Drinking & smoking during pregnancy: everyone knows you shouldn't drink alcohol or smoke cigarettes during pregnancy, right? Hardly.

Today about 18 percent of pregnant women smoke cigarettes and only about one in four women who smoke quit when they become pregnant. (18) In addition, 13 percent of women continue to drink alcohol throughout their pregnancies, and 3 percent binge drink. (19)

Studies examining the reasons why some women don't quit these habits during pregnancy find low employment and educational status, not being married, age, and the habits of friends, coworkers and partners as contributing factors. (29, 30, 31)

The potential damage these women do to their unborn infants is extreme. Smoking during pregnancy is responsible for 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries and about 10 percent of all infant deaths, wreaking its damage by depriving fetuses of up to 25 percent of necessary oxygen. (20) Additionally, drinking during pregnancy is the single greatest preventable cause of mental retardation. (21)

Perhaps the most widely studied result of drinking during pregnancy is fetal alcohol syndrome (FAS). Children with the condition don't grow normally, have facial abnormalities and experience central nervous system problems. (22)

However, FAS lies at one end of a continuum of birth defects that affect children of women who drink during pregnancy. The continuum itself is called fetal alcohol spectrum disorders (FASD), an umbrella term describing a variety of physical, mental and/or behavioral defects that can have lifelong effects. These conditions include ADHD, language deficits, low IQ, deficits in spatial processing and memory, slow reaction times and decision-making problems. (22)

Between 2,000 and 8,000 infants are born each year with FAS, with rates much higher among Native Americans and in families that already have one child with FAS. However, an estimated one percent of all live births (approximately 40,000 babies a year) are estimated to have some form of FASD. (22)

There is no safe time during pregnancy to drink. Prenatal alcohol exposure during the first trimester can interfere with organ development, including the brain, as well as development of the face, while during the third trimester it is associated with cell death in the brain or developmental abnormalities. (22)

When a pregnant woman stops smoking, taking drugs or using alcohol at any time during her pregnancy, she significantly reduces the risk of harm to her baby, studies show. Yet only between 5 and 10 percent of pregnant substance-abusing women get treatment, says Susan Foster, director of policy research for the National Center on Addiction and Substance Abuse at Columbia University in New York City. Many fear losing their other children if they talk about their problems. Yet studies find that treatment works for many pregnant women with substance abuse issues.

"We have found that pregnancy is a wonderful opportunity for change, because women are wondering if their baby will be healthy," says Arkansas CARES Executive Director Cynthia C. Crone.

What is one of the best ways to get women motivated to quit smoking, drinking or abusing drugs? An ultrasound. "If we can make that baby real for her, even before she feels the baby move," says Ms. Crone, "it's one of the best ways we've found to help her change."

References

18 American Lung Association. Women & Smoking. [Fact sheet] www.lungusa.org. Accessed Dec 3, 2006.

19 Substance Abuse and Mental Health Services Administration. Pregnancy and substance use, 2004. www.drugabusestatistics.samhsa.gov. Accessed Nov 30, 2006.

20 U.S Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General, 2001.

21 Austin G, Prendergast M. Young children of substance abusers. Prevention Research Update. 8. 1991.

22 Riley EP, McGee CL. Fetal alcohol spectrum disorders: an overview with emphasis on changes in brain and behavior. Exp Biol Med (Maywood). 2005 Jun;230(6):357-65.

29 Giglia RC, Binns CW, Alfonso HS. Which women stop smoking during pregnancy and the effect on breastfeeding duration. BMC Public Health. 2006 Jul 26;6:195.

30 Flick LH, Cook CA, Homan SM, McSweeney M, Campbell C, Parnell L. Persistent tobacco use during pregnancy and the likelihood of psychiatric disorders. Am J Public Health. 2006 Oct;96(10):1799-80

31 Alcohol Use Among Women of Childbearing Age--United States, 1991-1999. Morbidity and Mortaility Review. April 5, 2002. www.cdc.gov. Accessed Jan 8, 2007.