The 1988 National Maternal Infant Health Survey reported that 45 percent of women respondents consumed alcohol during the 3 months before they learned of their pregnancy. Nearly 21 percent reported consuming alcohol after learning that they were pregnant, 17 percent took three or fewer drinks per month during pregnancy, and 0.6 percent took six or more drinks per week during pregnancy (CDC, 1995a). Alcohol use was most prevalent among white, non-Hispanic women, followed by Hispanic and black women.
Infants are at risk from alcohol and illicit substances transmitted through the placenta and/or through breast milk. They are also at risk of nutritional deficits secondary to maternal nutrition deficits. Postnatally, the infant may also be at nutritional risk owing to the impaired ability of the mother to provide optimal care, including nutrition.
Alcohol is a rapidly absorbed drug that enters the fetal circulation and maternal milk. The safe amount of alcohol consumption during pregnancy is unknown. Pregnant women who consume greater than 6 fluid ounces of liquor daily (or the equivalent) have at least a 20 percent likelihood of delivering an infant with fetal alcohol syndrome (FAS) (Benson and Pernell, 1994). FAS is characterized by prenatal and postnatal growth restriction, distinct facial anomalies, and mental deficiency. Between 2 and 5 cases of FAS are estimated to occur per 1,000 live births (Bloss, 1994).
Adverse physical and neurobehavioral effects may also occur at lower levels of exposure to alcohol (Bloss, 1994). These effects range from spontaneous abortion to subtle behavioral effects in the offspring. Fetal growth restriction has been noted, although inconsistently, at levels of alcohol ingestion of 1 to 2 oz/day (Hanson et al., 1978; Little, 1977; Wright et al., 1983). Postnatal growth may be adversely affected in children who do not have full FAS.
Many animal studies have demonstrated a direct dose-response effect of alcohol on fetal growth and development (IOM, 1990), and malnutrition may be involved. Chronic alcoholics typically have an inadequate nutrient intake. In a prospective study of alcohol use during pregnancy, those with positive scores on the Michigan Alcoholic Screening Test had lower intakes of protein from meat and vegetable sources, dairy foods, cereal and breads, calcium, B vitamins, and vitamin D (Sokol et al., 1981). Heavy alcohol intake may interfere with nutrient absorption and lead to impaired nutrient metabolism by the liver. Specific deficiencies