Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review

Longitudinal analysis of proinflammatory and anti-inflammatory cytokines in the cerebrospinal fluid and peripheral blood of treatment-naïve first-episode psychosis patients, and their correlation with psychosis severity and cognitive impairment in sub-Saharan Africa

BACKGROUND

Inflammation is indicated as one of the factors that play a role in the development of schizophrenia, with several studies having found considerable inconsistencies in their results. Few have investigated the role of inflammation in primary psychosis in blood and cerebrospinal fluids simultaneously, the aim of this study being to investigate the expression of blood and cerebrospinal fluid inflammatory cytokines in treatment-naive first-episode psychotic participants.

METHODS AND ANALYSIS

This is a combined cross-sectional and prospective observational study, which is currently taking place in Durban, South Africa, will recruit 60 participants (30 cases and 30 matched controls). The primary objective is to describe baseline CSF and longitudinal expression/levels of inflammatory cytokines in the blood in persons diagnosed with first-episode psychosis (FEP) for 12 months. The secondary objective is to describe the associations between inflammatory cytokines and psychosis severity, neurocognitive performance, antipsychotic response and metabolic changes at different time points (baseline, 3, 6 and 12 months).

INTERVENTIONS

We will collect the sociodemographic details of all participants, and the Positive and Negative Symptoms Scale, Patient Health Questionnaire-9, Childhood Trauma Scale, Repeatable Battery for the Assessment of Neuropsychological Status Update, metabolic markers and inflammatory markers (venous blood and lumbar puncture cerebrospinal fluid) for those with FEP. Data from matched controls will only be collected at one point and no follow-ups (cross-sectional).

ETHICS AND DISSEMINATION

The study protocol has been approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC/00004714/2022). The study is nested in an ongoing study titled the burden of HIV and Psychosis in an African setting: a longitudinal study of HIV-infected and non-infected patients with First-Episode Psychosis (BREC 571/18). The results will be actively disseminated through peer-reviewed journal publications and conference presentations.

Importance of Fetal Alcohol Spectrum Disorders Prevention and Intervention

The consumption of alcohol and other substances during pregnancy can impair prenatal development. While scientifically informed public health measures have raised awareness of the risks of harmful prenatal substance exposures, the use of alcohol and other substances during pregnancy continues to rise. The successful dissemination of consistent messaging, health care professional education and training, and universal implementation of clinical interventions may help reduce drinking in pregnancy and prevent fetal alcohol spectrum disorders (FASDs), a constellation of developmental disabilities and birth defects caused by alcohol use during pregnancy. Alcohol screening and brief intervention (alcohol SBI) is an evidence-based preventive practice that enables early identification of excessive drinking and intervention prior to serious consequences. Routine clinical implementation of alcohol SBI has been shown to effectively reduce excessive alcohol consumption among adults, including pregnant people. Many barriers prevent widespread implementation of the practice: a lack of health care professional knowledge of the prevalence and implications of prenatal alcohol exposure, stigma surrounding individuals who use substances potentially harmful to their pregnancy, resistance to public health messages encouraging alcohol avoidance during pregnancy, and discomfort and hesitancy with alcohol SBI procedures among practitioners. The Centers for Disease Control and Prevention (CDC) leads the public health effort to prevent alcohol use during pregnancy and improve identification of and care for children living with FASDs. CDC partners with health systems, health care professional associations, universities, and community-based networks to promote alcohol SBI as an effective but underused preventive health service. This special section consisting of 6 articles including this introductory commentary represents the efforts of 11 CDC projects and their partners to demonstrate the rationale for FASD prevention and intervention, engage health care disciplines to expand prevention messaging and education for providers, develop practical approaches for implementing alcohol SBI in diverse clinical settings, and prevent alcohol use in pregnancy and FASDs.

Effect of prenatal alcohol consumption on maternal anemia among pregnant women in Gondar town, Northwest Ethiopia: a retrospective cohort study

BACKGROUND

Alcohol consumption during pregnancy can lead to multiple health, social and behavioral problems for both the mother and the offspring. Anemia is one of the major public health concerns and causes of morbidity and mortality among pregnant women with poor maternal and fetal outcomes in developing countries. This study aimed to identify the link between prenatal alcohol consumption and anemia among pregnant women in Gondar town, Northwest Ethiopia.

METHODS

A facility-based retrospective cohort study was conducted among 1669 pregnant women who were booked in for antenatal care in Gondar town. We used a two-stage random sampling technique to recruit and include study participants in the cohort. Data were collected using an interviewer-administered questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and anemia in pregnancy using log-binomial regression modeling. The burden of anemia in pregnancy was reported using the adjusted risk ratio (ARR) and population-attributable risk.

RESULTS

The prevalence of anemia during pregnancy was 14.86% (95% CI 13.23 to 16.65%). Hazardous alcohol consumption during pregnancy was significantly associated with anemia in pregnancy (ARR=2.24; 95% CI 1.60, 3.15). The adjusted population-attributable risk of anemia in pregnancy related to hazardous alcohol consumption during pregnancy was 7.68%.

CONCLUSIONS

This study revealed that anemia during pregnancy continues to be a public health concern. Regardless of timing, there is a clear association between prenatal alcohol consumption and anemia during pregnancy that suggests a need for targeted prenatal alcohol use screening, and ongoing intervention for alcoholic pregnant women.

Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries

Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.

The role of general practitioners in Reunion in detecting alcohol use in pregnant women and identifying fetal alcohol spectrum disorder: a qualitative study

BACKGROUND

Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of non-genetic intellectual disability and social maladjustment in children. International guidelines recommend abstinence from alcohol during pregnancy. Réunion is the most affected of all French regions with an estimated Fetal Alcohol Spectrum (FAS) prevalence of 1.2‰ births. General practitioners (GPs) are at the forefront of identifying patients with FASD.

OBJECTIVE

To understand how GPs identify FASD.

METHODS

Qualitative study using a grounded theory approach, through semi-structured face-to-face interviews with GPs. Interviews were conducted with the aim of reaching theoretical saturation. These were transcribed verbatim and then analyzed by four researchers to ensure triangulation of the data.

RESULTS

GPs reported barriers to the identification of FASD: challenges in overcoming social taboos and paradoxical injunctions, the influence of limited knowledge and experience, non-specific and highly variable symptoms, ambiguous classification and method of diagnosis involving the mobilization of a multidisciplinary team and lengthy consultations. Conversely, they felt competent to identify neurodevelopmental disorders of any cause, but were concerned about the long waiting time to access specialized care. From the perspective of GPs, it is crucial to prioritize promotion and training aimed at improving the identification and coordination of care pathways for children diagnosed with neurodevelopmental disorders, such as FASD.

Factors associated with perinatal substance use among Ethiopian women: an institutional-based cross-sectional study

Introduction: Substance use during the perinatal period is a significant public health concern, as it can have potential adverse effects on maternal and neonatal health outcomes. Unexpectedly, no previous studies have been conducted to assess the prevalence of substance use during the perinatal period among Ethiopian women. Therefore, this study aimed to determine the magnitude of substance use and its determinant factors during the perinatal period. Method: We conducted a hospital-based descriptive cross-sectional study among a systematically selected sample of 418 women who attended perinatal care between May and July 2022. Data were collected using an interviewer-administered structured questionnaire. Multivariate logistic regression analysis, with a 95% confidence interval and p-values less than 0.05, was employed to identify factors associated with substance use behavior. Result: The prevalence of perinatal substance use was found to be 38.3% (95% CI: 33.5-43.5). Of the women who used substances, 109 (26.1%) reported using chat, 46 (11.0%) reported alcohol consumption, and 5 (1.20%) reported using shisha. Factors significantly associated with substance use behavior during the perinatal period included a history of obstetric complications (AOR = 1.722, 95% CI: 1.022-2.902), the presence of chronic medical conditions (AOR = 3.784, 95% CI: 2.164-6.615), experiencing physical abuse (AOR = 5.323, 95% CI: 2.171-13.050), depression (AOR = 1.963, 95% CI: 1.028-3.749), and experiencing sleep disturbances (AOR = 2.016, 95% CI: 0.975-4.168). Conversely, giving birth to a live baby was found to be a protective factor against substance use behavior (AOR = 0.389, 95% CI: 0.187-0.810). Discussion: This study highlights a high prevalence of substance abuse among women during the perinatal period. In light of these findings, a comprehensive approach is recommended to address perinatal substance use among Ethiopian women. This should include the integration of preventive educational programs into perinatal care.

