The situation: Your friend never thought she'd see the day, but there she is, grinning over a light-blue pee stick plus sign. Sure, she wasn't planning on getting pregnant right this second, but she's talked about it with the lucky person who's knocked her up—plus, she just got a promotion, and babies sure do look adorable in those tiny checkered Vans. Then she suddenly flashes back to last Saturday night when she drunkenly belted out "Bad Blood" at karaoke and puked on the side of the street as soon as her Uber dropped her off at home. Uh-oh. Now what?
The basics: Cut "your friend" a little slack—she's far from the first person this has happened to. Three in four women who want to get pregnant "as soon as possible" report drinking alcohol, according to the CDC, and an April study found that more than half of women did some drinking during the early months of their pregnancy. In the same study, 18 percent of those with intended pregnancies and 27 percent of those with unintended pregnancies said they binge drank in the first trimester.
And there are lots of different takes on whether or not a few drinks will hurt a baby. In one 2010 survey, 66 percent of obstetricians said even occasional alcohol consumption while pregnant is straight-up unsafe, but the other 34 percent said some drinking is fine, and there was no consensus among the doctors about whether alcohol's impact on a developing fetus is clear. More than one study has found no developmental difference in kids of women who abstained entirely versus those who had up to a drink a day.
Of course, we're not talking about a few somewhat-sanctioned sips of red wine with dinner, we're talking an ovaries-to-the-wall night of tequila and T-Swift. And if your friend turns to Google looking for info on that, she's likely to turn up stories like this one, which say that even one night of binge drinking can impact her unborn kid's mental health and school results, deeming her a terrible parent before she can even slip those Vans on the kid.
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The worst that could happen: Daniela Carusi, director of the surgical obstetrics program at Brigham & Women's Hospital and an assistant professor of obstetrics and gynecology at Harvard Medical School, says we actually don't—and likely won't—know the point at which alcohol consumption goes from harmless to harmful to a fetus. "Because we can't do good studies on alcohol and human development—we can't give pregnant women different amounts of alcohol and measure how it affects their children," she explains. (That uncertainty is why organizations like the CDC advise pregnant women to abstain entirely.)
If your friend made it home from her night out in one piece, Carusi says she already avoided the worst possible outcome. "Quite literally, the worst thing I can imagine happening is that the woman gets into a serious accident, passes out and hurts herself, drowns, or is hit by a car," she says. "It's important to consider that about 15 percent of pregnancies will be lost early in the first trimester, the vast majority for reasons unrelated to any activity on the part of the woman, including a drinking episode."
What will probably happen: Bingeing can still be cause for concern, says Carusi. If she hears a patient has been drinking heavily early in a pregnancy, her focus is then on whether the woman might have trouble avoiding alcohol over the course of the next nine months. Quitting drinking can be really tough, and a number of patients have told her that they miss it, whether for social reasons or because alcohol's sedative effects helped ease their anxiety.
But yes, she says that overall, your friend doesn't need to get worked up over what happened last weekend. "Again, we don't have research on the direct fetal effects of one binge drinking episode," Carusi explains. "However, if 18 to 27 percent of women binge drink in early pregnancy, it's reasonable to conclude that most of these women have a baby with a normal quality of life."
What your friend should do: It's pretty straightforward: She needs to be honest with her doc—both about this incident and throughout the rest of their pregnancy. "This comes up pretty frequently," Carusi says. "I tell women that there is nothing that can reverse the effects, if there are any, but most likely the pregnancy is fine." She'd advise a patient in this situation to stop drinking (if they hadn't already) and focus on good nutrition. And if she's finding quitting drinking a little tricky, she recommends finding a support system your friend can confide in and switching to mocktails or non-alcoholic beer.
If you're really struggling to give up the sauce, Carusi suggests seeking professional help, but you don't need to dwell on that one night.
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