The Alcohol Pharmacology Education Partnership: When Can Alcohol Damage the Fetus?

Prenatal alcohol exposure can damage the fetus during the entire pregnancy, but depending on when the exposure occurs determines which organ is affected. Pregnancy can be subdivided into three trimesters, each about twelve weeks long. Important events in fetal development occur during each of these trimesters.

The majority of structural development takes place during the first trimester (the 1st twelve weeks of pregnancy). During the first trimester the musculoskeletal system is formed, along with the internal organ systems (for example, the endocrine system, respiratory tract, digestive tract, and the nervous system). The stage in development when organs are formed is referred to as organogenesis. Prenatal alcohol exposure during the first trimester can cause damage to specific cell populations crucial to organ formation. Some of the most common physical defects include facial abnormalities, small skull circumference, skeletal and muscle problems, and problems with internal organs.

An unfortunate reality is that during the early stages of the first trimester many women do not realize they are pregnant, and if they drink alcohol, they may unknowingly cause structural damage (skeletal and organ) to their unborn child.

Alcohol exposure at during the first trimester is not limited to skeletal and organ damage. Damage to the brain occurs as well, leading to cognitive and behavioral problems.

Alcohol-induced brain damage can occur at any time during pregnancy (and during breast-feeding as well!). During all 3 trimesters (and beyond), the major cells of the brain, the neurons and glia, are formed from stem cells (neurogenesis and gliogenesis, respectively). Then, neurons multiply, grow and establish their branches and connections. The long axons of neurons become surrounded by myelin, which insulates and protects the neurons and allows electrical information to be transmitted along the axon. When a pregnant mother drinks alcohol during periods of neurogenesis, the alcohol actually kills the neural stem cells, reducing neurogenesis. Thus, the fetus can still develop neuronal abnormalities leading to behavioral and learning deficits, without any manifestation of the physical abnormalities described above.

Learn more about neurogenesis and alcohol

Learn more about neurogenesis

module 05 figure 07Figure 5.7 The stages of development of the brain and spinal cord over the 3 trimesters are shown. Alcohol affects brain development during all 3 trimesters.

There is a common misconception that the absence of facial abnormalities means that the child’s exposure to alcohol was minimal and therefore the child has a milder form of FAS. On the contrary, drinking during the second and third trimesters can produce children with severe cognitive and behavioral problems in the absence of facial abnormalities.

Alcohol consumed throughout pregnancy (during all three trimesters), can cause a wide variety of effects on the fetus, ranging from brain damage to musculoskeletal damage and growth retardation. In cases of episodic binge drinking (once in a while), injury to the brain and other organs may be more selective. Damage to specific organs (including the brain) will depend on whether the particular organ is undergoing a significant step in development or a growth spurt at the time when alcohol consumption takes place.

Alcohol exposure at any time during pregnancy can cause damage to the fetal brain.

Brain Studies Point to Perils of Adolescent Alcohol Use

The brain takes longer to develop and mature than any other organ in the body. Beginning in the third week of gestation and extending into the mid-20s, an ongoing interplay of genetic and environmental factors results in the mature human brain, a structure composed of more than 100 billion neurons. Some of the most rapid and pronounced changes in the brain take place during childhood and adolescence.

During normal adolescent brain development, widespread structural and functional changes occur rapidly within individual brain regions and in the connections between them. These changes help the brain systems that regulate cognitive, emotional, and social behavior to mature. The extent and complexity of these changes make the adolescent brain particularly vulnerable to the adverse effects of alcohol. Indeed, studies have associated heavy alcohol use during adolescence with harm to various brain structures, lingering problems with cognitive functions such as attention and memory, and an increased risk for future alcohol use disorder (AUD) and other mental health disorders.

“We have long known that adolescent alcohol use is associated with many adverse outcomes, both during adolescence and in later life,” says George F. Koob, Ph.D., Director, National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Our expanding research investment in this area is allowing us to define more precisely why alcohol and the adolescent brain are a particularly dangerous combination.”

