There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time for alcohol use during pregnancy. All types of alcohol are equally harmful, including all wines and beer.

FASDs are preventable if a baby is not exposed to alcohol before birth.

Why Alcohol is Dangerous

Alcohol in the mother’s blood passes to the baby through the umbilical cord. Alcohol use during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioral, and intellectual disabilities. These disabilities are known as fetal alcohol spectrum disorders (FASDs). Children with FASDs might have the following characteristics and behaviors:

• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
• Small head size
• Shorter-than-average height
• Low body weight
• Poor coordination
• Hyperactive behavior
• Difficulty with attention
• Poor memory
• Difficulty in school (especially with math)
• Learning disabilities
• Speech and language delays
• Intellectual disability or low IQ
• Poor reasoning and judgment skills
• Sleep and sucking problems as a baby
• Vision or hearing problems
• Problems with the heart, kidney, or bones

How Much Alcohol is Dangerous

There is no known safe amount of alcohol use during pregnancy.

When Alcohol is Dangerous

There is no safe time for alcohol use during pregnancy. Alcohol can cause problems for the baby throughout pregnancy, including before a woman knows she is pregnant. Alcohol use in the first three months of pregnancy can cause the baby to have abnormal facial features. Growth and central nervous system problems (e.g., low birthweight, behavioral problems) can occur from alcohol use anytime during pregnancy. The baby’s brain is developing throughout pregnancy and can be affected by exposure to alcohol at any time.

It is never too late to stop alcohol use during pregnancy. Stopping alcohol use will improve the baby’s health and well-being.

Get Help!

If you are pregnant or trying to get pregnant and cannot stop drinking, get help! Contact your healthcare provider, local Alcoholics Anonymous, or local alcohol treatment center.

What’s the Problem?

Maternal prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities. Children exposed to alcohol during fetal development can suffer a wide array of disorders, from subtle changes in I.Q. to profound mental retardation. They can also suffer growth retardation in varying degrees and be born with birth defects of major organ systems.

The rate of “risk drinking” (seven or more drinks per week or five or more drinks on one occasion) during pregnancy remains high. Approximately one in 30 pregnant women in the United States engages in “risk drinking.” One of the most severe effects of drinking during pregnancy is Fetal Alcohol Syndrome (FAS), which includes abnormalities in three areas at the same time – disorders of the brain, growth retardation, and facial malformations.

Who’s at Risk?

More than half of all women of childbearing age in the United States report that they drink alcohol. Also, more than 50% of pregnancies are unplanned. Alcohol consumed during the first three to eight weeks of pregnancy, when many women do not know they are pregnant, can subtly or profoundly affect the organ development of the embryo, depending on the amount consumed. Although early pregnancy is a particularly vulnerable time, damage to the fetus’ developing organ systems can occur throughout pregnancy as a result of continued alcohol exposure.

Women consuming alcohol who are pregnant or could become pregnant are at risk of having an alcohol-exposed pregnancy. Every year in the United States, more than 130,000 women are at risk of having a baby exposed to alcohol in the womb. Women who drink regularly or binge drink and who do not use effective contraception are at highest risk of having a baby with FAS or other alcohol-related condition.

Can It Be Prevented?

The good news is that prenatal alcohol exposure is completely preventable. Any woman who is pregnant or could become pregnant should avoid drinking alcohol. To reduce prenatal alcohol exposure, prevention efforts should target not only pregnant women who are currently drinking, but also women who could become pregnant, are drinking at high-risk levels, and engaging in unprotected sex. These women are also at risk of having an alcohol-exposed pregnancy.

Healthcare providers should routinely talk to women who are pregnant, planning to get pregnant, or could become pregnant about their alcohol use and advise women on the dangers of drinking in general and during pregnancy. Asking questions about alcohol use can present a challenge for providers since women who drink and already have children are often reluctant to seek help because they fear they will lose custody of their children if they admit using alcohol.

The Bottom Line

• Women of reproductive age should not engage in risk drinking (seven or more drinks per week or five or more drinks on any one occasion) if they are pregnant or at risk of becoming pregnant. If a woman does decide to drink, she should make certain that she is using birth control properly to avoid an unplanned, potentially alcohol-exposed pregnancy.
• Any time a pregnant woman drinks, she puts her unborn child in danger of having physical problems, behavioral challenges, and learning disabilities. No amount of alcohol use is considered safe for a pregnant woman.