The Current State of Alcohol Screening and Management in Virginia Primary Care Practices: An Evaluation of Preventive Service Use

The US Preventive Services Task Force (USPSTF) recommends screening and behavioral counseling for adults over 18 years for unhealthy alcohol use. Recommended screening instruments include the Alcohol Use Disorders Identification Test-Concise and or Single Alcohol Screening Question. Behavioral counseling is feasible in primary care, taking on average 30 minutes. Baseline data for a practice facilitation trial demonstrated clinicians appropriately screened only 10.8% of patients and only identified 9.6% as having risky drinking. Yet, 24% of patients reported risky drinking on a survey, demonstrating the implementation gap of the USPSTF recommendation and opportunity to improve health.

Predicting Fetal Alcohol Spectrum Disorders Using Machine Learning Techniques: Multisite Retrospective Cohort Study

BACKGROUND

Fetal alcohol syndrome (FAS) is a lifelong developmental disability that occurs among individuals with prenatal alcohol exposure (PAE). With improved prediction models, FAS can be diagnosed or treated early, if not completely prevented.

OBJECTIVE

In this study, we sought to compare different machine learning algorithms and their FAS predictive performance among women who consumed alcohol during pregnancy. We also aimed to identify which variables (eg, timing of exposure to alcohol during pregnancy and type of alcohol consumed) were most influential in generating an accurate model.

METHODS

Data from the collaborative initiative on fetal alcohol spectrum disorders from 2007 to 2017 were used to gather information about 595 women who consumed alcohol during pregnancy at 5 hospital sites around the United States. To obtain information about PAE, questionnaires or in-person interviews, as well as reviews of medical, legal, or social service records were used to gather information about alcohol consumption. Four different machine learning algorithms (logistic regression, XGBoost, light gradient-boosting machine, and CatBoost) were trained to predict the prevalence of FAS at birth, and model performance was measured by analyzing the area under the receiver operating characteristics curve (AUROC). Of the total cases, 80% were randomly selected for training, while 20% remained as test data sets for predicting FAS. Feature importance was also analyzed using Shapley values for the best-performing algorithm.

RESULTS

Overall, there were 20 cases of FAS within a total population of 595 individuals with PAE. Most of the drinking occurred in the first trimester only (n=491) or throughout all 3 trimesters (n=95); however, there were also reports of drinking in the first and second trimesters only (n=8), and 1 case of drinking in the third trimester only (n=1). The CatBoost method delivered the best performance in terms of AUROC (0.92) and area under the precision-recall curve (AUPRC 0.51), followed by the logistic regression method (AUROC 0.90; AUPRC 0.59), the light gradient-boosting machine (AUROC 0.89; AUPRC 0.52), and XGBoost (AUROC 0.86; AURPC 0.45). Shapley values in the CatBoost model revealed that 12 variables were considered important in FAS prediction, with drinking throughout all 3 trimesters of pregnancy, maternal age, race, and type of alcoholic beverage consumed (eg, beer, wine, or liquor) scoring highly in overall feature importance. For most predictive measures, the best performance was obtained by the CatBoost algorithm, with an AUROC of 0.92, precision of 0.50, specificity of 0.29, F1 score of 0.29, and accuracy of 0.96.

CONCLUSIONS

Machine learning algorithms were able to identify FAS risk with a prediction performance higher than that of previous models among pregnant drinkers. For small training sets, which are common with FAS, boosting mechanisms like CatBoost may help alleviate certain problems associated with data imbalances and difficulties in optimization or generalization.

Continuities in maternal substance use from early adolescence to parenthood: findings from the intergenerational cohort consortium

BACKGROUND

This study assessed the extent to which women's preconception binge drinking, tobacco use and cannabis use, reported prospectively in adolescence and young adulthood, predicted use of these substances during pregnancy and at 1 year postpartum.

METHODS

Data were pooled from two intergenerational cohort studies: the Australian Temperament Project Generation 3 Study (395 mothers, 691 pregnancies) and the Victorian Intergenerational Health Cohort Study (398 mothers, 609 pregnancies). Alcohol, tobacco and cannabis use were assessed in adolescence (13-18 years), young adulthood (19-29 years) and at ages 29-35 years for those transitioning to parenthood. Exposures were weekly or more frequent preconception binge drinking (5 + drinks in one session), tobacco use and cannabis use. Outcomes were any alcohol, tobacco and cannabis use prior to awareness of the pregnancy, after awareness of pregnancy (up to and including the third trimester pregnancy) and at 1 year postpartum.

RESULTS

Frequent preconception binge drinking, tobacco use and cannabis use across both adolescence and young adulthood were strong predictors of continued use post-conception, before and after awareness of the pregnancy and at 1 year postpartum. Substance use limited to young adulthood also predicted continued use post-conception.

CONCLUSIONS

Persistent alcohol, tobacco use and cannabis use that starts in adolescence has a strong continuity into parenthood. Reducing substance use in the perinatal period requires action well before pregnancy, commencing in adolescence and continuing into the years before conception and throughout the perinatal period.

Breastfeeding practices and associations with pregnancy, maternal and infant characteristics in Australia: a cross-sectional study

BACKGROUND

Exclusive breastfeeding to six months of age is a major global public health priority. Several characteristics are known to be associated with early cessation of breastfeeding, however, limited evidence exists regarding whether women's reported reasons for cessation are associated with maternal, pregnancy and infant characteristics. The aims of this study were to: i) describe women's reported intention to breastfeed and their subsequent breastfeeding practices; ii) describe women's reported reasons for breastfeeding cessation prior to the infant being five months of age; and iii) examine associations between these factors and maternal, pregnancy and infant characteristics.

METHODS

Telephone and online surveys were conducted between October 2019 and April 2020 with 536 women who had given birth in the previous eight to 21 weeks at four public maternity services in Australia.

RESULTS

The majority of women intended to (94%), and did, initiate (95%) breastfeeding. At the time the survey was conducted, 57% of women were exclusively breastfeeding. Women who: had less than University level education, had a pre-pregnancy BMI in the overweight or obese category, and who smoked tobacco at the time of the survey had lower odds of exclusively breastfeeding. The most common self-reported reasons for breastfeeding cessation were breastfeeding challenges (47%) and low milk supply (40%). Women aged 26-35 years and 36 + years had greater odds of reporting breastfeeding cessation due to low milk supply (OR = 2.92, 95% CI: 1.11, 7.66; OR = 5.57, 95% CI: 1.70, 18.29) compared to women aged 18-25 years. While women who had completed a TAFE certificate or diploma had lower odds of reporting this as a reason for breastfeeding cessation (OR = 0.28; 95% CI: 0.11, 0.73) compared to women who had University level education. There were no other significant associations found between characteristics and reasons for ceasing breastfeeding.

CONCLUSIONS

The most common reasons for breastfeeding cessation may be modifiable through the provision of breastfeeding support in the early postpartum period, with such support being tailored to women's age and level of education. Such support should aim to increase women's self-efficacy in breastfeeding, and be provided from the antenatal period and throughout the first six months postpartum.

Online randomised factorial trial of electronic Screening and Brief Intervention for alcohol use in pregnancy: a study protocol

INTRODUCTION

Approximately 1 in 7 pregnant women in the USA report past-month alcohol use. Strong evidence connects prenatal alcohol exposure with a range of adverse perinatal outcomes, including the spectrum of conditions known as fetal alcohol spectrum disorders. Screening and Brief Intervention (SBI) has been recommended for pregnant women but has proven difficult to implement. This study will test the efficacy of single-session technology-delivered SBI (electronic SBI) for alcohol use in pregnancy, while simultaneously evaluating the possible additional benefit of tailored text messages and/or booster sessions in a 3×2 factorial trial.

