Tobacco and Alcohol During Pregnancy

So the majority of us mommas have heard that tobacco use, alcohol and drug use are all no-no’s for pregnant women. But why? What’s the risk? First of all, I know (and have seen it happen first hand) that a mandated reporter can contact children and youth regarding a pregnant woman who is smoking. I’ve actually seen them step in for just that reason. Who knew! To me, that in itself is scary enough. But here’s some more detailed information about why you shouldn’t drink or smoke during pregnancy.

Smoking: I looked at a study that reviewed 5315 other meta-analysis studies (that captures a TON of women!). This study specifically found that mothers who smoked or were exposed to a significant amount of second hand smoke were much more likely to have children with low birth weight. This same study also found a correlation between smoke exposure and an increased risk for congenital anomalies, stillbirth and preterm birth. A separate study I looked at found that exposure to tobacco smoke while in utero may be linked to increased rates (by 4x) of ADHD in children. Yet another study also found a correlation between smoking while pregnant and having children who are overweight!

The CDC supports most of this information and states that smoking while pregnant increases the risk for miscarriages, preterm birth, low birth weight, SIDS, and certain birth defects. The CDC also lists common risks that go along with being exposed to a significant amount of second hand smoke, including low birth weight, increased risk for ear infections and asthma, and SIDS. Furthermore, the CDC recommends stopping use of e-cigarettes while pregnant due to harmful side effects of nicotine.

Alcohol: There is a lot of very controversial information on drinking during pregnancy. I will try to capture some of the interesting points here as well as give you the recommendations that the CDC and The American Pregnancy Association provide.

Curiously, a few of the studies that I looked at (most not performed in the United States) have actually found that very low levels of alcohol while pregnant may have a protective effect on your baby. Shocking, right? One study in particular found a higher incidence of low birth weight in those who did not drink during pregnancy v. those who drank 2.4-6g of alcohol per day (this is less than half of a glass of wine, about 1/4 of a regular beer or about half of a shot). This same study reviewed 16 articles and found that 15 of the 16 suggested there was no decrease in risk for premature births with consumption of up to 10g per day (a small glass of wine, ½ of a beer, or one shot). Three of the 16 studies actually found a protective effect of alcohol when consumed up to about 3g/day (which is not a lot!)

Now, all that being said, those are VERY low levels of alcohol and these studies did not look at which trimester the women were drinking in. Most of the other studies published state that alcohol does increase risk for certain problems with pregnancy, birth and even later on in life. One study found a link between alcohol consumption and risk for ADHD in children (and found this link to be correlated with the amount of alcohol consumed). Another study found that drinking up to 11g/day actually increases risk for 1st trimester miscarriages when compared to those who abstain.

The tough part is, no one really knows if any amount of alcohol is safe during pregnancy. Binge drinking has definitively been correlated to increased risk for Fetal Alcohol Spectrum Disorders (FASD). Any alcohol consumption during pregnancy has been linked to babies with abnormal facial features, small head size, shorter than average height, low birth weight, poor coordination, stillbirth, miscarriage, ADHD, poor attention, poor memory, difficulty in school, other learning disabilities and speech delays, lower IQ, poor reasoning and judgment skills, sleep problems as an infant, vision and hearing problems and problems with the heart, kidneys or bones.

I would say the large majority of the research recommends staying away completely from alcohol, especially since the research is just not clear as to a safe amount. The CDC, American Pregnancy Association and The National Organization on Fetal Alcohol Syndrome recommend completely abstaining throughout pregnancy, and even quitting once you start TTC. As with everything during pregnancy, its your choice, but for me, the risk involved in maybe just one drink definitely outweighs the pleasure of tasting that delicious Corona and lime this summer.






Nieuwenhuijsen, Mark et. al. “Environmental Risk Factors of Pregnancy Outcomes: A Summary of Recent Meta-Analyses of Epidemological Studies.” Biomed Central: 2013.
Oken, E et. al. “Maternal Smoking During Pregnancy and Child Overweight: A Systematic Review and Meta-Analysis.” International Journal of Obesity; 2008: 32, 201-210.
Henderson, J, R Gray and P Brocklehurst. “Systematic Review of Effects of Low-Moderate Prenatal Alcohol Exposure on Pregnancy Outcome.” RCOG; 2007.
Markussen, Karen, et. al. “Maternal Lifestyle Factors in Pregnancy Risk of ADHD and Associated Behaviors: A Review of Current Evidence.” Am J Psychiatry; 2003: 160.

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