Case Example

Jill, who already has two children, drinks alcohol at home in the evenings and on weekends, sometimes heavily. She finds out that she is pregnant again. Although Jill is aware that alcohol might affect her pregnancy, she is not quite sure how her baby could be affected by alcohol, or how much is too much. There are a number of reasons why she feels that she doesn’t want to or can’t stop drinking (i.e., she suffers from depression; she denies she has a drinking problem; she cannot control her drinking), so she doesn’t ask for help. She continues to drink frequently during her pregnancy (drinking at least seven drinks a week), or binge drinks (drinking at least five drinks on one occasion) on the weekends. She first learns about FAS when her baby boy is born showing physical signs of FAS (i.e., low birth weight, small head, facial abnormalities). She finds that her child will need special care throughout his life and will have problems in school and in relating to other people. She now says that if she had known how serious the consequences of her drinking could be for herself, her family, and her affected child, she would have sought help to stop drinking.

When You Are Pregnant…

Drinking Can Hurt Your Baby

When you are pregnant, your baby grows inside you. Everything you eat and drink while you are pregnant affects your baby. If you drink alcohol, it can hurt your baby’s growth. Your baby may have physical and behavioral problems that can last for the rest of his or her life. Children born with the most serious problems caused by alcohol have fetal alcohol syndrome.

Children with fetal alcohol syndrome may:

• Be born small.
• Have problems eating and sleeping.
• Have problems seeing and hearing.
• Have trouble following directions and learning how to do simple things.
• Have trouble paying attention and learning in school.
• Need special teachers and schools.
• Have trouble getting along with others and controlling their behavior.
• Need medical care all their lives.

Here are some questions you may have about alcohol and drinking while you are pregnant.

1. Can I drink alcohol if I am pregnant?

No. Do not drink alcohol when you are pregnant. Why? Because when you drink alcohol, so does your baby. Think about it. Everything you drink, your baby also drinks.

2. Is any kind of alcohol safe to drink during pregnancy?

No. Drinking any kind of alcohol when you are pregnant can hurt your baby. Alcoholic drinks are beer, wine, wine coolers, liquor, or mixed drinks. A glass of wine, a can of beer, and a mixed drink all have about the same amount of alcohol.

3. What if I drank during my last pregnancy and my baby was fine?

Every pregnancy is different. Drinking alcohol may hurt one baby more than another. You could have one child that is born healthy, and another child that is born with problems.

4. Will these problems go away?

No. These problems will last for a child’s whole life. People with severe problems may not be able to take care of themselves as adults. They may never be able to work.

5. What if I am pregnant and have been drinking?

If you drank alcohol before you knew you were pregnant, stop drinking now. You will feel better and your baby will have a good chance to be born healthy. If you want to get pregnant, do not drink alcohol. You may not know you are pregnant right away. Alcohol can hurt a baby even when you are only 1 or 2 months pregnant.

6. How can I stop drinking?

There are many ways to help yourself stop drinking. You do not have to drink when other people drink. If someone gives you a drink, it is OK to say no. Stay away from people or places that make you drink. Do not keep alcohol at home.

If you cannot stop drinking, GET HELP. You may have a disease called alcoholism. There are programs that can help you stop drinking. They are called alcohol treatment programs. Your doctor or nurse can find a program to help you. Even if you have been through a treatment program before, try it again. There are programs just for women.

Nearly 14% (or 1 in 7) pregnant people reported current drinking and about 5% (or 1 in 20) reported binge drinking in the past 30 days, according to a new Morbidity and Mortality Weekly Report (MMWR).

Alcohol use during pregnancy continues to be a serious problem. Alcohol use during pregnancy can cause birth defects and developmental disabilities known as fetal alcohol spectrum disorders (FASDs) and might increase the risk for miscarriage and stillbirth. Screening for alcohol use combined with brief counseling by primary care providers, integration of mental health services, improved access to care, and community-based interventions might reduce alcohol use during pregnancy and the risk for poor pregnancy and birth outcomes.

