Alcohol-Related Birth Defects

Remember those “Miracle of Life” movies they showed in high school health class to explain the stages of human development? However much you rolled your eyes or slept through them at the time, the title isn’t an exaggeration — life is a miracle. It’s mind-boggling if you think about it: somehow, a tiny cell divides and grows into a complex cluster that continues to divide and differentiate, eventually becoming, well, you!

Another key fact those videos drilled into us from an early age is that pregnancy is a no-drinking zone. No matter what your next-door neighbor or great aunt said was true “back in the day,” there’s no wiggle room here. Alcohol-related birth defects are a sad reality of drinking during pregnancy. Let’s find out more about how they develop and how to prevent them!

Why Alcohol in Pregnancy Is Dangerous

According to the CDC, drinking during pregnancy isn’t safe. This simple statement is crucially important to understand. Alcohol can affect the fetus at any stage, including the time we don’t even know we’re pregnant yet — before that missed period, the home pregnancy test, and the 3-minute wait for the telltale line to appear (or not). (For an in-depth look, check out our blog “What Are the Risks of Drinking Alcohol While Pregnant?”)

Alcohol Through the Pregnancy Journey

So what’s the connection between pregnancy, alcohol, and birth defects? Let’s take an overall view of the stages of fetal development and see what role alcohol plays in each one. (Spoiler alert: while the exact effects and their severity may vary, the answer is the same — there is no known safe amount of alcohol during pregnancy at any developmental stage.)

• Zygote stage: off to the races. The zygote enters the uterus about two or three days after fertilization. Now, it’s all about building up the emerging blastocyst (pre-embryo) so it can be implanted on the uterine wall, which happens after about six days. At this point, alcohol consumption might not have a direct effect on development (there’s no embryo to speak of yet). However, this doesn’t mean we’re in the clear to drink — alcohol can interfere with implantation, leading to miscarriage.
• Embryonic stage: planning in progress. After the blastocyst implants itself on the wall of the uterus, the embryonic stage begins around the third week of pregnancy and ends around the eighth. This is the crucial time when a “blueprint” for every organ system will form, setting the stage for further development. 
  
  At this critical stage, alcohol can do some of the most damage to the developing organ systems. During the third and fourth weeks, the neural tube develops, eventually giving rise to the brain and spinal cord. Any interference with this delicate process can lead to serious developmental problems down the road.
  
  Likewise, the structures that give rise to the heart develop during the embryonic stage (around the third and fourth week). This, too, is a delicate time as far as possible damage by alcohol is concerned — any glitches in the process can spell trouble. 
• Fetal stage: filling in the blueprint. Somewhere around the eighth week of pregnancy, the fetal stage begins. For the next few months, the blueprint created in the first few weeks will be filled in by what will eventually turn into a full-term baby ready to meet the outside world! (Alcohol continues to pose a risk at this time.) 
  
  Then the central nervous system emerges from so-called radial glia cell pools, directing the formation and migration of neurons. Alcohol can interfere with the signal pathways and reduce the fetus’s brain volume.

All in all, at each stage, there’s potential harm that can cause developmental delays further down the line. This harm is dose-dependent, but both moderate drinking over time and single instances of binge drinking can cause damage.

The Role of the Placenta

How exactly does the alcohol (or any other substance for that matter) get from mom to baby during the fetal stage? It all has to do with the placenta — a unique organ that forms in the womb and sustains the fetus throughout pregnancy.

The placenta acts as a multipurpose house, food delivery system, oxygen-providing service, and waste-removal system all in one. It’s connected to the growing fetus by a tube-like umbilical cord, which later falls off leaving an ever-present reminder — the belly button.

In addition to nourishing the fetus, the placenta passes on some of the substances in the mother’s bloodstream, including alcohol. The placenta’s permeability can cause birth defects from alcohol.

Birth Defects From Alcohol

Now, let’s look in more detail at the range of problems that can develop in the different stages of pregnancy.

