Screening and Brief Intervention in Prenatal Care Settings

By Chang, Grace | Alcohol Research, April 1, 2004 | Go to article overview

Screening and Brief Intervention in Prenatal Care Settings


Chang, Grace, Alcohol Research


Pregnant women continue to drink despite evidence that prenatal alcohol consumption can negatively affect fetal growth and development. Because no universally safe level of prenatal alcohol use has been established, it is beneficial to identify and modify a woman's prenatal alcohol use early in her pregnancy, particularly as her past drinking habits can predict her drinking levels during pregnancy. Some women may voluntarily disclose the extent of their prenatal alcohol consumption. If not, the T-ACE, a four-item screening questionnaire based on the CAGE assessment tool, has been demonstrated to be a valuable and efficient method for identifying a range of alcohol use. Studies have shown that combined with brief interventions, early identification of a woman's prenatal alcohol use could avert its more severe adverse consequences and may be the logical first-line approach. KEY WORDS: pregnancy; prenatal alcohol exposure; identification and screening for AOD (alcohol and other drug) use; CAGE Questionnaire; T-ACE; brief intervention

According to the U.S. Surgeon General's most recent advisory, no level of alcohol consumption by pregnant women can be considered safe. A woman drinking alcohol at any time during her pregnancy, even during the earliest weeks, increases the risk of her fetus developing alcohol-related birth defects (see the textbox) (Office of the Surgeon General 2005). Despite the accumulating evidence, pregnant women continue to drink. This article examines the prevalence of alcohol use among pregnant women and the importance and difficulties of identifying a pregnant woman's level of alcohol consumption. It also describes the implementation of the T-ACE questionnaire as an effective screening instrument for prenatal alcohol consumption, outlines the usefulness of brief interventions with pregnant women, and reviews studies that investigate the use of brief interventions with pregnant women who screen positive on the T-ACE.

PREVALENCE OF ALCOHOL CONSUMPTION AMONG PREGNANT WOMEN

Women who drink during pregnancy come from all walks of life-and in fact, those who are older (at least 35), non-Hispanic, well educated (beyond high school), and who have a higher household income are more likely to drink while pregnant (CDC 2002). The prevalence of any alcohol use by pregnant women was 12.8 percent in 1999, with 2.7 percent reporting frequent drinking (defined as more than seven drinks per week) and 3.3 percent reporting binge drinking (defined as five or more drinks per episode) (CDC 2002).

The Pregnancy Risk Assessment Monitoring System covering 2000 and 2001 found the overall prevalence of alcohol use in pregnancy to range from 3.4 percent to 9.9 percent in eight States (Phares et al. 2004). Although these figures represent an improvement over the 1988 baseline rate of 21 percent of pregnant women using alcohol, they still fall short of satisfying both the Healthy People 2000 and Healthy People 2010 goals of 94-percent abstinence from alcohol during pregnancy.1

IDENTIFYING A PREGNANT WOMAN'S LEVEL OF ALCOHOL CONSUMPTION

In accord with the U.S. Surgeon Generals advisory, both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend that pregnant and preconceptional women be abstinent (Sokol et al. 2003). Thus, it is important to be able to identify and modify a woman's prenatal alcohol use early in her pregnancy, particularly as her past drinking habits can predict her drinking levels during pregnancy (Russell et al. 1994).

Ascertaining a woman's prenatal alcohol consumption poses several challenges. First, many women will reduce their alcohol consumption once they learn they are pregnant (Smith et al. 1987), but a woman may have been drinking harmful amounts of alcohol prior to detecting her pregnancy. Therefore, asking a pregnant woman standard questions about her current quantity and frequency of alcohol use may not provide accurate information. …

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