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Alcohol, Caffeine and Smoking in Pregnancy

01 In Brief

Alcohol in pregnancy continues to cause controversy. Fetal alcohol syndrome is usually associated with repeated binge drinking. However it is now known that in vulnerable women, even a drink per day of alcohol can cause subtle neurological problems in their unborn child e.g. symptoms similar to ADHD . The safest option is to avoid alcohol altogether whilst pregnant. There is no safe level of smoking in pregnancy and women who smoke should be supported to decrease and cease where possible. The safe level of consumption of caffeine per day during pregnancy is 200 mg, equivalent to 2 cups of ground coffee.

02 What Do I Need To Know?

ALCOHOL IN PREGNANCY

• There is probably no other teratogen in pregnancy that causes as much controversy as alcohol consumption.
• The lack of very clear guidelines is due to lack of definitive evidence that small amounts of alcohol in pregnancy, known as low level drinking, causes harm. Low level drinking is considered 1-2 drinks per week.
• When you drink alcohol during pregnancy it crosses the placenta rapidly and the baby's blood alcohol level becomes the same as the mother. However, the fetus and infant take much longer than the mother to clear alcohol from their bloodstream.  
• Frequent and heavy drinking in early pregnancy is associated with Fetal Alcohol Syndrome, which results in poor growth and intellectual disability. However not all heavy drinkers will have an affected infant.  
• Recent studies suggest there is an increased risk of subtle neurodevelopment problems in some children whose mothers consume moderate levels of alcohol in pregnancy (an average of one drink per day). This is known as Fetal Alcohol Spectrum Disorder or Alcohol Related Neuro-developmental Disorder (ARND). Affected children have problems with hyperactivity, inattention, behaviour or learning problems similar to ADHD.
• It is less clear about the possible harmful effects of lower levels of drinking, ranging between occasional drinking and less than one drink per day, during pregnancy.
• Australia, Canada, France, the USA and, more recently, the UK have revised their guidelines in recommending that in view of the lack of evidence, the safest option is to avoid alcohol altogether. The prevalence of Fetal Alcohol Spectrum Disorder has been estimated at around 1 per cent of pregnancies and in Europe it has been reported to be as high a 3-4 per cent. The increase in Europe is probably related to the high level of consumption of alcohol in Eastern European countries.  
• Alcohol consumed prior to confirming pregnancy in the early weeks is likely to be of low risk to the unborn baby.

CAFFEINE IN PREGNANCY

• Caffeine is contained in many of the foods and drink we consume and enjoy on a regular basis. Fortunately many women develop an aversion to caffeine drinks in pregnancy. 
• There are mixed reports regarding the effects of caffeine in pregnancy but high levels of intake have been associated with miscarriage, premature delivery and stillbirth.
• It is recommended that the safe level of consumption in pregnancy is 200 mg of caffeine per day equivalent to:
  • 2 cups of ground coffee or 2 and a half cups of instant coffee;
  • 4 cups of medium strength tea;
  • 4 cups of cocoa or hot chocolate;
  • 6 cups of cola.

TOBACCO SMOKING IN PREGNANCY

There is no safe level of smoking and it increases the risk of low birth weight, breathing problems and SIDS.

03 What Others Say

• June 2003 National Alcohol prevention strategy

  Alcohol in a Woman's Blood stream may affect her unborn child 

• The National Organisation for Fetal Alcohol Syndrome and Related Disorders Inc 

Alcohol in pregnancy fact sheet: Be kind to me stay alcohol-free

• RWH  Melbourne fact sheet: caffeine and alcohol

Food safety in pregnancy: caffeine and alcohol

• Smoking in pregnancy

NSW health fact sheet: Smoking in Pregnancy

Better Health Channel fact sheet: smoking in pregnancy

04 I Want To Know More

• NHMRC 2009 guidelines to reduce health risks from drinking alcohol 

Australian Guidelines to reduce health risks from drinking alcohol

• Excellent review article on safe levels of alcohol in pregnancy and also has several references on long-term data on the subtle effects on children’s mental health

BMJ Evidence-based mental health: Alcohol consumption in pregnancy as a risk for later mental health problems

• Fetal Alcohol syndrome - A review, August 2002

National Drug Strategy: Fetal Alcohol Syndrome; a literature review

• Australian Government website www,alcohol.au: Standard drinks guide

05 Clinicians Tools and Resources

• NSW Health information on caffeine - chart showing amount of caffeine in various foods and drink 

NSW fact sheet on caffeine

Last updated: 13/07/2011 by Dr Elizabeth Hallam*/Claire Galea

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