solo private practice for many years” she explained. “It can be very challenging to properly screen patients while gathering their history, approaching their intimate needs and concerns, and doing a directed physical.”

“We should all be using a validated screening tool like AUDIT-US” she added. “Properly tackling this at preconception and annual visits can address the issue and drastically decrease the incidence of FASDs.”