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ALCOHOL IN PREGNANCY: PART 1

A quality hoppy beer is an indulgence for me.  My favorite is a Bell’s Two Hearted Ale, named after a river famous for fly fishing in my home state of Michigan. In fact, one of my favorite ways to spend a free weekend evening is hanging out at a local brewery. 

One of the best is Trophy Brewing Company on Hillsborough Street.  They have a fun atmosphere, delicious pizza, and several innovative beers in rotation.  Consider getting some samples and trying a new type of beer. Trophy has a Gose on tap now, which is a trendy style in the beer world. Gose (pronounced ‘GOH-zuh’) is a light, slightly sour German beer with a teeny bit of salt added. Big Boss is another great local brewery that offers free tours on the second Saturday of each month with $1 beers to sample.  The brewing area tends to get hot or cold depending on the weather, so make sure to dress appropriately!

I don’t have the opportunity to talk much about my “beer hobby” in the office, since so many of our patients are pregnant, trying to get pregnant, or breastfeeding. If I do mention that I’m a hophead, I’m often asked, “Can I have a few sips? How much alcohol is safe in pregnancy? Does beer really help the milk let down when breastfeeding?” 

A survey of Ob/Gyn doctors in 2010 reported that 66% advised their patients that occasional alcohol consumption is not safe at any point in pregnancy.   The remainder didn’t have quite a hard line on alcohol use in pregnancy.  Since I love my saisons, IPAs, and Doppelbocks, I decided to do my own research about alcohol use while pregnant and breastfeeding.  I was surprised with what I found…

We have known about the adverse effects of alcohol on fetal development since 1973, when fetal alcohol syndrome (FAS) was first described.  The US Surgeon General issued a public health advisory in 1981 cautioning the public that alcohol use in pregnancy causes birth defects. And later in 1989, this warning was added to the label of all alcoholic beverages.

FAS is diagnosed with characteristic facial features (short distance between inner and outer corner of eye, thin upper lip, and smooth philtrum), growth retardation, and neuro-cognitive impairment.  Since there are some affected by alcohol use in pregnancy that do not fit the strict definition of FAS, the umbrella term of Fetal Alcohol Spectrum Disorders (FASD) has come into use.  This term covers the varying, and often long term, effects of alcohol use– physical, cognitive, and behavioral effects.  Birth defects involving the heart, bone, kidneys, eyes, and ears have been correlated with alcohol use in pregnancy.  Difficulty with balance and other gross motor skills, like handling a ball, have also been associated.  A range of behavioral issues, including hyperactivity, difficulty concentrating, trouble regulating mood, and poor social skills are linked to alcohol use in pregnancy.

Based on all of this, alcohol is certainly a teratogen (pronounced ‘teh-RAT-oh-jen,’ a scientific term for an exposure in pregnancy that causes harmful effects).  And, alcohol readily crosses the placenta.  A fetus can only clear alcohol at 3-4% of the rate mom does, and exposure for the fetus is often prolonged due to swallowing and absorption of amniotic fluid. Furthermore, there is no exact ‘dose-response’ curve with alcohol intake – meaning that no study has been able to determine a threshold for what amount of alcohol, if any, is safe in pregnancy.

The American Academy of Pediatrics issued a statement in November 2015: “No amount of alcohol in any trimester of pregnancy should be considered safe.”  After weighing the evidence, I agree.

So, what about after your sweet little one is born, is it OK to have an IPA or glass of wine while breastfeeding? Stay tuned for the answer in blog #2… and I’ll also let you in on some of my favorite beer stores in town.

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