The brain is a highly complex organ. Human brain imaging studies have shown that, over the course of adolescence, the volume of gray matter—which represents the cell bodies of neurons and their connections with nearby neurons—decreases in the prefrontal cortex. This decrease likely reflects the normal process of “synaptic pruning,” through which the brain gets rid of excess connections that are no longer needed. However, the volume of white matter—which is important for pathways connecting neurons located at farther distances from each other—increases during adolescence, presumably reflecting enhanced brain connectivity and improved communication between areas. Initial findings from NIAAA-supported research indicate that adolescents who drink heavily, when compared with nondrinking adolescents, have accelerated reductions in gray matter and smaller increases in white matter.

To build on these findings, NIAAA supports the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA), a nationally representative, accelerated, longitudinal study of more than 800 youth. NCANDA’s accelerated design allows researchers to follow multiple youth cohorts, each starting at a different age, so that the cohorts together span a broader age range of interest than a traditional cohort design. The goals of the NCANDA study are to determine the short- and long-term effects of alcohol use on the developing adolescent brain and identify brain characteristics that predict AUD.

NIAAA, along with the National Institute on Drug Abuse, is a major contributor to the National Institutes of Health Adolescent Brain Cognitive Development (ABCD) Study, a 10-year longitudinal study of 10,000 youth, the largest long-term study of brain development and child health in the United States. NCANDA and ABCD investigators are providing much-needed information about the neurodevelopmental consequences of alcohol and other drugs, alone and in combination.

A recent NCANDA study led by Adolf Pfefferbaum, M.D., of SRI International in Menlo Park, California, and colleagues found disordered brain growth trajectories among young people who initiated drinking during adolescence. The researchers noted possible factors that contribute to the abnormal trajectories include peak alcohol consumption in the past year and having a family history of AUD.

Another recent NCANDA investigation led by Eva Müller-Oehring, Ph.D., also of SRI International, and colleagues found that development of intrinsic functional networks (IFNs)—brain circuits that underlie specific functions—were susceptible to adolescent alcohol use. In particular, they reported evidence that IFNs associated with cognitive and emotional functioning become rewired among adolescents who exceeded the study’s criteria for no or low alcohol use. This effect, they conclude, may impede maturation of complex social and emotional behaviors.

The growing evidence of alcohol’s impact on adolescent brain development, as well as its position as the substance of choice for young people, underscores the need for health professionals to screen adolescents for alcohol.

A 2016 study funded by NIAAA demonstrated that a single screening question about drinking frequency in the past year could help doctors identify adolescents at risk for alcohol problems. The study supported the use of the age-based screening thresholds put forward in NIAAA’s Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide and demonstrated that simple screening tools, such as those in NIAAA’s Youth Guide, are efficient and effective.

Pfefferbaum, A.; Kwon, D.; Brumback, T.; Thompson, W.K.; Cummins, K.; Tapert, S.F.; Brown, S.A.; Colrain, I.M.; Baker, F.C.; Prouty, D.; De Bellis, M.D.; Clark, D.B.; Nagel, B.J.; Chu, W.; Park, S.H.; Pohl, K.M.; and Sullivan, E.V. Altered brain developmental trajectories in adolescents after initiating drinking. American Journal of Psychiatry 175(4):370–380, 2018. PMID: 29084454

Müller-Oehring, E.M.; Kwon, D.; Nagel, B.J.; Sullivan, E.V.; Chu, W.; Rohlfing, T.; Prouty, D.; Nichols, B.N.; Poline, J.B.; Tapert, S.F.; Brown, S.A.; Cummins, K.; Brumback, T.; Colrain, I.M.; Baker, F.C.; De Bellis, M.D.; Voyvodic, J.T.; Clark, D.B.; Pfefferbaum, A.; and Pohl, K.M. Influences of age, sex, and moderate alcohol drinking on the intrinsic functional architecture of adolescent brains. Cerebral Cortex 28(3):1049–1063, 2018. PMID: 28168274

Clark, D.B.; Martin, C.S.; Chung, T.; Gordon, A.J.; Fiorentino, L.; Tootell, M.; and Rubio, D.M. Screening for underage drinking and DSM-5 alcohol use disorder in rural primary care practice. Journal of Pediatrics 173:214–220, 2016. PMID: 27059911

Retrieved from

Improving communication of guidance on drinking alcohol in pregnancy


Advice about alcohol consumption during pregnancy could be conveyed more effectively to parents and health professionals, research at Cardiff University has found.

