Dissecting the CDC's Advice to Avoid Alcohol-exposed Pregnancies

February 16, 2016 02:59 pm Chris Crawford

There's no disputing that the CDC's recently released Vital Signs(www.cdc.gov) report on alcohol use and pregnancy, along with an accompanying article(www.cdc.gov) in the agency's Morbidity and Mortality Weekly Report (MMWR), has sparked plenty of discussion.

[Woman sitting on exam table, talking with doctor]

The CDC recommended, among other things, that health care professionals discuss appropriate contraception methods with their female patients who say they are sexually active and drink alcohol, with the goal of reducing the prevalence of fetal alcohol spectrum disorders (FASDs). But some people took offense at the agency's further cautionary message: that women who are sexually active and who are not using contraception consider not drinking.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that family physicians strive to empower their patients to make good decisions for their health and the health of their families.

"The message is not, 'If you're fertile and having sex, you can't drink!' That's not what (the CDC) intended," she said. "The decision is always (the patient's), but we must provide them with information so that they understand the potential health consequences of their behaviors."

Story highlights
  • The CDC recently released a Vital Signs report on alcohol use and pregnancy that generated lots of discussion.
  • The agency recommended, among other things, that health care professionals discuss appropriate contraception methods with female patients who say they are sexually active and yet still drink alcohol in an effort to reduce the prevalence of fetal alcohol spectrum disorders.
  • The CDC also recommended that health care professionals advise women who want to become pregnant to stop drinking alcohol as soon as they stop using birth control.

CDC's Recommendation

In its MMWR report, the CDC estimated 3.3 million U.S. women ages 15-44 risk exposing their developing infant to alcohol because they are drinking, they are sexually active, and they are not using birth control.

The report also found that three in four women who are trying to get pregnant don't stop drinking alcohol when they stop using birth control.

"Alcohol use during pregnancy can cause fetal alcohol spectrum disorders," Frost said. "There is no 'safe amount,' which is not the same thing as saying that any amount will cause the disorder. We just don't know the safe threshold, if there is one."

Thus, the CDC recommended that health care professionals advise women who want to become pregnant to stop drinking alcohol as soon as they stop using birth control.

Because most women don't know they're pregnant until they are four to six weeks into the pregnancy, said the MMWR, women who continue to use alcohol after discontinuing use of contraception could unknowingly be exposing their developing infant to alcohol. FASDs are completely preventable if a woman doesn't drink any alcohol during pregnancy, CDC officials point out.

In addition, the agency said physicians should follow the U.S. Preventive Services Task Force's recommendation(www.uspreventiveservicestaskforce.org) to conduct alcohol misuse screening in all adult patients, including reproductive-age and pregnant women, and to offer those who engage in risky or hazardous drinking behavior brief behavioral counseling interventions.

Translation to Practice

Frost said the recommendations in the CDC's MMWR report are consistent with the AAFP's own recommendations on the topic. She also pointed to the Academy's preconception care position paper, which specifically recommends screening for alcohol use and providing effective contraception when pregnancy is not desired.

This advice is in line with the CDC's recommendation that states, "the best time to assess alcohol consumption and inform women about health consequences to them and their child is before pregnancy."

According to Frost, there is nothing new about screening for alcohol use. Family physicians routinely screen their patients for smoking, alcohol and recreational drug use. If a patient says he or she consumes alcohol, the physician then should discuss how much and how often he or she does so to determine if the patient is at risk, she said.

"For women, we also have to consider their reproductive plan," Frost added. "If they are sexually active and not using contraception, we must inform them of the potential risk of alcohol exposure if they were to become pregnant, as well as discuss contraception if pregnancy is not desired.

"We know that about 50 percent of pregnancies in the U.S. are unplanned," Frost continued. "So there are women getting pregnant without 'trying,' and if they are drinking alcohol, they may inadvertently expose their fetus, which may result in FASDs."

Regardless of whether female patients want to get pregnant or are trying to prevent pregnancy, they need to be informed, Frost stated.

"What the woman decides to do with this information is ultimately up to her," she said.

Related AAFP News Coverage
AAFP Urges FPs to Integrate Preconception Care Into Patient Visits
Position Paper Offers Recommendations for Counseling, Screening

(1/19/2016)

Research Suggests Teen Alcohol Use Can Lead to Adult Brain Abnormalities
Second Study Says Binge Drinking Up, Especially Among Women

(5/15/2015)

More From AAFP
Clinical Recommendations: Maternity Care


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