Patient Education · Maternal-Fetal Medicine

Alcohol & Pregnancy

What Every Expectant Parent Should Know

Atlanta Perinatal Associates  ·  Dr. Chukwuma Onyeije, MFM
The Most Important Fact

No Amount of Alcohol
Is Safe in Pregnancy

There is no known safe amount, type, or timing of alcohol during pregnancy. Complete avoidance is the only way to fully protect your baby.

How Alcohol Reaches Your Baby

Alcohol Crosses the Placenta

🍷
Mother
Drinks
🫀
Enters
Bloodstream
🧬
Crosses
Placenta
👶
Baby
Exposed

When you drink, your baby drinks. Alcohol passes freely through the placenta and can harm developing organs and the brain at every stage.

Understanding the Diagnosis

Fetal Alcohol Spectrum Disorders

FAS
Fetal Alcohol
Syndrome
pFAS
Partial FAS
ARND
Neurodevelopmental
Disorder
ARBD
Birth
Defects

FASD is a range of lifelong conditions caused by prenatal alcohol exposure — affecting learning, behavior, and physical development.

100% Preventable
Complete abstinence eliminates all FASD risk
Trimester-Specific Risk · 1 of 3

1st Trimester: Structural Formation

⚠ Wks 1–12
Critical Period
Wks 13–26
Wks 27–40
  • Weeks 3–8 are the "critical period" — organs and facial features form
  • Alcohol disrupts midline brain development and craniofacial formation
  • Binge drinking (≥4 drinks/occasion) strongly linked to classic FAS facial features
  • Increased risk of spontaneous abortion during this window
Clinical Recognition · Fetal Alcohol Syndrome

Recognizable Features of FAS

Small palpebral fissures (short eye openings)
Epicanthal folds
Smooth philtrum (no ridges above lip)
Thin vermilion border (thin upper lip)
Low nasal bridge, upturned nose
Micrognathia (small jaw)
These features are permanent markers of first-trimester alcohol exposure.
Trimester-Specific Risk · 2 of 3

2nd Trimester: Brain Wiring

Wks 1–12
⚠ Wks 13–26
Neuronal Migration
Wks 27–40
  • Nerve cells migrate to their final positions in the brain during this period
  • Alcohol disrupts this migration, causing lasting deficits in executive function
  • Increased risk of stillbirth with continued alcohol use
  • Hippocampus and cerebellum are especially vulnerable to alcohol toxicity
Trimester-Specific Risk · 3 of 3

3rd Trimester: Growth & Brain Expansion

Wks 1–12
Wks 13–26
⚠ Wks 27–40
Rapid Brain Growth
  • Rapid brain volume expansion and weight gain occur in this window
  • Alcohol can cause intrauterine growth restriction (IUGR) and microcephaly
  • Disrupts synaptogenesis — the formation of brain connections
  • Long-term deficits in memory, cognition, and behavioral regulation
Clinical Summary

Trimester-by-Trimester: What's at Stake

Trimester Key Development Risk of Alcohol Exposure
1st
Weeks 1–12
Organogenesis
Craniofacial formation
Structural birth defects
FAS facial features
Spontaneous abortion risk
2nd
Weeks 13–26
Brain wiring
Neuronal migration
Skeletal growth
Disrupted neuronal migration
Executive function deficits
Stillbirth risk
3rd
Weeks 27–40
Rapid brain growth
Weight gain
Synaptogenesis
IUGR · Microcephaly
Reduced brain volume
Long-term cognitive deficits
Monitoring & Screening · 1 of 3

How We Screen for Alcohol Use

Your care team uses validated questionnaires at every prenatal visit. Honest answers allow us to provide the best support for you and your baby.

