Clinical Edge

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Alcohol-Exposed Pregnancies in US

Study reveals adverse reproductive outcomes

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Alcohol use in pregnancy is associated with low birthweight, preterm birth, birth defects, and developmental disabilities. Women of reproductive age should be informed of the risk of alcohol use during pregnancy. This is the conclusion from data obtained from the 2011-2013 National Survey of Family Growth which generated US prevalence estimates of risk for an alcohol-exposed pregnancy for 4,303 nonpregnant, nonsterile women aged 15 to 44 years. Researchers found:

• The prevalence of any alcohol consumption over the prior month was approximately 70% for women 15 to 44 years of age who were not using contraception and who had sex in that month. It was only slightly higher in women who were trying to get pregnant than in those who were not.

• The prevalence of alcohol-exposed pregnancy was 7.3%.

• During a 1-month period, approximately 3.3 million women in the US reported drinking alcohol in the past month even though they had sex and did not use contraception, and so were at risk for an alcohol-exposed pregnancy.

• A developing baby can be exposed to alcohol before a woman knows she is pregnant. Approximately half of all pregnancies in the United States are unplanned.

• To help prevent adverse consequences of alcohol consumption during pregnancy, health care providers should discuss and recommend available contraception to women who are sexually active and drink alcohol.

• Women wanting a pregnancy should be advised to stop drinking at the same time contraception is discontinued.

• Healthcare providers should advise women not to drink at all if they are pregnant or there is any chance they might be pregnant.

• Alcohol misuse screening and behavioral counseling is recommended for all adults in primary care, including reproductive-aged and pregnant women, as an evidence-based approach to reducing alcohol consumption among persons who consume alcohol in excess of the recommended guidelines.

Citation: Green PP, McKnight-Eily LR, Tan CH, Mejia R, Denny CH. Vital signs: Alcohol-exposed pregnancies — United States, 2011–2013. MMWR Morb Mortal Wkly Rep 2016;65:91–97. doi: http://dx.doi.org/10.15585/mmwr.mm6504a6.

Commentary: Alcohol use during pregnancy is associated with a range of complications included under the term fetal alcohol spectrum disorders (FASDs). FASDs are characterized by permanent physical, behavioral, and intellectual disabilities. The estimated prevalence of FASDs, based on a study of first grade students in the United States, ranges from 2% to 5%.1 Any sexually active woman of reproductive age who is drinking alcohol and not using birth control is at risk for an alcohol-exposed pregnancy. If alcohol were a drug we prescribed, it would have a registration program and require 2 signatures that the patient was informed to use birth control in order to be prescribed the medication. Since alcohol use is so common, we often forget that it can have severe, long-term consequences when used during pregnancy. This MMWR heightens our awareness of this important issue. —Neil Skolnik, MD

1.) May PA, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics 2014;134:855–66. doi: http://dx.doi. org/10.1542/peds.2013-3319.

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