Main Findings

In a new MMWR article, CDC researchers found

• Nearly 1 in 7 pregnant people reported current drinking, meaning at least one drink of any alcoholic beverage in the past 30 days.
• About 1 in 20 pregnant people reported binge drinking, meaning four or more drinks on one occasion at least once in the past 30 days.
• Pregnant people 25–34 years were less likely to report current drinking than those aged 35–49 years. College educated, employed, and unmarried pregnant people were more likely to report current drinking.
• A new finding in this report is that pregnant people who experienced frequent mental distress (14 or more days of poor mental health in the past 30 days) and those who did not have a usual healthcare provider were more likely to report alcohol use.
• Overall, these prevalence estimates are consistent with slightly increasing trends in current and binge drinking observed in the same survey since 2011. However, alcohol use among pregnant people was not higher in 2020 than in 2019, despite some evidence of increased alcohol sales and consumption among the general public during the COVID-19 pandemic.

People who reported their sex at birth as female were asked if they were currently pregnant.

About this Study

• The study uses self-reported data collected from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based, landline and cellphone survey of U.S. adults aged 18 years and over.
• To estimate current drinking and binge drinking for pregnant people aged 18–49 years, data from the 2018–2020 BRFSS were analyzed for all 50 states and the District of Columbia.

New Jersey did not collect enough data to meet the minimum requirements for inclusion in the 2019 BRFSS public use dataset.

Are you pregnant or might be pregnant?

• There is no known safe amount, no safe time, and no safe type of alcohol use in pregnancy.
• If you need help for substance use, talk with a healthcare provider.

Are you a healthcare provider?

• Universal alcohol screening and brief intervention is recommended in primary and obstetric care settings.
• Use these resources for applying screening and brief intervention in your practice.

Our Work

CDC addresses alcohol and other substance use during pregnancy and FASDs. Example activities include:

• Understanding alcohol use during pregnancy: CDC estimates how much and how often pregnant people report alcohol use and binge drinking as well as use multiple substances. These data are important to help reduce prenatal alcohol use by identifying groups at increased risk and designing prevention programs to reduce risk behaviors.
• Promoting evidence-based care: CDC and partners support the implementation, adoption, and promotion of evidence-based interventions to reduce alcohol use during pregnancy, including alcohol screening and brief counseling. We are also working together to promote effective treatments for children, adolescents, and young adults living with FASDs and their families. Early identification and management of FASDs can help children and families living with FASDs receive the care and services they need to thrive.
• Providing training and resources: CDC enhances healthcare provider education, including free online training courses on preventing prenatal alcohol use and identifying and caring for people with FASDs. We are also offering FASD-related educational information and materials as well as disseminating guidelines on alcohol use, including the Dietary Guidelines for Americans.
• Disseminating accurate, up-to-date information: CDC educates and informs the general public and policymakers about effective strategies for reducing excessive alcohol use, such as those recommended by the Community Preventive Services Task Force (e.g., limiting alcohol sales).

Q: I just found out I am pregnant. I have stopped drinking now, but I was drinking in the first few weeks of my pregnancy, before I knew I was pregnant. What should I do now?

A: The most important thing is that you have completely stopped alcohol use after learning of your pregnancy. It is never too late to stop alcohol use during pregnancy. Because brain growth takes place throughout pregnancy, stopping alcohol use will improve the baby’s health and well-being.

If you used any amount of alcohol while you were pregnant, talk with your child’s health care provider as soon as possible and share your concerns. Make sure you get regular prenatal checkups.

Q. What is a “drink”? What if I drink only beer or hard seltzer?

A: Any type of alcohol use can affect your baby’s growth and development and cause FASDs. This includes all wines, beer, and mixed drinks. A standard drink is defined as .60 ounces of pure alcohol. This is equivalent to one 12-ounce beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80 proof distilled spirits (hard liquor). Some drinks, like mixed alcoholic drinks or malt liquor drinks, might have more alcohol in them than a 12-ounce beer. There is no safe kind of alcohol. If you have any questions about your alcohol use and its risks to your health, talk to your health care provider.

Q: Is it okay to drink a little or at certain times during pregnancy?

A: There is no known safe amount of alcohol use during your pregnancy or when you are trying to get pregnant. There is also no safe time for alcohol use during pregnancy. Alcohol can cause problems for your baby throughout your pregnancy, including before you know you are pregnant.

FASDs are preventable if a baby is not exposed to alcohol before birth.

Q: I drank wine during my last pregnancy and my baby turned out fine. Why shouldn’t I drink again during this pregnancy?

A: Every pregnancy is different. Alcohol use during pregnancy might affect one baby more than another. You could have one child who is born healthy and another child who is born with problems.

Q: If I drank when I was pregnant, does that mean my baby will have an FASD?

A: If you used any amount of alcohol while you were pregnant, talk with your child’s healthcare provider as soon as possible and share your concerns.