METHOD AND ANALYSIS

This full factorial trial will use online advertising and clinic-based flyers to recruit pregnant women meeting criteria for unhealthy alcohol use, and randomly assign them to one of six conditions crossing three levels of brief intervention (none, single 120-minute session and single session plus two 5-minute boosters) with two levels of tailored text messaging (none vs twice weekly messages). The primary analysis will test for dose-response effects of the brief intervention on alcohol abstinence, defined as no self-report of alcohol use in the 90 days prior to 34 weeks' gestation, and negative results for ethyl glucuronide analysis of fingernail samples. Secondary analyses will examine main and interaction effects of tailored text messaging as well as intervention effects on birth outcomes.

ETHICS AND DISSEMINATION

Ethical approval was provided by the Michigan State University Biomedical and Health Institutional Review Board (STUDY00005298). Results will be presented at conferences and community forums, in addition to being published in a peer-reviewed journal. Intervention content demonstrating sufficient efficacy and safety will be made publicly available.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04332172).

Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW)

INTRODUCTION

Low birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is to estimate the effect of implementing fast-track referral for early intervention on psychosocial and behavioural risk factors-smoking, alcohol consumption, depression and physical violence-in reducing the incidence of LBW.

METHODS AND ANALYSIS

Parallel superiority pragmatic clinical trial randomised by clusters. Primary healthcare units (PHCU) located in Portugal will be randomised (1:1) to intervention or control groups. Pregnant women over 18 years of age attending these PHCU will be eligible to the study. Risk factors will be assessed through face-to-face interviews. In the intervention group, women who report at least one risk factor will have immediate access to referral services. The comparison group will be the local standard of care for these risk factors. We will use intention-to-treat analyses to compare intervention and control groups. We estimated a sample size of 2832 pregnant women to detect a 30% reduction in the incidence rate of LBW between the control and intervention groups. Secondary outcomes are the reduction of preterm births, reduction of the four risk factors and acceptance of the intervention.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the Public Health Institute of the University of Porto (no CE20140). The findings will be disseminated to the public, the funders, health professionals, health managers and other researchers.

TRIAL REGISTRATION NUMBER

NCT04866277.

Alcohol use and intimate partner violence in HIV-uninfected pregnant women in Cape Town, South Africa

In settings with a high burden of HIV, pregnant women often experience a cluster of risk factors, including alcohol use and intimate partner violence (IPV). These interrelated risks are poorly understood among pregnant women at risk of HIV in sub-Saharan Africa. We aim to determine cross-sectional associations between pregnant women's alcohol use and victimization due to IPV in the HIV-Unexposed-Uninfected Mother-Infant Cohort Study in Cape Town, South Africa. Women who tested HIV-negative at first antenatal care (ANC) visit were followed to delivery. Trained interviewers collected demographic and psychosocial information, including recent alcohol use and experiences of IPV victimization. We assess the prevalence of alcohol use and associations with IPV using multivariable logistic regression. In 406 HIV-uninfected pregnant women (mean age = 28 years; mean gestational age = 21 weeks), 41 (10%) reported alcohol consumption in the past 12 months; 30/41 (73%) of these at hazardous levels. Any and hazardous alcohol use were associated with greater odds of reporting past year IPV (adjusted odds ratio [aOR] for hazardous use: 3.24, 95% CI = 1.11, 7.56; aOR for any alcohol use: 2.97, 95% CI = 1.19, 7.45). These data suggest the occurrence of overlapping HIV risk factors among pregnant women and may help design improved health interventions in this population.

Experiences of Norwegian community midwives with caring for vulnerable pregnant women - A national cross-sectional study

OBJECTIVES

The study aimed to describe Norwegian community midwives' care for vulnerable pregnant women. It assessed vulnerability factors midwives identified and the type of care they provided. Factors associated with use of identification tools and care of vulnerable pregnant women were investigated.

METHOD

A quantitative, cross-sectional study. Data collected via an anonymous online survey conducted spring 2020. Of approximately 700 eligible community midwives in Norway, 257 (36.7%) participated.

RESULTS

Community midwives who worked primarily in the community, in close to full-time positions (>80%) and who were responsible for >100 women a year in large community clinics were more likely to identify vulnerable pregnant women than midwives who worked in combined hospital and community posts, less than 80% in the community and at smaller community centres. Attended a training progam called 'Early Start' (Tidlig Inn) was associated with an increased use of standardized identification tools. Almost all community midwives reported providing vulnerable women with more frequent consultations, individual and culturally personalized care, and relevant information about support options.

CONCLUSION

Community midwives appeared to be aware of their role as a midwife in the care of vulnerable pregnant women. They reported encountering vulnerable pregnant, identifying them by actively using methods to do so and addressing their needs in various ways. This study suggests that specific training increases midwives' ability to identify vulnerable pregnant women. Further research is needed to assess how midwives experience interdisciplinary collaboration in caring for these women.

Testing the validity of the AUDIT-C and AUDIT-3 to detect unhealthy alcohol use among high-risk populations in Zambia: A secondary analysis from two randomized trials

BACKGROUND

This study evaluated the test characteristics of brief versions of the Alcohol Use Disorders Identification Test (AUDIT), the AUDIT-C and AUDIT-3, compared to the full AUDIT in populations with heavy drinking living in Zambia and compared differences in effect size estimates when using brief versions in clinical trials.

METHODS

Data were obtained from two randomized trials of the Common Elements Treatment Approach (CETA) for reducing unhealthy alcohol use among adult couples and people living with HIV (PLWH) in Zambia. The full AUDIT was administered to participants at baseline and at 6- or 12-month follow-up. Sensitivity and specificity of the brief versions were calculated in comparison to the full AUDIT. Mixed effects regression models were estimated to calculate the effect sizes from the trials using the brief versions and these were compared to the originally calculated effect sizes using the full version.

RESULTS

The AUDIT-C performed well at cut-off ≥ 3 for both men (sensitivity: >80%; specificity: >76%) and women (sensitivity: >84%; specificity: >88%). The AUDIT-3 performed best at cut-off ≥ 1, but with comparatively reduced validity for men (sensitivity: >77%; specificity: ≥60%) and women (sensitivity: ≥72%; specificity: >62%). Effect sizes were different by up to 52% using the AUDIT-C and up to 60% for the AUDIT-3 compared to the AUDIT.

CONCLUSIONS

The AUDIT-C is recommended as a brief screening tool for community-based and clinic-based screening in Zambia among populations with high prevalence of unhealthy alcohol use. For research studies, the full AUDIT is recommended to calculate treatment effect.

Substance Use During Pregnancy: A Comparative Review of Major Guidelines

Importance

Substance use during pregnancy is a major health issue for both the mother and the fetus, but it also represents an important public health concern.

Objective

The aim of this review was to summarize and compare recommendations from recently published guidelines on substance use during pregnancy and especially regarding alcohol, smoking, and drug use.

Evidence Acquisition

A descriptive review of guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on substance use was conducted. Regarding the term "substance use," the most recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition substances were used.

Results

All the reviewed guidelines recommend appropriate counseling and screening women regarding alcohol, smoking, and drug use during the antenatal period, while the management options vary. More specifically, the prompt management of alcohol dependence is emphasized by all the guidelines except from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which makes no recommendation upon. The use of alcohol during breastfeeding should be avoided. Regarding smoking cessation, all guidelines recommend the use of certain psychosocial, behavioral interventions, and pharmacotherapy. All the guidelines, except the one from the WHO, suggest screening drug users for coexistent sexually transmitted infections. Brief interventions are considered beneficial, while a gradual decrease in benzodiazepines is suggested, as well as the discontinuation of marijuana and methamphetamine use. However, there is controversy regarding breastfeeding in those women as the WHO recommends in favor, whereas the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists recommend against this practice. Finally, all the guidelines state that, following delivery, close monitoring of the neonate is needed.

