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Recommendations Summary

GDM: Alcohol 2016

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    GDM: Alcohol Intake 

    The registered dietitian nutritionist (RDN) should reinforce abstinence from alcohol during pregnancy for women with gestational diabetes mellitus (GDM). The safest choice for all pregnant women is to abstain from alcohol to eliminate the risk for alcohol-related birth defects such as behavioral or neurological defects, growth deficiencies, facial abnormalities and impaired intellectual development.

    Rating: Consensus
    Imperative

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      • Alcohol use during pregnancy is typically addressed by their health care provider and other health professionals during the first obstetric visit and reinforced throughout pregnancy
      • Women who are unwilling or unable to refrain from alcohol consumption during pregnancy (e.g., heavy drinker, alcohol dependency, binge drinker) should be referred for supportive services, such as counseling and possible treatment (O’Leary and Bower, 2012).

    • Potential Costs Associated with Application

      There are no obvious costs that may be associated with the application of this recommendation.

    • Recommendation Narrative

      • Alcohol exposure during pregnancy has been linked to birth-related defects in the fetus including fetal alcohol spectrum disorders and low birth weight [Centers for Disease Control & Prevention (CDC), 2016]
      • Evidence-based scientific information is limited given the nature of any research involving the alcohol intake of pregnant women. However, fetal alcohol spectrum disorders are the leading cause and the most commonly identifiable cause of preventable developmental delays and intellectual disabilities (CDC, 2016).
      • While there is a lack of consensus among healthcare providers regarding the amount of alcohol that would be considered detrimental to the fetus, the Academy of Nutrition and Dietetics (The Academy) and several health organizations, including American Academy of Pediatrics (Williams et al, 2015), American College of Obstetricians and Gynecologists (2015), March of Dimes (2015), CDC (2016) have advised pregnant women to abstain from alcohol. 
      • The position of The Academy on alcohol use during pregnancy is as follows: "Alcohol should not be consumed by pregnant women or those who may become pregnant. Drinking alcohol during pregnancy,  especially in early pregnancy, may result in behavioral or neurological defects in the offspring and affect a child’s future intelligence. No safe level of alcohol consumption during pregnancy has been established (Procter & Campbell, 2014)."

    • Recommendation Strength Rationale

      Consensus: This topic was not included in the EAL systematic review. The recommendation is based on consensus publications.

    • Minority Opinions

      None.

  • Supporting Evidence

    The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

    • References
    • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

      • American College of Obstetricians and Gynecologists. Alcohol abuse and other substance use disorders: ethical issues in obstetric and gynecologic practice. Committee Opinion No. 633. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125: 1, 529–1, 537.
      • Centers for Disease Control and Prevention (CDC); Fetal Alcohol Spectrum Disorders (FASDs). National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Birth Defects and Developmental Disabilities. Web page updated Oct 14, 2016.  Accessed Nov 3, 2016 at http://www.cdc.gov/ncbddd/fasd/index.html.  
      • March of Dimes. Alcohol During Pregnancy. Web page reviewed April, 2016. Accessed October 5, 2016 at http://www.marchofdimes.org/pregnancy/alcohol-during-pregnancy.aspx.
      • O'Leary CM, Bower C. Guidelines for pregnancy: what's an acceptable risk, and how is the evidence (finally) shaping up? Drug Alcohol Rev. 2012 Mar;31(2):170-183. doi: 10.1111/j.1465-3362.2011.00331.x. Epub 2011 Sep 29. Review. PMID: 21955332.
      • Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014 Jul; 114 (7): 1, 099-1, 103. PMID: 24956993.
      • Williams JF, Smith VC and the Committee on Substance Abuse. Fetal Alcohol Spectrum Disorders. American Academy of Pediatrics. Pediatrics. 2015;135(5): e1, 395-e1, 406.