SCREENING AND RECORDING OF ALCOHOL USE AMONG WOMEN OF CHILD-BEARING AGE AND PREGNANT WOMEN
Main Article Content
Keywords
.
Abstract
woman’s alcohol use during pregnancy is one of the top preventable causes of birth defects and developmental disabilities that are known as fetal alcohol spectrum disorders (FASD). The social and economic burden of FASD is substantial. Lifetime direct tangible costs per individual related to health care, education and social services in Canada have been estimated to be $1.4 million.
Screening women of child-bearing age and pregnant women and recording their alcohol consumption is a practical process to identify and evaluate women at-risk and to identify potentially exposed infants.
The FASD Advisory Workgroup proposes the following three levels of screenings which should be done on consenting women:
? Level I screening involves practice-based approaches that can be used by health care providers when talking to women about alcohol use, such as motivational interviewing and supportive dialogue.
? Level II screening includes a number of structured questionnaires that can be used with direct questioning (TLFB) or indirect / masked screening (AUDIT, BMAST / SMAST, CAGE, CRAFFT, T-ACE, TWEAK).
? Level III screening includes laboratory-based tools that can be used to confirm the presence of a drug, its level of exposure and determine the presence of multiple drugs.
There are challenges and limitations in the use of the screening and assessment tools outlined. For example, the single question about alcohol use and the various questionnaires rely on a woman to provide details about her alcohol use. There is no consensus on the appropriate screening to use across Canada as each provincial / territorial jurisdiction, health care organization and health care provider uses a variety of formal and informal screening tool. In addition, there are inconsistent processes across Canada for the recording of the alcohol use in a woman’s chart and the transfer of the information to the infant and the child’s health records.
The FASD Advisory Workgroup proposes eleven recommendations to improve the screening and recording processes for alcohol use in women of child-bearing age and pregnant women.
References
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10. Stade BC, Stevens B, Ungar WJ, Beyene J, Koren G. Health-Related Quality of Life of Canadian Children and Youth Prenatally Exposed to Alcohol. Health and Quality of Life Outcomes 2006;4:81.
11. Square D. Fetal Alcohol Syndrome Epidemic on Manitoba Reserve. Canadian Medical Association Journal. 1997;157(1):59-60.
12. Stade B, Ungar WJ, Stevens B, Beyen J, Koren G. Cost of Fetal Alcohol Spectrum Disorder in Canada. Canadian Family Physician August 2007;53(8):1303-4.
13. Henderson J, Gray R, Brocklehurst P. Systematic Review of Effects of Low-Moderate Prenatal Alcohol Exposure in Pregnancy Outcome. BJOG 2007;114:243-252.
14. Testa M, Quigley BM, Das Eiden R. The Effects of Prenatal Alcohol Exposure on Infant Mental Development: A Meta-Analytical Review. Alcohol and Alcoholism 2003;38(4):295-304.
15. Tough S, Clarke M, Hicks M, Clarren S. Attitudes and Approaches of Canadian Providers to Preconception Counselling and the Prevention of Fetal Alcohol Spectrum Disorders. Journal FAS International 2005; 3:e3.
16. Nevin AC, Parshuram C, Nulman I, Koren G, Einarson A. A Survey of Physicians’ Knowledge Regarding Awareness of Maternal Alcohol Use and the Diagnosis of FAS. Biomed Central Family Practice 2002; 3(1):2.
17. Cyr MG, Wartman SA. The Effectiveness of Routine Screening Questions in the Detection of Alcoholism. JAMA 1988;259:51-4.
18. Burd L, Klug MG, Martsolf JT, Martsolf C, Deal E, Kerbeshian J. A Staged Screening Strategy for Prenatal Alcohol Exposure and Maternal Risk Stratification. JRSH 2006;126(2):86-94.
19. Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B, et al. Brief Intervention for Alcohol Use in Pregnancy - A Randomized Trial. Addiction 1999;94:1499-1508.