T-ACE
Tolerance · Annoyed
Cut Down · Eye-opener
Specifically validated for obstetric populations. Identifies risky drinking patterns in pregnant patients.
TWEAK
Tolerance · Worried
Eye-opener · Amnesia · K/Cut Down
Highly sensitive for detecting at-risk drinking in pregnancy. Recommended at first prenatal visit and each trimester.
AUDIT-C
Alcohol Use Disorders
Identification Test
General screening tool — may miss lower-threshold "at-risk" drinking specific to pregnancy.
Monitoring & Screening · 2 of 3

Objective Testing When Needed

Lab tests can detect alcohol use objectively. These are used in high-risk scenarios to complement questionnaire screening.

Urine EtG/EtS
3–4 days
Blood EtG
~1–2 days
Hair EtG
Months of retrospective history
EtG = Ethyl glucuronide  |  EtS = Ethyl sulfate — direct metabolites of alcohol that provide objective evidence of recent use.
Monitoring & Screening · 3 of 3

Monitoring Continues After Birth

👶
Newborn
🧪
Meconium Testing
🌱
Early Intervention
  • Meconium (baby's first stool) can be tested for FAEE and EtG
  • Reflects alcohol exposure during the 2nd and 3rd trimesters
  • Early identification enables early support services and developmental intervention
Why Total Avoidance Matters

Even Small Amounts Can Have Effects

No Safe Threshold Has Been Identified

Low-to-moderate drinking has been linked to subtle but real deficits in attention, information processing speed, and emotional regulation — even without visible physical features.

  • Attention and concentration difficulties
  • Slower speed of information processing
  • Emotional regulation and behavioral challenges
  • These effects may not be visible at birth — they emerge over time
Clinical Evidence · Support Works

A Short Conversation Can Make a Difference

Brief Interventions (BIs) are short, structured conversations between patient and provider focused on motivation and goal-setting. Research shows BIs significantly reduce or eliminate alcohol use during pregnancy.
💬
Honest Conversation
+
🎯
Goal Setting
=
📉
Reduced Exposure

You are not alone. Your care team is here to support — not judge — you.

Risk Before You Know You're Pregnant

Nearly Half of All Pregnancies Are Unplanned

~50%

of pregnancies in the United States are unplanned

Alcohol exposure often occurs before a woman knows she is pregnant. Women of childbearing age who are not using effective contraception should receive counseling about alcohol-exposed pregnancy (AEP) risk — even before conception.

What You Can Do Today

Your Action Plan

1
🛑

Stop All Alcohol Now

There is no safe time to drink. Every day of abstinence protects your baby.

2
💬

Tell Your Provider

Be honest about past or current alcohol use. Disclosure is never judged — it helps us help you.

3
🤝

Ask for Support

Brief counseling, support groups, and resources are available. You don't have to do this alone.

4
📅

Attend All Visits

Screening at each prenatal visit ensures ongoing support and early identification of concerns.

Our Commitment to You

Your Care Team Is Here With You

🤝

Disclosure is never judged. Our goal is to support you and your baby with compassion and evidence-based care. Together, we can prevent FASD and build the healthiest possible start for your child.

No Judgment. Just Support.

Universal screening at the first prenatal visit and at least once per trimester is recommended by ACOG and SMFM.

Summary

What to Remember

1

No safe amount of alcohol exists during pregnancy — at any trimester, in any form.

2

Risk exists in all three trimesters, from structural defects to brain development impairment.

3

Screening and monitoring tools are available — questionnaires, labs, and neonatal testing.

4

Complete avoidance is the only strategy that prevents FASD entirely — 100% preventable.

Trusted Resources

Where to Learn More

  • ACOG — American College of Obstetricians and Gynecologists  acog.org
  • SMFM — Society for Maternal-Fetal Medicine  smfm.org
  • CDC — Alcohol Use in Pregnancy  cdc.gov/ncbddd/fasd
  • NOFAS — National Organization on Fetal Alcohol Syndrome  nofas.org
  • SAMHSA Helpline — 1-800-662-4357  Free, confidential, 24/7
Atlanta Perinatal Associates  ·  Dr. Chukwuma Onyeije, MFM  ·  atlantaperinatal.com
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