Drinking During TTC and Pregnancy

Should women really be expected to abstain from alcohol indefinitely while TTC and during pregnancy? OBGYN Dr. Gleaton explains the recommended guidelines, research, and risks.

By Dr. Kenosha Gleaton

According to the Center for Disease Control and Prevention (CDC), three out of four women report consuming alcoholic beverages while trying to conceive (TTC). An additional 30 percent of pregnant women admitted to some alcohol use during their pregnancy. So, is just a little alcohol every now and again ok? Should women really be expected to abstain from alcohol indefinitely while TTC and during pregnancy?

What are the Guidelines on Alcohol When Trying to Conceive?

The American College of Obstetrics & Gynecology (ACOG) recommends that women who are at risk for pregnancy or TTC abstain from drinking. And for good reason, since fifty percent of pregnancies in the US are unintended and unrecognized during the earliest stages. Because most women are nearly four to five weeks pregnant at the time of a missed cycle, drinking during this time will often unintentionally expose a developing pregnancy, and sometimes an embryo, to the adverse effects of alcohol.

How Does Drinking Impact Fertility?

It's no secret that alcohol, in moderation, can offer various health and social benefits. [1-2] And when TTC, feelings of uncertainty and frustration may leave couples searching for a means to reduce stress, often with alcohol. However, the cons of drinking while TTC represent a greater significant harm. The risk of fetal harm from drinking during early pregnancy is often irreversible and can last throughout the lifetime of your baby. In addition, there is evidence to suggest that moderate drinking may affect both female and male fertility and could decrease the success of fertility treatments. [3] 

Despite this, alcohol consumption is common amongst women of reproductive age, and many women will continue to drink while TTC. One alternative strategy is to chart your ovulation, and avoid drinking for fourteen days after ovulation. Can you drink while doing IVF? Find out >> 

What Are the Guidelines for Drinking Alcohol While Pregnant?

The US Surgeon General along with ACOG advise that pregnant women completely abstain from alcohol. This recommendation has remained solid despite a widely-publicized study that reported one drink per day did not increase the risk of preterm delivery or low birth-weight infants. Unfortunately, this study failed to assess the more common effects alcohol has on the fetus including neurologic, cognitive, and behavioral patterns, or Fetal Alcohol Syndrome. 

What Are the Effects of Alcohol During Pregnancy?

The effect of alcohol use in pregnancy remains the best studied among prenatal substance exposures, so there's lots of information to guide us. [4] We do know prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities. What we don’t know is whether small amounts of alcohol or infrequent use is “okay.”  Consequently, most medical organizations, including ACOG, agree that there is no proven safe amount of alcohol during pregnancy and recommend against it.  Common risks associated with alcohol consumption during pregnancy include [4-7]:

• Fetal alcohol spectrum disorders (FASD), which includes the more commonly recognized Fetal Alcohol syndrome (FAS) characterized by poor growth, abnormal facial appearance, and intellectual disability.
• Cognitive and behavioral problems: Most typically seen after age ten and include severe brain dysfunction, attention deficits, and alterations in language and memory.
• Miscarriage: Increased risk of early pregnancy loss has been linked to alcohol consumption. Although some studies contradict this fact, the weight of the evidence supports this correlation.
• Stillbirth: This rate was higher among all levels of alcohol consumption.

Alcohol freely crosses the placenta and fetal blood alcohol levels approach maternal levels within two hours of maternal drinking. So, if there’s ever a time in life to become a teetotaler, it's while growing your baby. Read about alcohol use while breastfeeding. 

Are Certain Drinks Safer Than Others? Wine vs. Liquor? 

All alcoholic beverages should be avoided during preconception and pregnancy; however, certain drinks have a higher alcohol content than others. Since alcohol's effects on the developing fetus are dose dependent, it is even more prudent to avoid drinks containing a high percentage of alcohol. 

Fertility-Friendly Drinks From Natalist

The negative impact of alcohol on conception and pregnancy is well established and has led to the strong recommendation to avoid alcohol when TTC and if pregnant. If you’re having difficulty or have concerns regarding your alcohol consumption, contact your OBGYN provider to learn more about available resources. If you’re looking for tasty, fertility-friendly additions to your mocktail recipes, check out the Drink Mix Duo featuring Magnesium Plus and Hydration & Energy packets. These drink powders provide electrolytes and important nutrients that can benefit both you and your baby, whether you’re currently pregnant or you’re actively TTC! 

Shop Ovulation and Pregnancy Tests 

References:

1. Movva R, Figueredo VM. Alcohol and the heart: to abstain or not to abstain?. Int J Cardiol. 2013;164(3):267-276. doi:10.1016/j.ijcard.2012.01.030
2. Stevens S, Cooper R, Bantin T, Hermann C, Gerlach AL. Feeling safe but appearing anxious: Differential effects of alcohol on anxiety and social performance in individuals with social anxiety disorder. Behav Res Ther. 2017;94:9-18. doi:10.1016/j.brat.2017.04.008
3. Mínguez-Alarcón L, Chavarro JE, Gaskins AJ. Caffeine, alcohol, smoking, and reproductive outcomes among couples undergoing assisted reproductive technology treatments. Fertil Steril. 2018;110(4):587-592. doi:10.1016/j.fertnstert.2018.05.026
4. At-risk drinking and alcohol dependence: obstetric and gynecologic implications. Committee Opinion No. 496. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:383–8.
5. Krulewitch CJ. Alcohol consumption during pregnancy. Annu Rev Nurs Res. 2005;23:101-134.
6. Sundermann AC, Velez Edwards DR, Slaughter JC, et al. Week-by-week alcohol consumption in early pregnancy and spontaneous abortion risk: a prospective cohort study. Am J Obstet Gynecol. 2021;224(1):97.e1-97.e16. doi:10.1016/j.ajog.2020.07.012
7. Kesmodel U, Wisborg K, Olsen SF, Henriksen TB, Secher NJ. Moderate alcohol intake during pregnancy and the risk of stillbirth and death in the first year of life. Am J Epidemiol. 2002;155(4):305-312. doi:10.1093/aje/155.4.305

Originally published on 08/10/2020. Updated for accuracy and relevancy on 01/07/2024. 

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University. She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women.