20. Hanking JR. Fetal Alcohol Syndrome Prevention Research. Alcohol Research and Health 2002;26(1):58-65.
21. Chang G. Screening and Brief Intervention in Prenatal Care Settings. Alcohol Research and Health 2004/2005; 28( 2):80-84
22. Miller WR, Rolnick S. Motivational Interviewing: Preparing People for Change. 2nd edition. New York, N.Y.: The Guilford Press; 2002.
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24. Sobell L, Sobell M. Timeline follow-back: A Technique for Assessing Self-Reported Alcohol Consumption. Maternal Alcohol Consumption. Ed. R. Litten and J. Allen. 1992. Totowa, NJ: Humana Press. 41-72.
25. Searles JS, Helzer JE, Rose GL, Badger GJ. Comparisons of Drinking Patterns Measured by Daily Reports and Timeline Follow Back. Psychology, Addiction and Behaviour. 2002;14:277-286.
26. Hartford TC. Effects of Order of Questions on Reported Alcohol Consumption. Addiction. 1994;89:421-424.
27. Sobell LC, Sobell MB, Leo GI, Cancilla A. Reliability of a Timeline Method: Assessing Normal Drinkers’ Reports of Recent Drinking and a Comparative Evaluation Across Several Populations. Br J Addict. 1988;84(4):393-402.
28. Sacks JA. Utility of the Time Line Follow Back to Assess Substance Abuse Among Homeless Adults. Journal of Nervous and Mental Disease 2003;191(3):145-153.
29. Bradley KA, Boyd-Wickizer J, Powell SH, Berman ML. Alcohol Screening Questionnaires in Women: A Critical Review. JAMA 1998;280(2):166-171.
30. Chang G, Walkins-Haug L, Berman S, Goetz MA. The TWEAK: Application in a Prenatal Setting. Journal of Studies on Alcohol 1999;60(3):306-9.
31. Russell M, Martier SS, Sokol RJ, Mudar P, Jacobson S, Jacobson J. Detecting Risk Drinking During Pregnancy: A Comparison of Four Screening Questionnaires. Am J Public Health 1996;86(10):1435-9.
32. Torres LAPD, Fernandez-Garcia JA, Arias-Vega R, Muriel-Palomino M, Marquez-Rebollo E, Ruiz-Moral R. Validity of AUDIT Test for Detection of Disorders Related with Alcohol Consumption in Women. Medicina Clinica 2005;125(19):727-30.
33. Cherpitel CJ. Performance of Screening Instruments for Identifying Alcohol Dependence in the General Population, Compared with Clinical Populations. Alcohol Clin Exp Res 1998;22(7):1399-1404.
34. Crowe RR, Kramer JR, Hesselbrock V, Manos G, Bucholz KK. The Utility of the 'Brief MAST' and the 'CAGE' in Identifying Alcohol Problems: Results from National High-Risk and Community Samples. Archives of Family Medicine 1997;6(5):477-483.
35. Breakey WR, Calabrese L, Rosenblatt A, Crum RM. Detecting Alcohol Use Disorders in the Severely Mentally Ill. Community Mental Health Journal 1998;34(2):165-174.
36. Chang G, Goetz MA, Wilkins-Haug L, Berman S. Identifying Prenatal Alcohol Use: Screening Instruments Versus Clinical Predictors. American Journal on Addictions 1999;8(2):87- 93.
37. Robin RW, Saremi A, Albaugh B, Hanson RL, Williams D, Goldman D. Validity of the SMAST in Two American Indian Tribal Populations. Substance Use & Misuse 2004;39(4):601-624.
38. Smart RG, Adlaf EM, Knoke D. Use of the CAGE Scale in a Population Survey of Drinking. Journal of Studies on Alcohol 1991;52:593-6.
39. Aertgeerts B, Buntinx F, Bande-Knops J, Vandermeulen C, Roelants M, Ansoms S, Fevery J. The Value of CAGE, CUGE, and AUDIT in Screening for Alcohol Abuse and Dependence Among College Freshmen. Alcoholism: Clinical & Experimental Research 2000;24(1):53-57.
40. Hankin JR, Sokol RJ. Identification and Care of Problems Associated with Alcohol Ingestion in Pregnancy. Seminars in Perinatology 1995;19:286-292.
