Fetal Alcohol Spectrum Disorder (FASD) describes a range of severe neurodevelopmental impairments caused by alcohol exposure before birth.

People with FASD can experience a wide variety of challenges including difficulties with physical coordination, language, memory, learning, executive function, behaviour and birth defects.

How much is too much?

While it’s well-known that alcohol crosses the placenta and can interfere with development and growth of a baby’s brain and other organs, the nuances of how occasional or minimal drinking impacts fetal development have remained unclear.

Although the risk of harm to the baby generally increases with the amount and frequency of alcohol use, a range of maternal and fetal factors can influence this.

This makes it difficult to predict the exact effects of drinking alcohol during pregnancy for any individual.

Since 2009, the Australian National Guidelines to Reduce Health Risks from Drinking Alcohol, (currently promoted in the Every Moment Matters campaign) have recommended that women abstain from drinking alcohol completely throughout pregnancy.

In addition, the latest data from the National Drug Strategy Household Survey revealed that despite longstanding advice, nearly one in three pregnant women (28 per cent) still drink alcohol.

While this statistic is troubling, it’s important to highlight that most women who drink alcohol during pregnancy do so at low levels, often significantly reducing or completely stopping once they’re aware of their pregnancy.

Balancing informed choices with clear public health messages

Not surprisingly, navigating the conversation around alcohol use during pregnancy is complex.

Recent findings from my team at Murdoch Children’s Research Institute (MCRI) indicate that many women who continue to drink alcohol during pregnancy are highly educated and well aware of the public health messages advising abstinence.

The lack of strong evidence linking lower levels of alcohol use to negative outcomes has sparked debate about whether abstinence is necessary.

However, it’s important to recognise that claims like this can be risky and may contribute to misinformation.

The potential harm lies in downplaying the uncertainty of this issue, as even low levels of alcohol use could have unforeseen effects on fetal development that we don't fully understand.

The risks of lower level alcohol exposure

Our Asking Questions about Alcohol in Pregnancy (AQUA) study began in 2011 and followed a large community-based group of more than 1,000 pregnant women and their children over the course of a decade.

Our aim was to study the potential risks of lower levels of prenatal alcohol exposure.

From the outset, we understood that accurate and honest reporting of alcohol use without fear of judgment was essential. Our questionnaire spent two years in development with considerable community input.

Our latest findings, published in JAMA Pediatrics, examined developmental and physical markers in children at early school age.

We discovered that prenatal alcohol exposure could affect both their facial and brain development, sometimes leading to distinct facial features and developmental concerns.

Using highly specialised 3D imaging and analysis techniques, we also found consistent changes in the shape of the children’s eyes and nose at 12 months and six to eight years of age who were exposed to relatively low doses of alcohol during pregnancy.

These facial changes, which are not discernible without specialised imaging and analysis, are similar regardless of whether they were exposed to alcohol in only the first trimester or throughout pregnancy.

We did not find a clear link between the level of alcohol exposure and degree of facial change, while our analysis of MRI brain scans from 143 children aged six to eight years did not find notable differences in children exposed to alcohol compared to those who were not.

However, we did find that the right caudal anterior cingulate, and its connecting pathways in the brain, differed in children with alcohol exposure at any stage of pregnancy.

The anterior cingulate is part of our limbic system and is involved in attention, reward-based learning, executive function (decision making and problem solving), impulse control, social interactions, emotional regulation and empathy.

Our findings suggest that this part of our brain may be particularly sensitive to even small amounts of alcohol, with many of the above functions affected in children with FASD.

We also saw weaker connections in a related brain network, the right cortico-basal ganglia-thalamo-cortical network, which influences problem solving, planning, decision-making and emotional regulation.

Reassuringly, we found no significant differences in cognition (thinking), behaviour, social skills, executive function, or language or motor (movement) development at age two and in early school-age children – with or without alcohol exposure.

The hidden biological consequences of alcohol

Our research at MCRI has shown that facial changes could occur even with lower levels of prenatal alcohol exposure. These specific differences also persist into early childhood.

Exposure throughout pregnancy may also change key brain structures and connectivity.

These differences, not always directly linked to developmental issues, highlighted the hidden biological consequences of alcohol use during pregnancy.

Understanding these effects is key to providing clearer guidance for parents and healthcare providers. It also reinforces the need for targeted health messaging to support informed decision-making during pregnancy.

Persistence of alcohol use among some pregnant women, despite education campaigns, suggests blanket advice that urges abstinence may not resonate with everyone.

A personalised approach to public health advice

We need a more tailored approach to health messaging that considers social influences, individual attitudes and personal experiences.

However, it’s essential to recognise that this conversation mainly applies to women who can make informed choices about their alcohol use.

For women struggling with alcohol dependency or finding it difficult to quit because of social circumstances, the issue is far more complicated. Advocating for abstinence alone may not be effective for these women, who may require additional support and professional intervention.

In these cases, the focus should be on providing resources and care, rather than placing the burden solely on individual choice.

More personalised information could provide pregnant women with a deeper understanding of the risks of alcohol use and address their specific concerns, ultimately promoting healthier behaviours.

To get the best possible outcomes for the child, abstinence from alcohol during pregnancy is considered the safest choice as even small amounts are associated with differences to the face and brain.

Where choice is possible, women and their partners can avoid potential harm to their unborn child by following this advice.

This study is a collaborative effort between the Murdoch Children’s Research Institute, Monash University, University of Melbourne, Royal Children’s Hospital, University of Sydney, University of Oxford and KU Leuven, with research conducted by Peter Anderson, Jane Halliday, Evi Muggli, Deanne Thompson, Stephen Hearps, Alicia Spittle, Tony Penington, Elizabeth Elliott, Michael Suttie, Harry Matthews, and Peter Claes.

Wirtten by Evelyne Muggli, Murdoch Children’s Research Institute (MCRI) and Professor Alicia Spittle, the University of Melbourne.

This article is republished from PURSUIT under a Creative Commons license. Read the original article.