Negative long-term effects of excessive prenatal alcohol or tobacco exposure (or both), increase the risk for multiple adverse outcomes, researchers observed.
Prenatal alcohol exposure is the leading cause of preventable intellectual disability, the study said, and smoking during pregnancy is one of the most modifiable causes of post-birth disease and death.
However, public health hasn't yet determined a safe level of alcohol or tobacco use during pregnancy, the study said. So the authors examined the link between prenatal exposure to alcohol and tobacco smoking and brain activity in newborns.
They didn't find a safe, conclusive level, but the findings suggested drinking or smoking in early stages and then quitting, or doing so at low, moderate or high levels all impacted newborn brain development.
Those who drank alcohol then quit in the first trimester had an average of nine drinks during that time period. A low level of alcohol is defined for the study's purposes as two standard drinks on average during the first trimester.
A moderate or high level meant, on average, 36 drinks during the first trimester, 16 in the second trimester and eight in the third trimester. (The authors didn't have enough participants to split between moderate and high level groups, so they combined them.)
For smokers, 14 cigarettes on average in each trimester was considered "low" and 45 to 50 cigarettes on average was deemed high. Those who quit smoking early smoked an average of seven cigarettes before quitting.
"Already we can see there was an alteration in the development of brain processes that can be quantified during sleep when babies are just a few days of age," said senior author William P. Fifer, a professor of medical psychology at Columbia University Irving Medical Center in New York City. "Babies of those moms who even had low levels of alcohol or tobacco exposure still had some alterations in the brain activity."
Effects of alcohol and tobacco on brain activity
Participants were 1,739 newborns enrolled in the Safe Passage Study, a large multidisciplinary study investigating the association between prenatal alcohol exposure, sudden infant death syndrome and stillbirth. The Safe Passage Study also determined the outcomes of prenatal exposures and how they're affected by environmental and lifestyle factors. The Safe Passage Study has concluded, but the current article is a follow up of the newborns included.
Their mothers were recruited from 2011 through 2015 from clinical sites in Cape Town, South Africa, and the Northern Plains region of the United States. Babies who were born at less than 37 weeks or more than 41 weeks gestation and mothers who birthed more than one newborn were excluded. Mothers who took psychiatric medication were also excluded from the current study but included in the previous Safe Passage Study.
Details regarding prenatal alcohol exposure were collected using a 30-day Timeline Followback Interview, in which women self-reported their daily alcohol consumption on their last drinking day and 30 days prior, up to four times during pregnancy. They also recorded whether they shared a drink with someone, the type and brand of alcohol, container size and how long they drank per instance.
Information for prenatal tobacco exposure was also gathered up to four times during pregnancy. Women reported their smoking habits on their last recorded smoking day and 30 days prior. They also indicated how often, and the number of tobacco cigarettes, they smoked on an average smoking day.
On 12 regions on the newborns' scalps, researchers conducted an electroencephalogram, or EEG, while they were sleeping.
An EEG is a noninvasive test of brain function and activity reflecting electrical activity in the brain's cortex. It's commonly used to examine and predict effects of in utero exposures and associations with development of the brain at later ages.
EEG spectral power, another measure utilized by the authors, measures the range or rhythm of the brain's EEG signal across a certain length of time.
Newborns whose mothers quit drinking before the second trimester, or were in the low to high continuous drinking groups, had increased low frequency EEG power in the left temporal section of their brain compared to infants with no prenatal alcohol exposure.
Infants whose moms smoked at moderate levels anytime during pregnancy, smoked at high levels anytime during pregnancy and smoked at any level in just the first trimester had decreased activity in the right-central area of their brains, compared with newborns who weren't exposed to tobacco while in the womb.
Newborns who had moderate or high continuous prenatal tobacco exposure had significantly decreased EEG power in the right-central area of their brain compared with those whose mothers quit smoking before the second trimester.
Changes in brain activity are normal as children age, but there's not enough information to conclude whether the increases and decreases observed in this study occurred too early or too late in the newborns' development, Fifer said. However, the measurements were a departure from what was found in infants with no alcohol or tobacco exposure.
The greatest contrasts in EEG power were between infants with no prenatal tobacco or alcohol exposure and those with moderate to high exposure.
"The ones that had the most dramatic effects were [those of mothers who] drank the most or continued to drink the most during pregnancy, and the ones who smoked the most throughout pregnancy," Fifer said.
Previous studies have shown the effects alcohol and tobacco exposure have on specific areas of the brain involved in the baby's ability to regulate their heart rate, respiration, blood pressure and temperature, Fifer said.
"All of those are extremely important to survive those first few months," he added. "We're finding a reflection of that in our measures of brain activity just while they're sleeping during the newborn period."
The authors plan to examine additional exposures and lifestyle factors that may affect long-term neurodevelopmental function.
More research is yet to come, but for now, the research shows it's best to consider an alcohol-free mocktail at that Zoom get-together or baby shower while pregnant.