Since 2016, guidance from UK Chief Medical Officers recommends that women who are planning a or are pregnant abstain from altogether.

A new stakeholder study by Dr. Rachel Brown and Heather Trickey of DECIPHer, (Development and Evaluation of Complex Interventions for Public Health Improvement) Cardiff University, considered the ways that this guidance is experienced and communicated by different groups. Mothers, antenatal teachers, midwives and policy makers were asked for their views. Following this work, the researchers have suggested ways in which communication of the advice might be improved.

Trickey said: “There is good evidence that a lot in pregnancy can be harmful. There is also a ‘dose-response’ effect with more alcohol leading to more adverse outcomes and Chief Medical Officers (CMOs) were unable to determine a ‘safe level’ after commissioning a comprehensive evidence review.

“However, the evidence for harm from drinking small amounts in pregnancy (below 1-2 units a week) is limited. CMOs concluded that lack of evidence is not the same thing as a lack of harm. They decided to take a ‘better safe than sorry’ (precautionary) approach by issuing a simple ‘Don’t Drink’ message, intended to help women avoid any risk.

Dr. Brown added: “Taking into account the evidence available, avoiding drinking alcohol completely during pregnancy is certainly the safest option. But our research also highlights potential for unintended adverse effects from an abstinence message. These included raised anxiety among women who had drunk alcohol before they knew they were pregnant, experiences of social shaming for choosing to have a drink, and experiences of having their decisions policed by strangers. The guidance should be there to advise and support expectant mothers in a positive way.”

Brown and Trickey believe communication strategies need to align with a wider agenda to improve public understanding of the evidence and could do more to be relevant to women’s lived experience of pregnancy planning and the fact that social drinking is a normal part of many women’s lives. Rather than targeting messages to individual mothers, they suggest an approach which considers the role of partners, family and friends in affirming and supporting mothers’ decisions, for example by joining an expectant mother in not drinking.

The researchers intend to explore ways in which the guidance about drinking during pregnancy can be communicated more effectively.

Explore further: Evidence for potential harms of light drinking in pregnancy ‘surprisingly’ limited

More information: Findings are available here: … nalReport_0151.1.pdf

Retrieved from

Girls, Women, Alcohol, and Pregnancy: New Annotated Bibliography of 2017 Articles on FASD Prevention

Each year since 2013, researchers associated with the Prevention Network Action Team (pNAT) of the CanFASD Research Network search the academic literature for articles related to prevention of fetal alcohol spectrum disorder (FASD). Articles are reviewed for relevancy, identified by topic and country, and the findings briefly summarized. For this year’s Annotated Bibliography of Articles Published in 2017, a total of 113 articles were identified from 17 countries. Countries with highest number of published articles were USA, (51 articles) Canada (26 articles), Australia (10 articles).

Findings are organized using a four-level prevention framework used by the pNAT to describe the wide range of work that comprises FASD prevention (see panel at left for more information). This year a record 32 articles pertained to Level 2 which involves discussion of alcohol use with all women of childbearing age and their partners/support systems. Articles pertaining to Prevalence of alcohol use in pregnancy, Influences on women’s drinking, and Preconception interventions were also well represented.

The annual literature search is intended to update those involved in FASD prevention in Canada, to inform their practice and policy work with current evidence. The members of the pNAT also have the opportunity to discuss the implications for their work of the findings of selected articles, in monthly web meetings.

Find earlier Annotated Bibliographies below and on the CanFASD Prevention page under “Bibliographies”.





Dispensaries Think Weed Is Safe to Treat Morning Sickness. It’s Not.

morning-sickness-639375656-59f8cadbaad52b00103489a3As marijuana legalization expands and cannabis products become more common, consumers suddenly find they have access to alternative cannabis-derived treatments that claim to help a host of medical conditions.

Could one of those ailments include morning sickness of expectant mothers? People who work at marijuana dispensaries think so.