Conclusions

The diversity of guidelines' recommendations concerning substance use reflects the different ways of the management of pregnant women during routine antenatal care due to absence of strong evidence. More research in the areas of dispute may allow the adoption of an international consensus, in order to early detect and appropriately manage pregnant women with harmful addictions.

Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives

Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women's alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.

The effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia: a prospective cohort study

BACKGROUND

The teratogenic effect of fetal alcohol exposure may lead to actual and potential problems, instantly after birth, at infancy; or even later, and mental impairment in life. This study aimed to investigate the effects of maternal alcohol consumption during pregnancy on adverse fetal outcomes at Gondar town public health facilities, Northwest Ethiopia.

METHODS

A facility-based prospective cohort study was performed among 1778 pregnant women who were booked for antenatal care in selected public health facilities from 29 October 2019 to 7 May 2020 in Gondar town. We used a two-stage random sampling technique to recruit and include participants in the cohort. Data were collected using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) standardized and pre-tested questionnaire. Multivariable analysis was performed to examine the association between reported prenatal alcohol exposure (non-hazardous and hazardous) and interested adverse birth outcomes using log-binomial regression modeling. The burden of outcomes was reported using the adjusted risk ratio and population-attributable risk (PAR).

RESULTS

A total of 1686 pregnant women were included in the analysis, which revealed that the incidences of low birth weight, preterm, and stillbirth were 12.63% (95% CI: 11.12, 14.31), 6.05% (95% CI: 5.00, 7.29) and 4.27% (95% CI: 3.4, 5.35), respectively. Non-hazardous and hazardous alcohol consumption during pregnancy was significantly associated with low birth weight (ARR = 1.50; 95% CI: 1.31, 1.98) and (ARR = 2.34; 95% CI: 1.66, 3.30), respectively. Hazardous alcohol consumption during pregnancy was also significantly associated with preterm birth (ARR = 2.06; 95% CI: 1.21, 3.52). The adjusted PAR of low birth weight related to non-hazardous and hazardous alcohol drinking during pregnancy was 11.72 and 8.44%, respectively. The adjusted PAR of hazardous alcohol consumption was 6.80% for preterm.

CONCLUSIONS

Our findings suggest that there is an increasing risk of adverse birth outcomes, particularly preterm delivery and low birth weight, with increasing levels of alcohol intake. This result showed that the prevention of maternal alcohol use during pregnancy has the potential to reduce low birth weight and preterm birth. Hence, screening women for alcohol use during antenatal care visits and providing advice with rigorous follow-up of women who used alcohol may save the fetus from the potential risks of adverse birth outcomes.

Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK

Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)-the most common neurodevelopmental condition-are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.

Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy

OBJECTIVE

To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence.

INTENDED USERS

Health care providers who care for pregnant women and women of child-bearing age.

TARGET POPULATION

Pregnant women and women of child-bearing age and their families.

EVIDENCE

Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus.

VALIDATION METHODS

The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework.

BENEFITS, HARMS, COSTS

Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes.

SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES)

RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

You Didn't Drink During Pregnancy, Did You?

BACKGROUND

Accurate characterization of prenatal alcohol exposure (PAE) is challenging due to inconsistent use of screening questionnaires in routine prenatal care and substantial underreporting due to stigma associated with alcohol use in pregnancy. The aim of this study was to identify self-report tools that are efficient in accurately characterizing PAE.

METHODS

Participants meeting eligibility criteria for mild-to-moderate PAE were recruited into the University of New Mexico Ethanol, Neurodevelopment, Infant and Child Health cohort (N = 121) and followed prospectively. Timeline follow-back (TLFB) interviews were administered at baseline to capture alcohol use in the periconceptional period and 30 days before enrollment; reported quantity was converted to oz absolute alcohol (AA), multiplied by frequency of use and averaged across 2 TLBF calendars. The interview also included questions about timing and number of drinks at the most recent drinking episode, maximum number of drinks in a 24-hour period since the last menstrual period, and number of drinks on "special occasions" (irrespective of whether these occurred within the TLFB reported period). Continuous measures of alcohol use were analyzed to yield the number of binge episodes by participants who consumed ≥4 drinks/occasion. The proportion of women with ≥1 binge episode was also tabulated for each type of assessment.

RESULTS

Average alcohol consumption was 0.6 ± 1.3 oz of AA/day (≈ 8.4 drinks/wk). Only 3.3% of participants reported ≥1 binge episode on the TLFB, 19.8% had ≥1 binge episode when asked about "special occasions," and 52.1% when asked about the number of drinks the last time they drank alcohol. An even higher prevalence (89.3%) of bingeing was obtained based on the maximum number of drinks consumed in a 24-hour period.

CONCLUSIONS

Self-reported quantity of alcohol use varies greatly based on type of questions asked. Brief targeted questions about maximum number of drinks in 24 hours and total number of drinks during the most recent drinking episode provide much higher estimates of alcohol use and thus might be less affected by self-reporting bias.

A Deep Learning Algorithm to Predict Hazardous Drinkers and the Severity of Alcohol-Related Problems Using K-NHANES

Purpose: The number of patients with alcohol-related problems is steadily increasing. A large-scale survey of alcohol-related problems has been conducted. However, studies that predict hazardous drinkers and identify which factors contribute to the prediction are limited. Thus, the purpose of this study was to predict hazardous drinkers and the severity of alcohol-related problems of patients using a deep learning algorithm based on a large-scale survey data. Materials and Methods: Datasets of National Health and Nutrition Examination Survey of South Korea (K-NHANES), a nationally representative survey for the entire South Korean population, were used to train deep learning and conventional machine learning algorithms. Datasets from 69,187 and 45,672 participants were used to predict hazardous drinkers and the severity of alcohol-related problems, respectively. Based on the degree of contribution of each variable to deep learning, it was possible to determine which variable contributed significantly to the prediction of hazardous drinkers. Results: Deep learning showed the higher performance than conventional machine learning algorithms. It predicted hazardous drinkers with an AUC (Area under the receiver operating characteristic curve) of 0.870 (Logistic regression: 0.858, Linear SVM: 0.849, Random forest classifier: 0.810, K-nearest neighbors: 0.740). Among 325 variables for predicting hazardous drinkers, energy intake was a factor showing the greatest contribution to the prediction, followed by carbohydrate intake. Participants were classified into Zone I, Zone II, Zone III, and Zone IV based on the degree of alcohol-related problems, showing AUCs of 0.881, 0.774, 0.853, and 0.879, respectively. Conclusion: Hazardous drinking groups could be effectively predicted and individuals could be classified according to the degree of alcohol-related problems using a deep learning algorithm. This algorithm could be used to screen people who need treatment for alcohol-related problems among the general population or hospital visitors.

Protocol for an economic evaluation and budget impact assessment of a randomised, stepped-wedge controlled trial for practice change support to increase routine provision of antenatal care for maternal alcohol consumption

Background

Antenatal clinical practice guidelines recommend routine assessment of women’s alcohol consumption during pregnancy. The delivery of advice and referral when necessary are also recommended. However, evidence suggests there are barriers to the uptake of best-care guidelines. Effective, cost-effective and affordable implementation strategies are needed to ensure the intended benefits of guidelines are realised through addressing identified barriers. This paper describes the protocol for evaluating the efficiency and affordability of a practice change intervention compared to the usual practice in an implementation trial.

Methods

The effectiveness of the intervention will be evaluated in a stepped-wedge randomised controlled implementation trial, conducted in an Australian setting. An economic evaluation will be conducted alongside the trial to assess intervention efficiency. A budget impact assessment will be conducted to assess affordability. The prospective trial-based economic evaluation will identify, measure and value key resource and outcome impacts arising from the multi-strategy practice change intervention compared with usual practice. The evaluation will comprise (i) cost-consequence analyses, where a scorecard approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial, and (ii) cost-effectiveness analyses, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for maternal alcohol consumption consistent with the guideline recommendations. Intervention affordability will be evaluated using budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fundholders. Results will be extrapolated to estimate the cost and cost-effectiveness of rolling out the model of care.