Some of the main physical abnormalities that can happen as a result of drinking during pregnancy are grouped together as “alcohol-related birth defects,” or ARBD. Unlike other types of abnormalities related to alcohol use during pregnancy, they are mostly physical in nature and can occur at any point, although they are more likely to be more severe if they happen in the embryonic stage. Let’s examine how alcohol use might affect different organs.

1. Heart

Did you know that the fetal heart starts beating as early as three weeks after fertilization? That’s right, in less than a month the tiny group of cells that will form the basis of our heart muscle is already pumping away — and will continue to do so for the rest of our life. 

Alcohol can disrupt the delicate process of fetal heart development and  lead to congenital heart defects. Both involve the formation of a small hole between heart chambers known as a septal defect:

• Atrial septal defect (ASD). An ASD is a hole in the wall between the two upper heart chambers. It can disrupt normal blood flow, causing the heart to strain from working too hard. According to pediatric cardiologist James Thompson, “Over time, ASD causes stress on the heart and can cause the right atrium, ventricle, and pulmonary arteries to become enlarged.” The opening can form anywhere in the atrial septum, but it’s most commonly found in the middle portion.
• Ventricular septal defect (VSD). A VSD, on the other hand, forms in the wall separating the two lower heart chambers. It can cause the heart to pump extra blood to the lungs, which can lead to breathing difficulties and and an increased risk of infections. During infancy, a VSD can cause symptoms such as lethargy, failure to thrive, eating challenges, and weight gain.

It’s important to note that while alcohol can cause these defects, these defects can also happen with no alcohol. Both septal defects are diagnosed through an echocardiogram, which takes a detailed picture of the heart and records its functions. To get a more detailed look, a doctor might perform a bubble study, which involves injecting tiny microbubbles into our veins and tracking them with an ultrasound device to pinpoint the hole’s location.

Luckily, both ASD and VSD are sometimes minor enough that they either heal by themselves or don’t cause too many problems. In other instances, however, they need surgical correction. 

2. Kidneys

Kidneys start to develop early in the embryonic stage and are fully formed by the end of the first trimester. Drinking alcohol at any point during their development can lead to potential abnormalities: 

• Renal agenesis. One or both kidneys might be missing at the time of birth.
• Urinary tract abnormalities. Glitches in the development of the urinary tract can affect the baby’s ability to process waste and fluids.

Like heart abnormalities, problems with the kidneys are often treatable. Still, many might require surgery or other complex procedures. 

3. Bones

Developing bones are not immune to alcohol’s effects, either. Problems can include limb and spine abnormalities: 

• Limb problems. Shorter limbs or fingers and toes that don’t develop properly.
• Deformities of the spine. Curvature (scoliosis) or spinal bifida (a condition that involves a malformation of the spine and is considered a type of neural tube defect).

While bone problems are often not life-threatening and treatments are available, they can certainly impact quality of life. 

4. Eyes and Ears

Finally, the sensory organs also can suffer as a result of exposure to alcohol:

• Vision problems. The baby could end up with cataracts, retinal issues, or microphthalmia (when one or both eyes are unusually small), all of which can affect their ability to see.
• Hearing loss. It’s also possible to lose hearing — partially or completely — in one or both ears due to structural abnormalities. 

Once again, these problems might not be life-threatening, but they can greatly impact a child’s life.

Other Alcohol-Related Birth Defects

Aside from ARBD, other birth defects can develop as a result of alcohol exposure during pregnancy. Let’s take a look.

Alcohol-Related Neurodevelopmental Disorder

Unlike ARBD, ARND isn’t marked by physical disabilities. Instead, the damages happen largely behind the scenes in the brain and can show up later as cognitive and behavioral issues. Here’s the gist:

• Intellectual disabilities. Memory and attention problems, as well as learning difficulties, are common in children affected by ARND.
• Behavioral problems. Children with ARND often develop learning difficulties and behavioral problems, such as attention deficit disorder (ADD) or oppositional defiant disorder (ODD). They might also have separation anxiety or impulsivity problems.
• Nerve or brain abnormalities. ARND also comes with disruptions in nerve and brain functioning that contribute to problems with cognitive development and behavioral issues.

