The U.S. surgeon general has a strong message for women who are pregnant or likely to become pregnant: Don’t drink alcohol.

In an advisory issued on Monday, Richard H. Carmona, MD, MPH, warns that no amount of alcohol can be considered safe during pregnancy.

“When a pregnant woman drinks alcohol, so does her baby,” Carmona says in a news release. “Therefore, it’s in the child’s best interest for a pregnant woman to simply not drink alcohol.”

The advisory updates a 1981 statement that called on pregnant women to limit the amount of alcohol they drank. The stronger admonishment against drinking was needed, Carmona says, because of concerns that exposure to even moderate amounts of alcohol in the womb can have a lifelong impact on learning and behavioral development.

Women who might become pregnant are included in the new advisory because almost half of all births in the United States are unplanned.

Researchers say abnormalities as a result of drinking during pregnancy may occur as early as the third week of pregnancy, a time in which most women might not even realize they are pregnant.

Fetal Alcohol Rates Unchanged

As many as two babies out of 1,000 are born with fetal alcohol syndrome, which is characterized by stunted physical growth, facial disfigurement, and brain damage. And studies now suggest that for every child born with the syndrome, three more develop learning or behavioral problems that are caused by prenatal exposure to alcohol.

Despite years of warnings about the dangers of drinking during pregnancy, fetal alcohol researcher Robert J. Sokol, MD, tells WebMD that the number of children born with defects caused by alcohol exposure in the womb has not declined.

Fetal alcohol syndrome is still the leading preventable birth defect associated with mental and behavioral impairment.

“Women do know that abusing alcohol during pregnancy is harmful,” says Sokol, who served on a task force that recommended the advisory update to the surgeon general. “But the message that no amount of alcohol can be considered safe is going to be new information to many women who are now at risk.”

Doctors May Be Confused, Too

Studies conducted by Sokol and others suggest that moderate drinking during pregnancy and even infrequent binge drinking can lead to impaired IQ and short-term memory, as well as other developmental problems. Moderate drinking is defined as one drink a day in women. The studies also suggest that some women are more susceptible than others.

The advisory calls on doctors to ask their female patients of childbearing age about their alcohol consumption and to advise them of the dangers of drinking during pregnancy.

Craig Stevens, who is a spokesman for the U.S. surgeon general’s office, tells WebMD that many doctors may be confused about what to tell their pregnant patients. He points out that only about a quarter of the textbooks used to train ob-gyns published since 1990 recommend abstinence during pregnancy.

“I think many women may think that one or two drinks won’t hurt them,” Stevens says. “We now know that if a woman binge drinks or abuses alcohol during pregnancy, the possibility of (fetal damage) increases. However, we don’t know what, if any, amount of alcohol consumption can be considered safe.”

By Salynn Boyles, reviewed by Brunilda Nazario, MD

SOURCES: U.S. Surgeon General’s Advisory on Alcohol Use in Pregnancy, Feb. 21, 2005. U.S. Surgeon General Richard H. Carmona, MD, MPH. Robert J. Sokol, MD, professor of obstetrics and gynecology, Wayne State University, Detroit. Craig Stevens, spokesman, U.S. Surgeon General’s office.