Discussion

Uptake of clinical guidelines requires practice change support. It is hypothesized that the implementation strategy, if found to be effective, will also be cost-effective, affordable and scalable. This protocol describes the economic evaluation that will address these hypotheses.

Trial registration

Australian and New Zealand Clinical Trials Registry, ACTRN12617000882325. Registered on 16 June 2017

Directive clinique no 405 : Dépistage et conseils en matière de consommation d'alcool pendant la grossesse

OBJECTIF

Établir des normes pancanadiennes fondées sur les meilleures données probantes actuelles sur le dépistage et les conseils en matière de consommation d'alcool et de troubles de consommation d'alcool chez les femmes enceintes ou en âge de procréer. PROFESSIONNELS CONCERNéS: Les fournisseurs de soins qui prodiguent des soins aux femmes enceintes et aux femmes en âge procréer.

POPULATION CIBLE

Les femmes enceintes, les femmes en âge de procréer et leurs familles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, Embase et CENTRAL avec le thème « alcohol use and pregnancy ». Les résultats ont été filtrés de façon à obtenir des publications parues entre 2010 et septembre 2018. Les termes de recherche ont été mis au point à partir des termes du thésaurus de référence biomédicale MeSH et de mots clés, dont les suivants : pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring et brief intervention. Les données probantes retenues proviennent d'essais cliniques, d'études observationnelles, de revues de la littérature, d'analyses systématiques et méta-analyses, de lignes directrices et de conférences de consensus. MéTHODES DE VALIDATION: Les auteurs ont rédigé et accepté le contenu et les recommandations de la présente directive. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des données probantes a été évaluée au moyen des critères de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation) (consulter les tableaux A1 et A2 de l'annexe en ligne). BéNéFICES, RISQUES, COûTS: La mise en œuvre des recommandations de la présente directive à l'aide d'outils de dépistage validés et de stratégies d'intervention brève peut améliorer la capacité des fournisseurs de soins obstétricaux à reconnaître la consommation d'alcool et la consommation problématique d'alcool chez les femmes enceintes ou en âge de procréer. Il est attendu des fournisseurs de soins de santé qu'ils deviennent confiants et compétents en matière de prise en charge et de soutien de ces femmes afin qu'elles puissent avoir la meilleure santé possible et une issue de grossesse optimale. DÉCLARATIONS SOMMAIRES (CLASSEMENT GRADE ENTRE PARENTHèSES): RECOMMANDATIONS (CLASSEMENT GRADE ENTRE PARENTHèSES).

Can broad-spectrum multinutrients treat symptoms of antenatal depression and anxiety and improve infant development? Study protocol of a double blind, randomized, controlled trial (the 'NUTRIMUM' trial)

BACKGROUND

Untreated antenatal depression and anxiety can be associated with short and long term health impacts on the pregnant woman, her infant and the rest of the family. Alternative interventions to those currently available are needed. This clinical trial aims to investigate the efficacy and safety of a broad-spectrum multinutrient formula as a treatment for symptoms of depression and anxiety in pregnant women and to determine the impact supplementation has on the general health and development of the infant.

METHODS

This randomised, controlled trial will be conducted in Canterbury, New Zealand between April 2017 and June 2022. One hundred and twenty women aged over 16 years, between 12 and 24 weeks gestation and who score ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) will be randomly assigned to take the intervention (n = 60) or an active control formula containing iodine and riboflavin (n = 60) for 12 weeks. After 12 weeks, participants can enter an open-label phase until the birth of their infant and naturalistically followed for the first 12 months postpartum. Infants will be followed until 12 months of age. Randomisation will be computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Participants and the research team including data analysts will be blinded to group assignment. The EPDS and the Clinical Global Impressions Scale of Improvement (CGI-I) will be the maternal primary outcome measures of this study and will assess the incidence of depression and anxiety and the improvement of symptomatology respectively. Generalized linear mixed effects regression models will analyse statistical differences between the multinutrient and active control group on an intent-to-treat basis. A minimum of a three-point difference in EPDS scores between the groups will identify clinical significance. Pregnancy outcomes, adverse events and side effects will also be monitored and reported.

DISCUSSION

Should the multinutrient formula be shown to be beneficial for both the mother and the infant, then an alternative treatment option that may also improve the biopsychosocial development of their infants can be provided for pregnant women experiencing symptoms of depression and anxiety.

TRIAL REGISTRATION

Trial ID: ACTRN12617000354381 ; prospectively registered at Australian New Zealand Clinical Trials Registry on 08/03/2017.

A reduction in reported alcohol use in pregnancy in Australian Aboriginal communities: a prevention campaign showing promise

OBJECTIVE

Aboriginal leaders in remote Western Australian communities with high rates of prenatal alcohol exposure invited researchers to evaluate the community-led Marulu foetal alcohol spectrum disorder (FASD) Prevention Strategy initiated in 2010.

METHODS

The proportion of women reporting alcohol use during pregnancy to midwives was compared between 2008, 2010 and 2015. Initial midwife appointments were calculated by weeks of gestation. The proportions of women reporting alcohol use by age at birth were compared.

RESULTS

Alcohol use reduced significantly from 2010 (61.0%) to 2015 (31.9%) with first-trimester use reducing significantly from 2008 (45.1%) to 2015 (21.6%). Across all years, 40.8% reported alcohol use during pregnancy and 14.8% reported use in both first and third trimesters. Most women attended the midwife in the first trimester. There was a significant relationship between increased maternal age and third-trimester alcohol use.

CONCLUSIONS

The reduction in reported prenatal alcohol exposure in an Aboriginal community setting during a period of prevention activities provides initial evidence for a community-led strategy that might be applicable to similar communities. Implications for public health: The reductions in alcohol use reduce the risk of children being born with FASD in an area with high prevalence, with possible resultant reductions in associated health, economic and societal costs.

Maternal Substance Use: Consequences, Identification, and Interventions

Alcohol, tobacco, and cannabis are the substances most frequently used during pregnancy, and opioid-exposed pregnancies have increased fourfold. The purpose of this review is to describe the prevalence and consequences of prenatal exposure to alcohol, tobacco, cannabis, and opioids. Currently available screening questionnaires for prenatal substance use are summarized and contrasted with the measures available for prenatal alcohol use. Because screening for prenatal alcohol and substance use is but the prelude to efforts to mitigate the potential adverse consequences, attempts for the modification of these consequences are briefly reviewed. In addition, areas of future research related to the criminalization of prenatal substance use, which may inhibit both inquiry and disclosure, are discussed. Indeed, the full potential of effective interventions has yet to be realized.

Clinical validation of screening test for at-risk drinking for young and middle-aged adults in an emergency department

Background:

Emergency department has been shown to be suitable for conducting screening and interventions for at-risk drinking groups. Simple screening test is needed for crowded environments such as the emergency department.

Objective:

This study explores the validity of screening test for at-risk drinking, which was a newly developed abbreviated version of the alcohol use disorder identification test, among patients in the emergency department.

Method:

A survey was conducted at the emergency department of an academic tertiary hospital in South Korea during 4 months. All patients, who visited the emergency department and were between 19 and 65 years of age, answered the alcohol use disorder identification test questionnaire. In this study, at-risk drinking was identified using alcohol use disorder identification test.

Results:

The screening test was completed by 178 patients in this study. At-risk drinking group comprises 78 patients (43.8%). The cut-off values of screening test for at-risk drinking were 3 for males and 2 for females. As a result, the sensitivity/specificity was 98.0/93.5 and 96.4/79.6 for men and women, respectively. Area under the receiver operating characteristics of screening test for at-risk drinking was 0.9 and 0.9 in men and women, respectively.

Conclusion:

screening test for at-risk drinking is a useful test that easily identifies at-risk drinking. It is expected that this test can facilitate screening for at-risk drinking in emergency department setting.

