Article Figures & Data
Tables
References Age: >30 89, 103 Caucasian 103 Hx binge drinking or long history of drinking 91–93 College educated 103 Low or high SES 94, 97 Special Education populations 90 Poor Native Americans 90 Hx of physical/sexual abuse ever 51 Hx of physical abuse in past year 103, 105 Heavy drinking by male partner or any family member 95, 97, 98 Loss of children to foster/adoptive care 94, 95, 99 Poly-drug use/cigarette smoking 92, 93, 96, 104 Previous child with FAS 95 Major depressive disorder 51, 100, 104 Post traumatic stress disorder 51 Unmarried 89, 98 Early age of drinking onset 101, 102 Hx, history.
Content Time Required Scoring and Cut-Off Score Sensitivity Specificity Quantity/Frequency Questions (3) Days per week of drinking Average number of drinks per day Maximum number of drinks consumed in 1 day during the past month 2 minutes >7 drinks per week or >3 drinks per day N/A N/A TWEAK47 Tolerance: (a) How many drinks does it take before you feel high (the first effects of alcohol)? or (b) How many drinks can you hold? (How many drinks does it take before the alcohol makes you fall asleep or pass out? If you never pass out, what is the largest number of drinks you have?)
Worried: Have your friends or relatives worried about your drinking in the past year?
Eye opener: Do you sometimes take a drink in the morning when you first get up?
Amnesia: Are there times when you drink and afterwards can’t remember what you said or did?
K/Cut Down: Do you sometimes feel the need to cut down on your drinking?
3 to 5 minutes Tolerance: (a) 3 drinks or more or (b) 5 drinks or more + 2 points Positive response to other questions = 1 point each Cut-off = 2 points 0.79–0.91 0.77–0.83 T-ACE48 Tolerance: How many drinks does it take to make you feel high?
Annoyed: Have people ever annoyed you by criticizing your drinking?
Cut Down: Have you ever felt that you needed to cut down on your drinking?
Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang over?
2 to 3 minutes Tolerance: 2 points if requires more than 2 drinks Other questions: 1 point each Cut off: 2 points 0.70–0.89 0.79–0.85 - Table 3.
Barriers to Providing Screening, Assessment, Brief Intervention, and Referral Services to Prevent Alcohol-exposed Pregnancies
Non-therapeutic attitude among family medicine physicians
A public health concern, not a clinical problem
A concern that questioning about alcohol use will lead to patient resistance, discomfort, and exiting from the practice
Other health problems are more urgent or important
Denial that drinking is a problem
Feeling that treatment isn’t effective
Inadequate knowledge and clinical skills
Limited training in medical school and residency
Feel ill-prepared to deal with the realities of screening and assessment
Lack of provider self-efficacy, feeling you can’t make a difference
Provider reference material lacks information and consistent recommendation to abstain
Lack of time
Inadequate reimbursement
System barriers
Lack of intervention tools
Lack of a system strategy or protocol
Lack of treatment and referral resources
Lack of office staff involvement
Legal barriers
1. Less than 1 drink per day in pregnancy is okay. 2. Drinking late in pregnancy is okay and makes labor easier. 3. Beer and wine are not alcohol, and thus are not a problem. 4. If I drank and have one child without FAS, I can drink and I won’t have another child with FAS. 5. If FAS doesn’t run in my family, my child won’t get FAS. 6. FAS is curable if diagnosed early. Activity Strategies Screening Include alcohol screening questions on initial patient questionnaires or instruct medical assistants to assess alcohol use while assessing vital signs during initial patient intake. Assessment Construct a questionnaire or checklist for the nurse to perform the assessment if screening is positive prior to the physician seeing the patient or construct a checklist that the physician can use if initial screening questions are positive while visiting with the patient in the examination room Education (on alcohol and contraceptive practices) The clinic nurse can provide alcohol-exposed pregnancy (AEP) prevention education during preconception counseling visits, contraceptive initiation visits, or pregnancy education visits. Posters and brochures on AEP can be placed in waiting rooms and examination rooms. Brief interventions Nurses can be trained to conduct brief interventions and follow-up visits can be conducted by telephone. Brief intervention materials can be kept in the examination rooms for physicians to use. - Table 6.
Strength of Evidence: Preventing Alcohol-exposed Pregnancies Summary Statement of Evidence
Grade 1. Fetal alcohol syndrome (FAS) occurs in 0.3 to 1.5/1000 live births in the United States B 2. Fetal alcohol effects occur in at least 1/100 live births in the United States B 3. Approximately one-half of all childbearing-aged women in the United States drink alcohol C 4. Approximately 10% of all women drink alcohol while pregnant C 5. Although binge drinking (more than 3 drinks on one occasion) demonstrates the strongest adverse effect on the developing fetus, there is no safe level of alcohol consumption during pregnancy C 6. With prenatal patients, the T-ACE and TWEAK are more effective screening measures than the CAGE. C 7. Screening for alcohol use in routine office visits will decrease patients’ alcohol consumption. B 8. Brief physician education and intervention about alcohol use in childbearing-aged women will reduce alcohol use, increase effective contraception or both. B
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- Article
- Abstract
- Potential Outcomes of Alcohol Use During Pregnancy
- Alcohol Exposure Issues during Pregnancy
- Prevalence of Drinking in Childbearing-aged Women
- Risk Factors for an Alcohol-Exposed Pregnancy
- Screening for Prenatal Alcohol Use
- Screening Tools
- Clinical Issues with Screening Measures
- Overview of Brief Intervention in Primary Care
- Brief Intervention among Pregnant Women
- Brief Intervention: Evidence for Effectiveness in Reducing AEP
- Barriers to AEP Prevention in Clinical Practice
- Conclusion
- Notes
- References
- Figures & Data
- References
- Info & Metrics