While ARND isn’t entirely treatable, it’s manageable with the right support. Early intervention is crucial — getting a diagnosis might be emotionally difficult, but at this point, it’s all about fixing what’s fixable. It’s important to get help as soon as possible!

Fetal Alcohol Syndrome

Finally, there’s the most serious alcohol-related set of issues, known as fetal alcohol syndrome. A group of alcohol-related birth defects that include physical and mental problems, FASD is a spectrum of disorders ranging from mild to severe.

According to Birthdefects.org, symptoms include several physical abnormalities:

• Growth problems. FASD infants tend to have a low birth weight and length. They often fail to gain weight compared to their peers and have trouble thriving as they get older.  
• Facial abnormalities. A typical “FASD face” is characterized by small eye openings; ear deformities; a short, upturned nose with a flattened, low, nasal bridge; and a thin, smooth, upper lip.
• Organ abnormalities. FASD comes with heart and liver defects.
• Skeletal deformities. Babies with FASD typically have smaller heads, deformed ribs, spine curvature, and joint problems. 
• Central nervous system damage. Unfortunately, FASD can lead to a range of neurological and psychiatric effects, including learning and social disabilities, anxiety, tremors, seizures, coordination problems, attention deficit, and hyperactivity.

Like other alcohol-related birth defects, it’s entirely avoidable if we stay away from alcohol when we’re pregnant and, ideally, during the time when we think pregnancy is on the horizon. Unfortunately, it’s largely untreatable once it develops, although special educational services and psychological support can provide some help.

A Safe Start to a Healthy Pregnancy

While alcohol-related birth defects are difficult to treat after they develop, the truth — both heartbreaking and encouraging — is that they’re highly preventable. Here’s what you can do:

1. Avoid alcohol during pregnancy. This one is the key to a healthy start. Do whatever it takes to stop if you’re currently drinking and try to stay on track throughout your pregnancy. It’s absolutely worth it! (And while we’re on the subject of what to avoid — stay away from smoking and using marijuana as well).
2. Be honest with your doctor. They’ve seen and heard it all and won’t judge. They need to know the truth about your situation, whatever that might be, so they can offer the best guidance and advice.
3. Ask for help. If you’re struggling, don’t hesitate to ask for help. It’s a sign of strength, and there are lots of resources out there that can help you stop drinking if you’re finding it difficult. Reframe is here for you as well!
4. Nourish your body. There are two (or more!) of you now, so make sure you’re eating enough protein and calcium-rich milk products to support your baby’s growing needs. Leafy green vegetables, fruits, whole grains, and sources of omega-3 fatty acids, such as avocados and nuts, will help provide your body with the nutrients and antioxidants you need.
5. Take vitamins. Folic acid is key. The CDC recommends taking 400 micrograms (mcg) daily before and during pregnancy.
6. Stay hydrated. Water is crucial for all of us (our bodies are about 60% water in composition!), but during pregnancy it’s even more critical to stay hydrated. 
7. Get vaccinated. Protecting your immune system from disease protects your baby as well. 
8. Create a safe environment. Last but not least, make sure your environment is safe. Household cleaners and some potential workplace hazards could pose risks, so check with your doctor if you’re unsure or worried about anything.

With these tips, you and your baby will be off to a safe start.

Prevention Is Key

In the end, pregnancy is a special, challenging, and exciting time, but adding alcohol to the mix can bring on a unique set of dangers and long-lasting effects. Let’s avoid alcohol-related birth defects by staying informed, avoiding alcohol, and taking care of our body and mind (and our baby’s!) during pregnancy and beyond!