Recent advances in genetic studies of alcohol use disorders

PURPOSE OF REVIEW

Alcohol use disorder (AUD) is a complex genetic disorder with very high heritability. This polygenic disorder not only results in increased morbidity and mortality, it is also a substantial social and economic burden on families and the nation. For past three decades, several genetic studies were conducted to identify genes and pathways associated with AUD. This review aims to summarize past efforts and recent advances in genetic association studies of AUD and related traits.

RECENT FINDINGS

Initial genetic association studies achieved a limted success and suffered from low power due to small sample sizes. AUD is a polygenic trait and data from several thousands individuals was required to identify the genetic factors of small effect sizes. The scenario changed recently with technological advances and significant reduction in cost of the genome wide association analyses (GWAS). This enabled researchers to generate genomic data on mega biobanks and cohorts with access to extensive clinical and non-clinical phenotypes. Public access to data from biobanks and collaborative efforts of researchers lead to identification of several novel loci associated with AUDs and related traits. Efforts are now underway to identify the causal variants under the GWAS loci to identify target genes and biological mechanisms underpining AUDs. Many GWAS variants occur in promoter or enhancer regions of the genes and are involved in regulation of gene expression of causal genes. This, large amounts of "omics" data from projects such as "ENCODE", RoadMap and GTEx is also helping researchers to integrate "multi-omics" data to interpret functional significance of GWAS variants.

SUMMARY

With current review, we aim to present the recent advances in genetic and molecular studies of AUDs. Recent successes in genetic studies of AUDs will definetely motivate researchers and lead to better therapeutic interventions for this complex disorder.

An Integrative Screening Tool of Alcohol Exposure During Early Pregnancy: Combining of the CDT Biomarker with Green Page Questionnaire

AIMS

In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman by applying questionnaires. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy.

METHODS

A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data.

RESULTS

About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women's body mass index and European white race.

CONCLUSION

Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Tutorial in Biostatistics: The use of generalized additive models to evaluate alcohol consumption as an exposure variable

Alcohol consumption is a commonly studied risk factor for many poor health outcomes. Various instruments exist to measure alcohol consumption, including the AUDIT-C, Single Alcohol Screening Questionnaire (SASQ) and Timeline Followback. The information gathered by these instruments is often simplified and analyzed as a dichotomous measure, risking the loss of information of potentially prognostic value. We discuss generalized additive models (GAM) as a useful tool to understand the association between alcohol consumption and a health outcome. We demonstrate how this analytic strategy can guide the development of a regression model that retains maximal information about alcohol consumption. We illustrate these approaches using data from the Russia ARCH (Alcohol Research Collaboration on HIV/AIDS) study to analyze the association between alcohol consumption and biomarker of systemic inflammation, interleukin-6 (IL-6). We provide SAS and R code to implement these methods. GAMs have the potential to increase statistical power and allow for better elucidation of more nuanced and non-linear associations between alcohol consumption and important health outcomes.

Alcohol use, pregnancy and associated risk factors: a pilot cross-sectional study of pregnant women attending prenatal care in an urban city

BACKGROUND

Alcohol consumption during pregnancy is associated with adverse pregnancy outcomes such as preventable alcohol-related developmental disability fetal alcohol syndrome. In Zambia, alcohol use and associated risk factors have not been investigated, and screening in prenatal care is nonexistent. This study determined individual correlates and the prevalence of alcohol use in pregnant women attending prenatal care at two health clinics in Lusaka, Zambia.

METHODS

A study adopted a cross-sectional design and recruited 188 pregnant women after seeking their informed consent from July 19 to 31, 2017. Participants aged 18 or over completed the T-ACE (Tolerance, Annoyance, Cut Down and Eye Opener) screening tool and validated alcohol-screening questionnaires on self-reported alcohol use periconceptional and during conception period while at their regular prenatal visit. The T-ACE screening tool assessed the risk of alcohol dependence in four short questions. The questionnaires included demographic questions. Bivariate analyses were performed using the χ2 test for dichotomous variables and the t-test for continuous variables. Mixed-effects linear models were used to evaluate the effect of outcome variables with patient-level variables.

RESULTS

About 40 (21.2%) pregnant women were identified by the T-ACE as at-risk for problem drinking during pregnancy. Except for regular prenatal care and distance, there was no difference in the demographic factors between pregnant women who scored < 2 on the T-ACE and those that scored > 2 points (all p's > 0.05). A small proportional of women at both clinics reported binge drinking during the periconceptional period (12.7% vs. 3.2%, p = 0.003) and beyond periconception period. Excluding employed women, no significant relationships were observed between alcohol use and demographic factors.

CONCLUSION

Alcohol consumption is prevalent in the periconceptional period and during pregnancy in pregnant women attending prenatal care in Zambia. Findings underscore the need for targeted alcohol use screening and intervention for pregnant women.

Antenatal care for alcohol consumption during pregnancy: pregnant women's reported receipt of care and associated characteristics

Background

Antenatal clinical guidelines recommend that during initial and subsequent antenatal visits all pregnant women: have their alcohol consumption assessed; be advised that it is safest not to consume alcohol during pregnancy and of the potential risks of consumption; and be offered referrals for further support if required. However, the extent to which pregnant women attending public antenatal services receive guideline recommended care at these visits, and the characteristics associated with its receipt, is unknown. The purpose of this study was to examine: 1) pregnant women’s reported receipt of guideline recommended care addressing alcohol consumption during pregnancy; 2) characteristics associated with the receipt of care; and 3) pregnant women’s acceptability of care.

Methods

From July 2017 – February 2018 a survey (telephone or online) was undertaken with 1363 pregnant women who had recently visited a public antenatal service in one health district in Australia. Receipt and acceptability of recommended care were assessed via descriptive statistics and associations via logistic regression analyses.

Results

At the initial antenatal visit, less than two thirds (64.3%) of pregnant women reported that they received an assessment of their alcohol consumption and just over one third (34.9%) received advice and referral appropriate to their self-reported level of alcohol consumption since pregnancy recognition. Less than 10% of women received such care at subsequent antenatal visits. Characteristics that significantly increased the odds of receiving all guideline elements at the initial antenatal visit included: less than university attainment (OR = 1.93; 95% CI:1.12, 3.34), not residing in an advantaged area (OR = 2.11; 95% CI:1.17, 3.79), first pregnancy (OR = 1.91; 95% CI:1.22, 2.99) and regional/rural service location (OR = 2.38; 95% CI:1.26, 4.48); and at subsequent visits: younger age (OR = 0.91; 95% CI:0.84, 0.99) and Aboriginal origin (OR = 3.17; 95% CI:1.22, 8.24). Each of the recommended care elements were highly acceptable to pregnant women (88.3–99.4%).

Conclusions

Although care for alcohol consumption is both recommended by clinical guidelines and highly acceptable to pregnant women, its receipt in public antenatal services is suboptimal. There is a need and an opportunity for interventions to support antenatal care providers to routinely and consistently provide such care to all pregnant women.

Alcohol Use in Pregnancy

Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder.

The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies

Prenatal alcohol exposure is a leading cause of disability, and a major public health concern in Canada. There are well-documented barriers for women and for service providers related to asking about alcohol use in pregnancy. Confidential research is important for learning about alcohol use before, during and after pregnancy, in order to inform fetal alcohol spectrum disorder (FASD) prevention strategies. The Research Advancement through Cohort Cataloguing and Harmonization (ReACH) initiative provides a unique opportunity to leverage the integration of the Canadian pregnancy and birth cohort information regarding women's drinking during pregnancy. In this paper, we identify: The data that can be collected using formal validated alcohol screening tools; the data currently collected through Canadian provincial/territorial perinatal surveillance efforts; and the data currently collected in the research context from 12 pregnancy cohorts in the ReACH Catalogue. We use these findings to make recommendations for data collection about women's alcohol use by future pregnancy cohorts, related to the frequency and quantity of alcohol consumed, the number of drinks consumed on an occasion, any alcohol consumption before pregnancy, changes in use since pregnancy recognition, and the quit date. Leveraging the development of a Canadian standard to measure alcohol consumption is essential to facilitate harmonization and co-analysis of data across cohorts, to obtain more accurate data on women's alcohol use and also to inform FASD prevention strategies.