You may not know right away if your child has been affected. FASDs include a range of physical and intellectual disabilities that are not always easy to identify when a child is a newborn. Some of these effects may not be known until your child is in school.

There is no cure for FASDs. However, identifying and intervening with children with these conditions as early as possible can help them to reach their full potential.

Q: Is it okay to drink alcohol if I am trying to get pregnant?

A: You might be pregnant and not know it yet. You probably won’t know you are pregnant for up to 4 to 6 weeks. This means you might be exposing your baby to alcohol without meaning to.

Alcohol use during pregnancy can also lead to miscarriage and stillbirth.

The best advice is to avoid any alcohol use when you start trying to get pregnant.

Q: If a woman has an FASD, but does not drink during pregnancy, can her child have an FASD? Are FASDs hereditary?

A: FASDs are not genetic or hereditary. If a baby is exposed to alcohol during pregnancy, the baby can be born with an FASD. But if a woman has an FASD, her own child cannot have an FASD, unless she uses alcohol during pregnancy.

Q: Can a father’s drinking cause harm to the baby?

A: How alcohol affects the male sperm is currently being studied. Whatever the effects are found to be, they are not fetal alcohol spectrum disorders (FASDs). FASDs are caused specifically when a baby is exposed to alcohol during pregnancy.

However, the father’s role is important. He can help the woman avoid alcohol use during pregnancy. He can encourage her to abstain from alcohol by avoiding social situations that involve drinking. He can also help her by avoiding alcohol himself.

Q: I’ve tried to stop drinking before, but I just couldn’t do it. Where can I get help?

A: If you cannot stop drinking, contact your doctor, local Alcoholics Anonymous, or local alcohol treatment center.

SAMHSA Treatment Locator — FindTreatment.gov
The Substance Abuse and Mental Health Services Administration (SAMHSA) has a treatment facility locator. This locator helps people find drug and alcohol treatment programs in their area.

NIAAA Alcohol Treatment Navigator
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has an Alcohol Treatment Navigator. The Navigator helps adults find alcohol treatment for themselves or an adult loved one.

Alcoholics Anonymous (A.A.) 
Alcoholics Anonymous® is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. 

Q: I suspect my child might have an FASD. What should I do?

A: If you think your child might have an FASD, talk to your child’s doctor and share your concerns. Don’t wait!

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from FASD United (formerly NOFAS).

At the same time as you ask the doctor for a referral to a specialist, call your state or territory’s early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

• If your child is younger than 3 years old, Call your state or territory’s early intervention program and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”
   
• If your child is 3 years old or older, contact your local public school system.
  Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

Alcohol Screening and Brief Intervention (SBI) is Effective at Reducing Excessive Drinking. CDC is working to make alcohol SBI a routine part of health care in primary care settings.

What Is Alcohol SBI?

Alcohol SBI is a preventive service, like blood pressure or cholesterol screening, which can occur as part of a patient’s wellness visit. It identifies and helps individuals who are drinking more than the recommended amounts. Alcohol SBI involves

• A validated set of screening questions, which only take a few minutes to complete, to identify patients’ drinking patterns; and
• A short conversation with patients who are drinking more than the recommended amounts, as well as referral to treatment when appropriate.

CDC is working to make alcohol SBI a routine part of health care in primary care settings.

Why is Alcohol SBI Important?

Excessive Alcohol Use* is Common

Binge Drinking*: More than 37 million American adults binge drink.

Heavy Drinking*: In 2018, according to the Behavioral Risk Factor Surveillance System survey, about 7% of the adult population reported heavy drinking.

Pregnant Women*: During 2018–2020, nearly 1 in 7 (14%) pregnant people aged 18–44 years in the United States reported drinking alcohol in the past 30 days, and about 1 in 20 (5%) reported binge drinking in the same time period.

Youth Younger Than 21 Years of Age*: In 2017, 60.4% of high school students reported having at least one drink of alcohol, on at least one day during their life (i.e. ever drank alcohol).

*Excessive alcohol use includes binge drinking (five or more drinks for men and four or more drinks for women within a 2-hour time period), heavy drinking (more than 14 drinks a week for men and more than seven a week for women), and any alcohol consumption by pregnant women or people younger than 21 years of age.

