Ask the Expert: Nutrition and FASD, Part I
04 Jun 2015
Nutrition and FASD, Part I: An Interview with Dr. Christina Chambers About Nutritional Issues for Pregnant Women - May 2015
This month, Ask the Expert takes the first of a two-part look at the importance of nutrition for pregnant women and new mothers. Our first part features an interview with Christina D. Chambers, Ph.D., M.P.H., a member of the Organization of Teratology Information Specialists (OTIS) and Director of the Center for the Promotion of Maternal Health and Infant Development at the University of California, San Diego (UCSD). Dr. Chambers discusses key nutritional issues for pregnant women, as well as her research and awareness efforts related to FASD and health issues related to pregnancy.
(Note: Our next Ask the Expert column will feature Part II of this series, an interview with Jeffrey Wozniak, Ph.D., L.P., on nutrition for newborns identified with an FASD.)
1. Our message at the FASD Center for Excellence is that there is no amount of alcohol or type of alcohol that is proven to be safe for a woman to consume during pregnancy. One of the reasons that it is difficult to establish a universal ‘safe amount’ is because every person metabolizes alcohol differently. Can you help us understand how alcohol is metabolized?
Alcohol is metabolized primarily by the liver. There are certain genes and variations in those genes that help to determine how quickly alcohol is metabolized. But other factors play a role in how much and how fast alcohol gets into the blood stream of the woman; for example, how much and what type of food is in the stomach at the time she drinks, her body weight and amount of body fat, hormone levels, and how quickly she drinks.
2. In addition to alcoholic drinks like beer and wine and hard liquor, there are many foods and beverages that contain some amount of alcohol, including vinegars, some hot sauces, some types of sugarless gum (which use alcohol as a sweetener), some energy drinks, and even some vitamins and over-the-counter prescription drugs. Are these safe for a woman to consume during pregnancy?
I always hesitate to use the word “safe,” but the main question here is the dose of alcohol. For example, some liquid nighttime cold/flu remedies have more than 10% alcohol content by volume, which seems like a lot. However, the recommended dose of a medication like this might be approximately 2 tablespoons every four hours, so the actual absolute dose of alcohol is very small. That being said, pregnant women should be aware of the alcohol content of all products they ingest and be careful to avoid alcohol where they can.
3. Is it safe to drink non-alcoholic beers and wines during pregnancy?
The definition of “non-alcoholic” in terms of product labeling varies in different countries and does not necessarily mean alcohol-free. Women should be aware of the actual alcohol content of a product by reading the label carefully. Avoiding alcohol-containing beverages in pregnancy is the best recommendation.
4. How about products that contain alcohol but that aren’t really intended to be ‘consumed’ or eaten, such as some types of mouthwash, hand sanitizers, and anti-bacterial soaps? Are these safe for pregnant women to use?
Again, the issue of dose is the question. Absorption through the skin or oral mucosa (thin membrane layer inside the mouth) would be expected to lead to much lower or even undetectable blood alcohol levels in the mother than the same amount of alcohol if the pregnant woman actually ingested it. However, in some situations and occupations, these products are used almost continuously throughout the day. To my knowledge, regardless of alcohol content, hand sanitizers have not been studied for safety in human pregnancy.
5. We’ve talked about some of the ‘dont’s.’ Let’s talk about some of the ‘do’s.’ How can taking choline and zinc help a pregnant woman improve the health of her baby?
Adequate—preferably optimal—nutrition in pregnancy is important to support normal growth and development of the baby, as well as good outcomes of pregnancy for the mother. There are recommended daily allowances (RDA) for many vitamins and minerals during pregnancy as established by the U.S. Food and Nutrition Board. For example, the RDA for zinc is 11-12 mg/day depending on the age of the pregnant woman. For some other micronutrients where research is still evolving, such as choline, the Food and Nutrition Board has established an “adequate intake” level of 450 mg/day (as opposed to an RDA). These two micronutrients have been examined in animal studies and have been suggested to have some specific benefits for pregnancy outcomes, particularly in the mother who has consumed alcohol.
However, the overall nutritional status of the mother both from dietary sources and supplements is important. It is also important for a mother-to-be to consider nutritional status prior to conception. The U.S. Public Health Service recommends that all women of reproductive potential (childbearing age) take a daily 400 microgram folic acid supplement. The recommendation to take folic acid, a B vitamin, is based on strong evidence that adequate folate helps protect the developing baby from certain birth defects of the spine that occur in the first few weeks of pregnancy, often before a woman knows she is pregnant.
6. Are there other things that you recommend for pregnant women to help them protect their health and the health of the baby during pregnancy?
See your doctor before you attempt pregnancy and go over all of your health concerns, medications you take, and your social habits, so you can make decisions about how to best prepare for pregnancy. Before becoming pregnant, try to modify any risks you may have – for example, bring your body weight into the normal range, stop using tobacco, avoid second-hand tobacco smoke, avoid alcohol, eat well, and take your folic acid supplement. Once you are pregnant, revisit all of these issues. However, some pregnancies occur that are unplanned; as soon as you suspect you are pregnant, absolutely stop consuming alcoholic drinks, and discuss your nutrition, medications, and other health habits with your doctor.
7. You work closely with the MotherToBaby initiative, which is a service of the Organization of Teratology Information Specialists, or OTIS, of which you are a member. Can you tell us about MotherToBaby and OTIS, their goals and objectives?
MotherToBaby (MotherToBaby.org) is a network of expert counseling services located across the U.S. and Canada in universities and medical centers. The network provides individualized risk assessment, counseling, and referral on pregnancy and breastfeeding exposures to medications, vaccines, occupational exposures, household and cosmetic products, medical procedures, infections, and lifestyle exposures, including alcohol, tobacco, and illicit drugs. This information is provided at no cost by phone (866-626-6847) or email to preconception, pregnant, or breastfeeding women, health care providers, adoptive parents, and other interested parties. The service is available to anyone in the U.S. or Canada in English or Spanish. Fact Sheets on common exposures in pregnancy and breastfeeding are also available on the MotherToBaby Web site.
Unfortunately, for many exposures in pregnancy and breastfeeding, there is not enough information available about safety. For this reason, the MotherToBaby network conducts pregnancy outcome studies to develop better information for women regarding specific exposures. Women who contact MotherToBaby Network services are offered participation in these studies, which can help other women in the future have more accurate information about healthy pregnancy. Pregnant women can also contact MotherToBaby studies directly (pregnancystudies.org)
8. What do you see as key research priorities for FASD and/or pregnant women going forward?
Key research priorities for FASD include developing and testing better prenatal alcohol prevention strategies, more effective biomarkers of risky alcohol exposure during pregnancy, better methods for earlier and accurate diagnosis of affected children, and better treatments or interventions for children and adults with FASD.
About the Expert
Christina Chambers, Ph.D., M.P.H., is a Professor in the Department of Pediatrics at the University of California San Diego. She is a perinatal epidemiologist who specializes in research on prenatal exposures and affects on the fetus and child. She is actively involved in prevention work through the MotherToBaby Network, and in FASD research in the U.S. and internationally, specifically related to prevention of alcohol-exposed pregnancies and the role of nutrition during pregnancy in modifying alcohol-related risks.
DISCLAIMER: The views, opinions, and content of this column are those of the authors/experts and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.