Screening for At-Risk Alcohol and Drug Use in the Antenatal Period: How Do Young Women Compare with Older Adult Women?

STUDY OBJECTIVE

In the present study we compared results of standardized screening tools for problem alcohol and other drug use in younger (ages 18-24 years) and older (ages 25 and older) women attending the same clinic. We separately investigated pregnant and nonpregnant women. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a cross-sectional study of women attending an urban, university-affiliated obstetrics and gynecology clinic. Women were recruited while awaiting appointments with their providers. In total, 3317 provided consent and completed a brief anonymous survey with standardized questions about alcohol and other drug problems. Measures included the T-ACE (acronym for Tolerance, Annoyed when others express concern, Cut down on drinking, Eye-opener) for alcohol and CAGE for other drugs (CAGE is a mnemonic for the following items: (1) Have you ever felt you should cut down on your use of other drugs? (2) Have people annoyed you by criticizing your use of other drugs? (3) Have you ever felt bad or guilty about your use of other drugs? and (4) Have you ever used drugs first thing in the morning to steady your nerves, avoid withdrawal, or get rid of a hangover [eye opener]?). Individual item responses and screener summary scores were compared separately for pregnant and nonpregnant younger (ages 18-24 years) and older adult (25 years of age or older) women using χ² for categorical and t tests for continuous variables.

RESULTS

For pregnant women, 386/1460 (26%) of older women screened at-risk for problem drinking compared to 250/1203 (21%) of younger women (P = .001). For other drugs, however, 192/1203 (16%) of younger pregnant women screened at risk compared to 186/1461 (13%) of older adult pregnant women (P = .02). For nonpregnant women, screen positive rates for at-risk drug use were nearly 2 times higher among older compared with younger women, with 48/321 (15%) of older women screening at risk compared to 28/332 (8%) of younger women (P < .01).

CONCLUSION

The present findings affirm the need for routine screening for alcohol and drug problems in women of all ages, regardless of pregnancy status.

Associated Factors of Drinking Prior to Recognising Pregnancy and Risky Drinking among New Zealand Women Aged 18 to 35 Years

Nearly half of all pregnant women in the Western world drink prior to recognising pregnancy. The current study aimed to investigate the factors associated with drinking prior to recognising pregnancy among pregnant women and factors associated with risky drinking among nonpregnant sexually active women. The study was a cross-sectional survey of a random sample of women aged 18 to 35 years (n = 1062) selected from the New Zealand electoral roll. Pregnant women (currently pregnant: n = 65; previously pregnant: n = 202) who were risky drinkers and who smoked in the year prior to pregnancy had five times the odds (p < 0.01) and women who planned their pregnancy (p = 0.05) and who used a community service card (p = 0.004) had less than half the odds to drink prior to recognising pregnancy than their respective counterparts. Among sexually active nonpregnant women who consumed alcohol, those who smoked in the year prior to the survey and those who drank for social reasons, for mood enhancement or coping reasons had higher odds of being risky drinkers (p < 0.05). Addressing risky drinking, especially in social settings, and smoking among women of peak childbearing age may mitigate the potential risk of drinking prior to recognising pregnancy.

Screening for substance use in pregnancy and the newborn

Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures. Lastly, we provide recommendations for the ethical implementation of screening and testing for substance use in the context of prenatal care.

The Standardization of Diagnostic Criteria for Fetal Alcohol Spectrum Disorder (FASD): Implications for Research, Clinical Practice and Population Health

OBJECTIVE

Fetal Alcohol Spectrum Disorder (FASD) is a preventable disorder caused by maternal alcohol consumption and marked by a range of physical and mental disabilities. Although recognized by the scientific and medical community as a clinical disorder, no internationally standardized diagnostic tool yet exists for FASD.

METHODS AND RESULTS

This review seeks to analyse the discrepancies in existing diagnostic tools for FASD, and the repercussions these differences have on research, public health, and government policy.

CONCLUSIONS

Disagreement on the adoption of a standardised tool is reflective of existing gaps in research on the conditions and factors that influence fetal vulnerability to damage from exposure. This discordance has led to variability in research findings, inconsistencies in government messaging, and misdiagnoses or missed diagnoses. The objective measurement of the timing and level of prenatal alcohol exposure is key to bridging these gaps; however, there is conflicting or limited evidence to support the use of existing measures.

WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women

OBJECTIVES

These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health.

METHODS

We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication.

RESULTS AND DISCUSSION

There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.

Prenatal alcohol exposure prevalence as measured by direct ethanol metabolites in meconium in a Native American tribe of the southwest

BACKGROUND

Although fetal alcohol spectrum disorders represent a significant public health problem, Native Americans are underrepresented in population and targeted screening programs. Prior reports suggest that Native American tribal communities may have a higher prevalence of alcohol use during pregnancy; however, systematic examination using ethanol biomarkers is lacking.

METHODS

This study utilized data collected through the Navajo Birth Cohort Study (NBCS)-a birth cohort study of a Southwestern tribal community. Prevalence of prenatal alcohol exposure (PAE) was assessed by a battery of meconium biomarkers among 333 NBCS participants. Meconium samples were analyzed for nine individual fatty acid ethyl ester (FAEE) species, ethyl glucuronide (EtG), and ethyl sulfate (EtS) by LC-MS/MS.

RESULTS

Participants were recruited from five hospitals at the Navajo Nation located in Arizona (Chinle, Tséhootsooí, Tuba City) and New Mexico (Gallup, Shiprock). All participants identified as Native American; most reported a personal income of <$20,000 per year (71.3%), and ≤high school education (55.3%). The most prevalent biomarker was EtS (7.8%) followed by ethyl oleate (6.9%); 5.4% of the sample were positive for at least two biomarkers.

CONCLUSIONS

Results of this study on the prevalence of PAE in the Navajo Nation, obtained for the first time with an objective comprehensive panel of meconium biomarkers, indicate that the rates in the NBCS may be comparable to the general U.S. population and are in accord with recent U.S. national survey estimates. Our findings emphasize that drinking behaviors among Native American communities in the United States can vary, and generalization across all Native American populations is not warranted.

A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities

BACKGROUND

Fetal alcohol spectrum disorder (FASD) is a preventable, lifelong neurodevelopmental disorder caused by prenatal alcohol exposure. FASD negatively impacts individual Indigenous communities around the world. Although many prevention interventions have been developed and implemented, they have not been adequately evaluated. This systematic review updates the evidence for the effectiveness of FASD prevention interventions in Indigenous/Aboriginal populations internationally, and in specific populations in North America and New Zealand, and offers recommendations for future work.

METHOD

The MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO, SocINDEX, and Informit databases were searched from inception to 22/08/2017 for all prevention and intervention papers published in peer-reviewed scientific journals, with results, targeting prenatal alcohol exposure and FASD in Indigenous populations. This review was limited to studies published in English and excluded interventions focusing on the workforce. All steps were completed independently by two reviewers with discrepancies resolved via consensus with the senior author.

RESULTS

There was significant heterogeneity in the ten included studies. Populations targeted included non-pregnant women of child-bearing age, pregnant women, school children and the general public. Study designs included one randomised controlled trial, five cohort studies with pre-post design, one cross-sectional study with different pre- and post-intervention groups, and four studies collected post-intervention data. Studies assessed changes in knowledge, and/or changes in risk for prenatal alcohol exposure including self-reported alcohol consumption, use of birth control or a combination of both. One study was conducted in Australia and nine in the US. The methodological quality of all studies was rated as 'Poor' using the systematic review assessment tools developed by The National Heart, Lung and Blood Institute. Studies were subject to substantial bias due to issues such as high loss to follow-up, lack of control groups and the reliance on self-report measures to assess the main outcome.