Excessive Alcohol Use Leads to Widespread Harm

Alcohol & Pregnancy: Drinking any amount of alcohol during pregnancy can cause a range of physical, behavioral, and learning problems in the baby, called fetal alcohol spectrum disorders (FASDs). Additionally, drinking during pregnancy is a risk factor for other poor pregnancy outcomes, such as miscarriage and stillbirth.

Health & Social Harm: Excessive alcohol use contributes to a wide range of negative health and social consequences, including motor vehicle crashes and intimate partner violence; over time, it can result in serious medical conditions, such as high blood pressure, digestive problems, liver disease, and various cancers.

Costly & Fatal: According to the ARDI application, during 2015–2019, excessive alcohol use was responsible for more than 140,000 deaths and 3.6 million years of potential life lost each year, on average.

Effective Clinical Interventions are Available

Alcohol SBI Works: More than 30 years of research has shown that alcohol SBI is effective at reducing excessive alcohol use. Based on this evidence, the U.S. Preventive Services Task Force, as well as many other organizations, have recommended that alcohol SBI be implemented for all adults being seen in primary healthcare settings.

In 2012, the Community Preventive Services Task Force recommended the use of alcohol electronic SBI (eSBI).

Fetal alcohol exposure occurs when a woman drinks while pregnant. Alcohol can disrupt fetal development at any stage during a pregnancy—including at the earliest stages before a woman even knows she is pregnant.

Research shows that binge drinking and regular heavy drinking put a fetus at the greatest risk for severe problems. (The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration [BAC] to 0.08 percent—or 0.08 grams of alcohol per deciliter—or higher. For a typical adult female, this pattern of alcohol consumption corresponds to consuming 4 or more drinks in about 2 hours. [NIAAA. (2007, November). Defining binge drinking. What Colleges Need to Know Now. Available at: https://www.collegedrinkingprevention.gov/media/1College_Bulletin-508_3….]) However, even lesser amounts can cause damage.In fact, there is no known safe level of alcohol consumption during pregnancy.

Alcohol passes easily from a mother’s bloodstream into her developing baby’s blood. Alcohol present in a developing baby’s bloodstream can interfere with the development of the brain and other critical organs, structures, and physiological systems.

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental abnormalities in the United States. It can cause a range of developmental, cognitive, and behavioral problems, which can appear at any time during childhood and last a lifetime.

The most profound effects of prenatal alcohol exposure are brain damage and the resulting impairments in behavioral and cognitive functioning.

Fetal Alcohol Spectrum Disorders

Scientists define a broad range of effects and symptoms caused by prenatal alcohol exposure under the umbrella term Fetal Alcohol Spectrum Disorders (FASD).

The medical disorders collectively labeled FASD include the Institute of Medicine of the National Academies (IOM) diagnostic categories:

• Fetal Alcohol Syndrome (FAS)

• Partial FAS (pFAS)

• Alcohol-Related Neurodevelopmental Disorder (ARND)

• Alcohol-Related Birth Defects (ARBD)

In addition to the IOM medical diagnoses, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) includes the psychiatric diagnosis, Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). People who meet criteria for an FASD diagnosis according to the IOM may also meet criteria for ND-PAE.

The essential features common to the IOM medical diagnoses and the DSM–5 psychiatric diagnosis are prenatal alcohol exposure and central nervous system (CNS) involvement.

Evidence of CNS involvement can be structural (e.g., small brain size, alterations in specific brain regions) or functional (e.g., cognitive and behavioral deficits, motor and coordination problems). Advanced imaging studies have revealed differences in brain structure and activity that are consistent with data from neuropsychological testing, including deficits in sensory processing, cognition, and behavior in persons with FASD compared to people without FASD.

FASD-Related Problems

Each individual with FASD experiences a unique combination of day-to-day challenges that may include medical, behavioral, educational, and social problems. People with FASD may have difficulty in the following areas:

• Learning and remembering

• Understanding and following directions

• Shifting attention

• Controlling emotions and impulsivity

• Communicating and socializing

• Performing daily life skills, including feeding, bathing, counting money, telling time, and minding personal safety

FASD-related brain damage makes it difficult to address routine life situations. It causes people to make bad decisions, repeat the same mistakes, trust the wrong people, and have difficulty understanding the consequences of their actions.

FASD cases are seriously under-diagnosed. FASD can be difficult for practitioners to distinguish from other developmental disorders since these disorders share certain learning and behavioral problems.

