Can alcohol consumption a few days after conception affect fetal development?

From the Guidelines

Alcohol consumption a few days after conception can potentially affect fetal development, so it's best to stop drinking as soon as you know you're pregnant or are trying to conceive. During the first few days after conception, the fertilized egg is traveling to the uterus and beginning to implant. While the embryo hasn't yet formed major organ systems at this early stage, alcohol can still interfere with cell division and development. There is no established safe amount of alcohol during pregnancy, and the effects can vary based on timing, amount consumed, and individual factors. The most severe effects of alcohol typically occur with regular or heavy drinking throughout pregnancy, leading to Fetal Alcohol Spectrum Disorders. If you consumed alcohol before knowing you were pregnant, stop drinking immediately and discuss this with your healthcare provider. The developing brain is particularly vulnerable to alcohol exposure throughout pregnancy, and abstaining completely is the safest approach for fetal development.

Key Points to Consider

• No safe threshold of alcohol use during pregnancy has been established, as stated in guidelines for identifying and referring persons with fetal alcohol syndrome 1.
• Alcohol use in pregnancy is strongly associated with increased risk of preterm birth and small for gestational age infants, as well as long-lasting impairments of the offspring due to alcohol exposure during pregnancy 1.
• All women should be screened for alcohol use in pregnancy, and those with alcohol use disorder should aim to achieve alcohol abstinence as the most important aspect of preconception and pregnancy management 1.
• The decision to continue medications for alcohol use disorder during pregnancy must be taken on an individual basis, weighing their risks against the risks connected to alcohol withdrawal syndrome 1.

Recommendations for Practice

• Stop drinking as soon as you know you're pregnant or are trying to conceive to minimize the risk of fetal alcohol spectrum disorders.
• Discuss any alcohol consumption before knowing you were pregnant with your healthcare provider.
• Abstain from alcohol completely during pregnancy as the safest approach for fetal development.
• Women with alcohol-related liver disease should delay conception until abstinence is achieved, and medication use to treat alcohol use disorder during pregnancy should be individualized 1.

From the Research

Alcohol Consumption and Fetal Development

• Alcohol consumption during pregnancy can have detrimental effects on fetal development, including impaired growth, stillbirth, and fetal alcohol spectrum disorder 2.
• The exact mechanisms of alcohol's effects on fetal development are not fully understood, but it is thought that alcohol exposure during the periconception period can affect the development and metabolism of the early embryo 3.
• Studies have shown that prenatal exposure to alcohol can have profound effects on many aspects of fetal development, including somatic growth, facial structure, and brain development 4.

Timing of Alcohol Consumption

• Alcohol consumption around the time of conception may be particularly harmful, as the early embryo is highly sensitive to the detrimental effects of alcohol during the periconception period 3.
• One study found that light-to-moderate maternal alcohol consumption during pregnancy did not adversely affect fetal growth characteristics, but further studies are needed to assess whether moderate alcohol consumption during pregnancy influences organ growth and function in postnatal life 5.

Recommendations

• Abstinence is recommended for women who are or may become pregnant, as there is evidence that alcohol consumption in pregnancy can cause fetal harm 6.
• Health care providers should create a safe environment for women to report alcohol consumption and provide brief interventions for women with at-risk drinking 6.
• Pregnant women should be given priority access to withdrawal management and treatment if they continue to use alcohol during pregnancy 6.

Key Findings

• A study published in 2019 found that almost half of women in the United States consume alcohol during pregnancy, despite the recommendation to abstain 2.
• A 2010 study found that there is insufficient evidence to define a threshold for low-level drinking in pregnancy, and that abstinence is the prudent choice for women who are or may become pregnant 6.
• A 2018 review discussed the potential mechanisms for the adverse developmental outcomes of early exposure to alcohol, including reduced retinoic acid synthesis and epigenetic reprogramming 3.