CONCLUSION

Overall, there is little evidence that previous interventions aiming to reduce the risk of prenatal alcohol exposure or FASD in Indigenous populations have been effective. Future intervention studies should address the cultural factors and historical context that are fundamental to successful work with Indigenous populations, and be designed, implemented and evaluated using rigorous methods. This systematic review was registered with PROSPERO, CRD42018086212.

A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial

Background

Despite clinical guideline recommendations, implementation of antenatal care addressing alcohol consumption by pregnant women is limited. Implementation strategies addressing barriers to such care may be effective in increasing care provision. The aim of this study is to examine the effectiveness, cost and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women.

Methods

The study will be a randomised, stepped-wedge controlled trial conducted in three sectors in a health district in New South Wales, Australia. Stepped implementation of a practice change intervention will be delivered to sectors in a random order to support the introduction of a model of care for addressing alcohol consumption by pregnant women. A staged process was undertaken to develop the implementation strategies, which comprise of: leadership support, local clinical practice guidelines, electronic prompts and reminders, opinion leaders, academic detailing (audit and feedback), educational meetings and educational materials, and performance monitoring. Repeated cross-sectional outcome data will be gathered weekly across all sectors for the study duration. The primary outcome measures are the proportion of antenatal appointments at ‘booking in’, 27–28 weeks gestation and 35–36 weeks gestation for which women report (1) being assessed for alcohol consumption, (2) being provided with brief advice related to alcohol consumption during pregnancy, (3) receiving relevant care for addressing alcohol consumption during pregnancy, and (4) being assessed for alcohol consumption and receiving relevant care. Data on resources expended during intervention development and implementation will be collected. The proportion of women who report consuming alcohol since knowing they were pregnant will be measured as a secondary outcome.

Discussion

This will be the first randomised controlled trial to evaluate the effectiveness, cost and cost-effectiveness of implementation strategies in improving antenatal care that addresses alcohol consumption by pregnant women. If positive changes in clinical practice are found, this evidence will support health service adoption of implementation strategies to support improved antenatal care for this recognised risk to the health and wellbeing of the mother and child.

Trial registrations

Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).

Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey

Objective

Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea.

Methods

Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group.

Results

A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively.

Conclusion

As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.

Cut-off points for screening at-risk drinking by AUDIT-C Korean version at emergency department

Purpose

To reduce problems caused by alcohol drinking, it is necessary to identify those with 'at-risk drinking' behavior to maximize therapeutic access or intervention. To this end, we sought to determine the cut-off point for screening of at-risk drinking by the Korean version of the AUDIT-C (Alcohol Use Disorder Identification Test-Consumption).

Materials and methods

We obtained data from the scientific research project of "the supervision of the Korea Center for Disease Control and Prevention (KCDCP)" in 2010. Injured patients over an 18-year-of age who visited an emergency department of an academic tertiary hospital from May to September 2010 were recruited to perform the AUDIT. The total number of patients who underwent the screening test was 640, 12.7% of the entire patients studied. Among them, 375 patients (58.4%) were men, and 265 patients (41.4%) were women. At-risk drinking was diagnosed based on the AUDIT total score and the cut-off points of the AUDIT-C were determined.

Results

Cut-off points were 5 for men [Area Under the Receiver Operation Characteristic (AUROC) 0.956], 4 for women (AUROC 0.966), and 4 in elders >65-year-of age (AUROC 0.972).

Conclusion

This study is the first research about the cut-off points of Korean version of AUDIT-C for patients including women and elders to screen for at-risk drinking in South Korea. AUDIT-C is a useful and accurate tool to screen patients for at-risk drinking.

Substance use in pregnancy: The medical challenge

Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.

Prevalence of alcohol use in pregnant women with substance use disorder

BACKGROUND

Prenatal care programs for women with opioid use disorder (OUD) often focus treatment/counseling plans around illicit substances, while concurrent use of alcohol might present an equal or greater risk to the fetus.

METHODS

This study evaluated self-reported prevalence of alcohol use in patients participating in a comprehensive prenatal care program for women with substance use disorder (SUD; n = 295), of which 95% are treated for OUD, and pregnant women being served through general obstetrical clinics at the University of New Mexico (n = 365). During the screening phase of a prospective study, patients were asked to report alcohol use in the periconceptional period, and between the last menstrual period and pregnancy recognition.

RESULTS

The screening interview was conducted at 22.3 (median = 22; Q1 = 16; Q3 = 29) gestational weeks. Among patients screened at the SUD clinic, 28.8% and 24.1% reported at least one binge drinking episode in the periconceptional period and in early pregnancy, respectively. The prevalence of binge drinking was similar in the general obstetrics population (24.7% and 24.4%, respectively). Among those who reported drinking in early pregnancy, median number of binge drinking episodes was higher among patients screened at the SUD clinic (median = 3; Q1 = 1; Q3 = 10) compared to the general obstetrics group (median = 1; Q1 = 1; Q3 = 3; p < 0.001).

CONCLUSIONS

This study demonstrates a high prevalence of prenatal alcohol use in early pregnancy in both groups, while patients with SUD/OUD consume more alcohol. These findings underscore the need for targeted screening and intervention for alcohol use in all pregnant women, especially those with SUD/OUD.

Screening Test for At-Risk Drinking: Development of New Abbreviated Version of Alcohol Use Disorder Identification Test for Young and Middle-Aged Adults

Several abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) have been developed for use in high-volume clinical situations such as emergency departments. In this study, we developed a new abbreviated version of AUDIT called the Screening Tool for At-risk Drinking (STAD) for young and middle-aged adults, consisting of two questions that reflect the structure of the AUDIT questionnaire using data from the Korea National Health and Nutrition Examination Survey (KNHANES). To derive the abbreviated test considering AUDIT item structure, we performed confirmatory factor analysis on the 10 AUDIT questions in the Korea National Health and Nutrition Examination Survey (KNHANES) IV. To validate the new abbreviated test, we analyzed the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) on the KNHANES V-VI except for the KNHANES VI-2. Based on the two-factor structure of AUDIT, question (Q) 3 and Q7 were finally selected for STAD. In validation, AUROC was significantly wider for STAD than for AUDIT-QF, which has the same number of questions. There was no significant difference between AUDIT-C, consisting of three questions, and STAD. It can be used as a simple and reliable screening test in clinical settings.

Is TWEAK a valid screening questionnaire to identify alcohol risk drinkers among pregnant women in Denmark?

INTRODUCTION

Identification of pregnant alcohol risk drinkers is crucial to prevent adverse birth outcomes. The TWEAK screening instrument has shown promising results for identifying risk drinkers. However, as the effectiveness of the screening questionnaire has only been investigated among American women with mainly low socioeconomic status, we aimed to investigate the ability of TWEAK to identify alcohol risk drinkers among pregnant Danish women.

MATERIAL AND METHODS

During 2000, Danish-speaking women referred to the Midwife Center at Aarhus University Hospital (n = 1554) and Fredericia Hospital (n = 499) for routine antenatal care were invited to participate in the study at their first visit. The women were interviewed about their periconceptional and current drinking habits including average weekly alcohol consumption and binge drinking. Additionally, the women were also asked the questions related to the TWEAK questionnaire.

RESULTS

We found that the sensitivity of TWEAK to identify periconceptional risk drinking was quite low, but its ability to identify risk drinkers during pregnancy was marginally higher. Our results suggested that older age (odds ratio 1.46, 95% confidence interval 0.95-2.23), current smoking (odds ratio 2.33, 95% confidence interval 1.63-3.33), being single (odds ratio 2.38, 95% confidence interval 1.38-4.11) and a TWEAK score with a cut-off score of ≥1 (odds ratio 2.75, 95% confidence interval 2.02-3.76) increased the risk of high-risk drinking during pregnancy.

CONCLUSIONS

In a Danish setting, TWEAK does not seem as an optimal screening tool to identify periconceptional risk drinkers but it may be useful in identifying high-risk drinking during pregnancy.