In addition, people with FASD are more likely to suffer from the following mental health disorders:

• Attention Deficit Hyperactivity Disorder (ADHD)

• Depression and anxiety

• Problems with hyperactivity, conduct, and impulse control

• Increased incidence of alcohol and other substance use disorders

Key Statistics for the United States—Maternal Drinking

• About 20 to 30 percent of women have reported drinking at some point during pregnancy—most typically during the first trimester.

• More than 8 percent of women have reported binge drinking at some time during pregnancy—most typically during the first trimester.

• Almost 10 percent of pregnant women reported drinking alcohol in the previous month.

• Almost 5 percent of pregnant women reported binge drinking in the previous month (4 or more drinks per occasion).

Relevant Clinical Diagnoses

IOM Diagnoses

Fetal Alcohol Syndrome (FAS)

Fetal Alcohol Syndrome (FAS) was the first form of FASD discovered and is the most well-known. Heavy alcohol use during the first trimester of pregnancy can disrupt normal development of the face and the brain. In fact, exposure at any point during gestation may affect brain development. An FAS diagnosis requires:

• Evidence of prenatal alcohol exposure

• Evidence of central nervous system (CNS) abnormalities (structural or functional)

• A specific pattern of three facial abnormalities: narrow eye openings, a smooth area between the lip and the nose (vs. the normal ridge), and a thin upper lip

• Growth deficits either prenatally, after birth, or both

Partial FAS (pFAS)

Partial FAS (pFAS) involves prenatal alcohol exposure, and includes some, but not all, of the characteristics of full FAS.

Alcohol-Related Neurodevelopmental Disorder (ARND)

A diagnosis of Alcohol-Related Neurodevelopmental Disorder (ARND) requires evidence of both prenatal alcohol exposure and CNS abnormalities, which may be structural or functional. Functional abnormalities may involve a complex pattern of cognitive or behavioral problems that are not consistent with developmental level, and that cannot be explained by factors other than prenatal alcohol exposure (e.g., family background, environment, and other toxicities). Facial abnormalities and growth retardation need not be present.

Alcohol-Related Birth Defects (ARBD)

This disorder includes medical conditions linked to prenatal alcohol exposure such as: heart, kidney, and bone problems and other malformations; difficulty seeing and hearing; and reduced immune function. Alcohol-Related Birth Defects (ARBD) is rarely seen alone but rather as a secondary disorder accompanying other FASD conditions (e.g., FAS and ARBD).

DSM–5 Diagnosis

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) is a new psychiatric diagnosis in the DSM–5. It requires evidence of both prenatal alcohol exposure and CNS involvement, as indicated by impairments in the following three areas: cognition, self-regulation, and adaptive functioning. This new diagnosis for use by mental health professionals will improve understanding of the multifaceted behavioral deficits seen in some people exposed to alcohol prenatally, and facilitate improved diagnosis and treatment of these individuals.

Risk Factors

The severity of alcohol’s effects on a fetus primarily depends on the following:

• Quantity—how much a pregnant woman drinks per occasion

• Frequency—how often a pregnant woman drinks

• Timing—in what stage of pregnancy a woman drinks and if she drinks heavily just as the fetus develops a particular feature or brain region

Other factors can also play a role in how prenatal alcohol exposure affects children. These include:​

Maternal Characteristics

Research demonstrates that children may be more affected by prenatal alcohol exposure if their mothers:

• Have poor nutrition

• Have had multiple pregnancies and births

• Have lower-than-average weight, height, and body mass index (BMI)

• Smoke

• Are older

• Are a member of a family of heavy drinkers

Environmental Factors

Research demonstrates that children can be more affected by prenatal alcohol exposure if their mothers experience adverse-living conditions and high levels of stress. These may include: social isolation, living in circumstances where alcohol misuse is common and accepted, and living in a community where resources for prenatal care are limited.

Genetics

The extent of FASD symptoms may depend on the mother’s genetic makeup, her child’s genetic makeup, and changes in gene activity caused by prenatal alcohol exposure.

Interventions

Researchers and clinicians have developed effective learning and behavioral interventions to help people with FASD. For example, school-based interventions can help children with FASD learn more easily. School-based interventions may include specialized teaching strategies that provide a consistent routine and allow children to practice new skills over and over again. Other promising interventions include:

• Family support groups and classes to help parents better care for a child with FASD.

• Nutritional supplements for pregnant women and postnatal supplements for their children.

• Behavioral interventions for affected children, including training in social skills, problem solving, and personal safety.

