Screening and brief intervention in prenatal care settings

Pregnant women continue to drink despite evidence that prenatal alcohol consumption can negatively affect fetal expansion and development. Because no universally safe horizontal 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 horizontals during pregnancy. Some women may voluntarily disclose the expansion of their prenatal alcohol consumption. If not, the T-ACE, a four-item screening questionnaire based upon the CAGE assessment tool, has been demonstrated to be a valuable and efficient means 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 relentless adverse consequences and may be the logical first-line approach. lock opener WORDS: pregnancy; prenatal alcohol exposure; identification and screening for AOD (alcohol and other drug) use; CAGE Questionnaire; T-ACE; brief intervention

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According to the U Surgeon General's greatest in quantity recent advisory, no level of alcohol consumption by the agency of pregnant women can be considered safe. A woman drinking alcohol at any time during her pregnancy, smooth during the earliest weeks, increases the risk of her fetus developing alcohol-related birth defaults (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 horizontal 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 shield positive on the T-ACE.

PREVALENCE OF ALCOHOL CONSUMPTION AMONG PREGNANT WOMEN

Women who drink during pregnancy advance 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 through pregnant women was 12.8 percent in 1999 with 27 percent reporting of frequent occurrence drinking (defined as more than seven drinks for week) and 3.3 percent reporting binge drinking (defined as five or more drinks for episode) (CDC 2002).

The Pregnancy Risk Assessment Monitoring combination of parts to form a whole covering 2000 and 2001 lay the foundation of the overall prevalence of alcohol use in pregnancy to range from 34 percent to 99 percent in eight States (Phares et al. 2004) Although these figures show an improvement over the 1988 baseline rate of 21 percent of pregnant women using alcohol, they still fall short of satisfying one as well as the other the Healthy People 2000 and Healthy nation 2010 goals of 94-percent abstinence from alcohol during pregnancy. (1)

IDENTIFYING A PREGNANT WOMAN'S horizontal OF ALCOHOL CONSUMPTION

In accord with the U Surgeon General's advisory, the couple the American Academy of Pediatrics and the American association of Obstetricians and Gynecologists commend 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 horizontals during pregnancy (Russell et al. 1994)

Ascertaining a woman's prenatal alcohol consumption artificial positions several challenges. First, many women will restore their alcohol consumption once they learn they are pregnant (Smith et al. 1987) on the contrary a woman may have been drinking harmful amounts of alcohol prior to detecting her pregnancy. Therefore, asking a pregnant woman standard questions about her general quantity and frequency of alcohol use may not provide accurate information. Asking a woman about her drinking patterns before she became pregnant could elicit more accurate measures of her first-trimester drinking (Day et al. 1993)

next to the first women may under-report their consumption because they are embarrassed or afraid to admit that they are drinking during pregnancy (Jacobson et al. 2002) or they may believe that small amounts of alcohol are inconsequential.

Third, popular screening instruments of the like kind as the CAGE or SMAST have been ordealed in other populations (e.g., heavy-drinking males), thus they may be less accurate in identifying risk drinking by means of pregnant women (Bradley et al. 1998)

The T-ACE, a four-item questionnaire based upon the CAGE, is a simple screening instrument. It can identify lifetime alcohol use; it also can identify prenatal consumption and has been experimented in diverse obstetric samples (Sokol et al. 1989; Chang et al. 1998) Moreover, it has proven to be a valuable and efficient tool for identifying a range of alcohol use, including any generally received prenatal alcohol consumption, prepregnancy risk drinking defined as more than sum of two units drinks per drinking day, and lifetime alcohol diagnoses based upon the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (Chang et al. 1998)