But medical experts caution it isn’t a good idea, and using marijuana can harm a pregnancy.

A new study published in the June issue of Obstetrics and Gynecology — the American College of Obstetricians and Gynecologists (ACOG) journal — found that nearly 70 percent of Colorado cannabis dispensaries contacted by study investigators recommended cannabis products to treat nausea during the first trimester.

This recommendation from dispensary employees goes directly against the guidance of the experts at ACOG.

“Obstetrician-gynecologists should be discouraged from prescribing or suggesting the use of marijuana for medicinal purposes during pre-conception, pregnancy, and lactation,” the study authors wrote, citing ACOG’s recommendation.

ACOG notes children prenatally exposed to marijuana may be at increased risk for behavioral issues, decreased attention span, and other visual-motor conditions. Pregnant women who use marijuana may be at increased risk for stillbirth.

Dr. Katrina Mark, assistant professor in the department of obstetrics, gynecology, and reproductive sciences at the University of Maryland School of Medicine, said that as people’s attitudes on marijuana change, the medical community needs to make sure they can address and answer patients’ questions about the drug.

“The liberalization of laws related to marijuana use are rapidly changing. This is not necessarily a negative thing, but we as healthcare professionals need to make sure that we are keeping up with our evidence-based counseling of patients,” Mark said.

“Legalization does not equate to safety, particularly in pregnancy,” Mark added, pointing out the study is needed to bring attention to this topic.

“The most obvious example of this is alcohol,” she said. “No liquor store would recommend alcohol to treat pregnancy ailments, and neither should a marijuana dispensary. I actually think the fact that dispensaries are providing any recommendations for treatment of medical conditions is very much overstepping appropriate boundaries.”

Click to read the full article

The Prevention Conversation: An online curriculum


The Prevention Conversation is an online training program for front-line health and social services professionals to provide them with the knowledge, skills, and confidence to engage their clients/patients in a supportive and non-judgmental conversation about alcohol use during pregnancy, its lasting effects on the developing child, and resources and supports available to women of childbearing age.

This course discusses FASD prevention by providing information about the risks of alcohol use during pregnancy as well as considerations to support women in a way that promotes healthy relationships with professionals and promotes safety and health in all facets of their lives.

By completing this training course, facilitators will:

  • Have an understanding of the FASD Prevention Conversation: A Shared Responsibility program; it’s history and evolution;
  • Understand the complex reasons why a woman may drink when pregnant and have the tools to support conversations with pregnant women;
  • Be able to apply and tailor the key messages of “The Prevention Conversation”;
  • Feel confident/comfortable to engage in brief empowering conversations to prevent alcohol-exposed pregnancy among women ages 18-45;
  • Be able to conduct universal screening for alcohol consumption with pregnant women and women of childbearing age;
  • Understand and be comfortable discussing harm reduction strategies if a woman chooses to continue drinking during pregnancy; and
  • Know how to connect with local and provincial resources.



The Prevention Conversation is an online training program for front-line health and social services professionals to provide them with the knowledge, skills, and confidence to engage their clients/patients in a supportive and non-judgmental conversation about alcohol use during pregnancy, its lasting effects on the developing child, and resources and supports available to women of childbearing age.

If for any reason you are not satisfied with your purchase, we will offer to review your decision with you and offer up to a full refund depending on the situation. To process this request, please email proof of your purchase and a description of the reason you require a refund within 30 days of receiving your order.


CCSA: Youth Alcohol Use and Its Harms, Case Study in the Community of Sherbrooke

Screen Shot 2018-05-10 at 12.38.42 PMClick image to download infographic

Many Canadian communities struggle in addressing the issue of excessive alcohol consumption among youth in general and postsecondary students in particular. This case study examines the collaborative response to build community partnerships, understand in depth the harms caused by alcohol, and plan a local group response.

The key was partnership. The case study shows that the partnership, which included campus administrators and students (from CEGEPs and universities), healthcare professionals and representatives from public health, the police, the City and CCSA, is poised to make meaningful headway in addressing harms.

Screen Shot 2018-05-10 at 12.56.22 PMClick to download ‘Report At A Glance’

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Click to download the full report




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