What Are Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to the wide range of physical, behavioral, and cognitive impairments that occur due to alcohol exposure before birth (also known as prenatal alcohol exposure). These impairments may appear at any time during childhood and last a lifetime. An estimated 1% to 5% of U.S. first graders have FASD, according to a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-supported study published in the Journal of the American Medical Association.

What Causes Fetal Alcohol Spectrum Disorders and How Are They Prevented?

Alcohol exposure during pregnancy can result in FASD by interfering with development of the baby’s brain and other critical organs and physiological functions. This can lead to deficits after birth and beyond. Alcohol can disrupt development at any stage, even before a woman knows that she is pregnant.

Research shows that binge drinking and heavy drinking during pregnancy put a developing baby at the greatest risk for severe problems. However, even lesser amounts can cause harm. In fact, there is no known safe amount of alcohol consumption during pregnancy.

What Are the Types of Fetal Alcohol Spectrum Disorders?

The term fetal alcohol spectrum disorders (FASD) refers to a range of physical, cognitive, and behavioral abnormalities caused by prenatal alcohol exposure. Depending on the features identified, the disorders categorized as FASD include:

• Fetal alcohol syndrome
• Partial fetal alcohol syndrome
• Alcohol-related neurodevelopmental disorder
• Alcohol-related birth defects
• Neurobehavioral disorder associated with prenatal alcohol exposure

Prenatal alcohol exposure and central nervous system (CNS) involvement are factors common to the disorders encompassing FASD. Evidence of CNS involvement can be structural (e.g., small brain size, alterations in specific brain regions) or functional (e.g., cognitive and behavioral deficits, motor and coordination problems). For fetal alcohol syndrome—which is also characterized by growth deficiencies, distinct facial features, and other physical factors in addition to CNS involvement—confirmation of prenatal alcohol exposure is not required.

If an individual was not exposed to alcohol before birth, they will not get FASD. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or are thinking about getting pregnant should not drink alcohol at all.

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental disorders in the United States. Women who need help to stop drinking alcohol can talk to their health care provider about treatment options. There are a variety of treatments available for pregnant women, including behavioral treatment and mutual-support groups.

How Common Is Alcohol Use During Pregnancy in the United States?

A study that analyzed 2015–2018 data from the National Survey on Drug Use and Health reports that:

• About 1 in 10 (9.8%) pregnant women report current alcohol use.
• About 1 in 22 (4.5%) pregnant women report binge drinking.
• Alcohol use is highest among women who are in the first trimester of pregnancy, with about 1 in 5 (19.6%) reporting current alcohol use and 1 in 10 (10.5%) reporting binge drinking.
• About 40% of pregnant women who report current drinking also report current use of one or more other substances—most commonly tobacco and marijuana.

What Are the Symptoms of Fetal Alcohol Spectrum Disorders?

Individuals with FASD experience day-to-day challenges, which may include cognitive and behavioral impairments as well as secondary disabilities including medical, educational, mental health, and social challenges, throughout their life. They are also subject to stigmatization for their disorder. People with FASD may have difficulty in the following areas:

• Learning and memory
• Understanding and following directions
• Switching attention between tasks
• Controlling emotions and impulsivity
• Communicating and developing social skills
• Experiencing depression and anxiety
• Performing daily life skills, including feeding, bathing, counting money, telling time, and minding personal safety

How Are Fetal Alcohol Spectrum Disorders Diagnosed?

Early identification of FASD is critical for the well-being of individuals affected by prenatal alcohol exposure and their families. Early identification can maximize help in the treatment of FASD and in building supportive networks with other individuals and families impacted by FASD. Unfortunately, FASD is often undiagnosed or misdiagnosed. This may be due, in part, to a lack of information about prenatal alcohol exposure or difficulty in distinguishing FASD from other developmental disorders that might have similar cognitive or behavioral symptoms.

The American Academy of Pediatrics (AAP) stresses the importance of universal screening for prenatal alcohol exposure for all children. A diagnosis of FASD can include evidence of CNS problems (see “What Are the Types of FASD?” box), physical abnormalities (e.g., growth deficits, specific facial anomalies), health concerns, and documented prenatal alcohol exposure. The AAP recommends initial assessment and diagnosis by the child’s pediatrician. Referrals for additional evaluation and treatment can be made to other clinicians and health care professionals or, when available, to a specialized multidisciplinary team for a comprehensive evaluation and care.

What Are the Interventions or Treatments for Fetal Alcohol Spectrum Disorders?

There are various approaches that may help reduce the symptoms of FASD and lessen the impact on affected individuals and their families. These include education and behavioral interventions for individuals with FASD and their caretakers as well as medications, social support, case management, and other services for children and adults with FASD. New interventions are currently being developed and evaluated. These treatments include:

• Prenatal nutritional supplements for pregnant women and postnatal supplements for their children
• Learning and behavioral interventions aimed at improving cognition, daily life skills, and impulsive behavior
• School-based approaches focused on specialized teaching strategies and computer-based games
• Mobile health apps and other interventions that support families and caregivers to assist them in caring for children with FASD

1. Alcohol use during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioral, and intellectual disabilities. These disabilities are known as fetal alcohol spectrum disorders, or FASDs. People with FASDs can have learning disabilities, hyperactivity, difficulty with attention, speech and language delays, low IQ, and poor reasoning and judgment skills. They can also have problems with their organs, including the heart and kidneys.
2. There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. All drinks with alcohol can affect a baby’s growth and development and cause FASDs. A 5-ounce glass of red or white wine has the same amount of alcohol as a 12-ounce can of beer or a 1.5-ounce shot of straight liquor.
3. There is no safe time for alcohol use during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she is pregnant. Most women will not know they are pregnant for up to 4 to 6 weeks.
4. Alcohol use during pregnancy remains high. Nearly 1 in 7 pregnant people in the United States reports alcohol use in the past 30 days. And about 1 in 20 pregnant people in the United States reports binge drinking in the past 30 days (having four or more drinks at one time).
5. Fetal Alcohol Spectrum Disorders (FASDs) are preventable. FASDs are preventable if a baby is not exposed to alcohol before birth.

Learn what you can do before and during pregnancy to improve your chances of having a healthy baby.

Before you get pregnant, try to reach a healthy weight.

Obesity increases the risk for several serious birth defects and other pregnancy complications. If you are underweight, overweight, or have obesity, talk with your healthcare provider about ways to reach and maintain a healthy weight before you get pregnant. Focus on a lifestyle that includes healthy eating and regular physical activity.

Be sure to take 400 micrograms (mcg) of folic acid every day.

Folic acid is important because it can help prevent some major birth defects of the baby’s brain and spine. If you plan to or could become pregnant, you should consume 400 micrograms (mcg) of folic acid every day to ensure your baby’s proper development and growth. In addition to eating foods with folate from a varied diet, you can get folic acid from

• Taking a vitamin that has folic acid in it;
  • Most vitamins sold in the United States have the recommended daily amount of folic acid (400 mcg) that you need.
  • Vitamins can be found at most local pharmacy, grocery, or discount stores. Check the label on the bottle to be sure it contains 100% of the daily value of folic acid, which is 400 mcg.
• Eating fortified foods;
  • You can find folic acid in some breads, breakfast cereals, and corn masa flour.
  • Be sure to check the nutrient facts label and look for a product that has “100%” next to folate.
• Getting a combination of the two: taking a vitamin that has folic acid in it and eating fortified foods.

Book a visit with your healthcare provider before stopping or starting any medicine.

Many women need to take medicine to stay healthy during pregnancy. If you are planning to become pregnant, discuss your current medicines with a healthcare provider, such as your doctor or pharmacist. Creating a treatment plan for your health condition before you are pregnant can help keep you and your developing baby healthy.

Become up-to-date with all vaccinations, including the flu shot.

Vaccines help protect you and your developing baby against serious diseases. Get a flu shot annually and a whooping cough vaccine (also called Tdap) during each pregnancy to help protect yourself and your baby.

• Flu: You can get the flu shot before or during each pregnancy.
• Whooping Cough: You can get the whooping cough vaccine in the last three months of each pregnancy.

Boost your health by avoiding substances that are harmful during pregnancy.

• Alcohol: There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. Alcohol can cause problems for a developing baby throughout pregnancy, so it’s important to stop drinking alcohol when you start trying to get pregnant and during your pregnancy.
• Tobacco: Smoking causes cancer, heart disease, and other major health problems. Smoking during pregnancy can also harm the developing baby and can cause certain birth defects. Quitting smoking will help you feel better and provide a healthier environment for your baby.
• Other Drugs: Using certain drugs during pregnancy can cause health problems for a woman and her developing baby. A healthcare provider can help you with counseling, treatment, and other support services.