41. Bisson J, Nadeau L, Demers A. The Validity of the CAGE Scale to Screen for Heavy Drinking and Drinking Problems in a General Population Survey. Addiction 1999;94(5): 715-722.
42. Soderstrom CA, Smith GS, Kufera JA, Dischinger PC, Hebel JR, McDuff DR, et al. The Accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in Screening Trauma Centre Patients for Alcoholism. Journal of Trauma 1997;43(6):962-9.
43. Knight JR, Sherritt L, Harris SK, Shrier LA, Chang G. Validity of the CRAFFT Substance Abuse Screening Test Among General Adolescent Clinical Patients. Archives of Pediatrics & Adolescent Medicine 2002;156(6):607-614.
44. Knight JR, Sherritt L, Harris SK, Gates EA, Chang G. Validity of Brief Alcohol Screening Tests Among Adolescents: A Comparison of the AUDIT, CAGE, POSIT and CRAFFT. Alcoholism: Clinical and Experimental Research 2003;27(1):67-73.
45. Sokol RJ, Martier SS, Ager JW. The T-ACE Questionnaire: Practical Prenatal Detection of Risk-Drinking. Am J Obstet Gynecol 1989;160(4):864-8.
46. Chang G, Wilkins-Haug L, Berman S, Goetz M, Behr S. Alcohol Use and Pregnancy: Improving Identification. Obstet Gynecol 1998;91(6):892-8.
47. Saunders JB, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT), 1993.
48. Selzer ML, Vinokur A, van Rooijen L. A Self- Administered Short Michigan Alcoholism Screening Test (SMAST). J. Stud Alcohol 1975;36(1):117-126.
49. McNamara T, Orav E, Wilkins-Haug L. Chang G. Risks During Pregnancy - Self-Report Versus Medical Record. American Journal of Obstetrics and Gynecology 2005;193(6):1981-5.
50. Russell M, Martier SS, Sokol RJ, Mudar P, Bottoms S, Jacobson S, et al. Screening for Pregnancy Risk-Drinking. Alcohol Clin Exp Res 1994;18(5):1156-61.
51. Russell M. New Assessment Tools for Risk- Drinking During Pregnancy. Alcohol Health & Research World. 1994;18:55-61.
52. Russell M, Skinner JB. Early Measures of Maternal Alcohol Misuses as Predictors of Adverse Pregnancy Outcomes. Alcohol Clin Exp Res 1988;12(6):824-30.
53. Chan AK, Pristach EA, Welte JW, Russell M. The TWEAK Test in Screening for Alcoholism / Heavy Drinking in Three Populations. Alcohol Clin Exp Res 1993;6:1188-1192.
54. Cherpitel CJ. Screening for Alcohol Problems in the Emergency Department. Annals of Emergency Medicine 1995;26:158-166.
55. Reinert DF and Allen JP. The Alcohol Use Disorders Identification Test (AUDIT): A Review of Recent Research. Alcohol Clin Exp Res 2002;26(2):272-9.
56. Ernhart CB. Underreporting of Alcohol use in Pregnancy. Alcohol Clin Exp Res 1988;12(4):506- 511.
57. Auwarter V. Sporkert F, Hartwig S, Pragst F, Vater H, Diefenbacher A. Fatty Acid Ethyl Esters in Hair as Markers of Alcohol Consumption. Segmental Hair Analysis of Alcoholics, Social Drinkers, and Teetotallers. Clinical Chemistry. 2001;47(12):2114-23.
58. Pragst F. Auwaerter V, Sporkert F, Spegel K. Analysis of Fatty Acid Ethyl Esters in Hair as Possible Markers of Chronically Elevated Alcohol Consumption by Headspace Solid- Phase Microextraction (HS-SPME) and Gas Chromatography-Mass Spectrometry (GC-MS). Forensic Sci Int 2001;121(1-2):76-88.
59. Koren G, Hutson J, Gareri J. Novel Methods for the Detection of Drug and Alcohol Exposure during Pregnancy: Implications for Maternal and Child Health. Clin Pharmacol Ther 2008;83(4):631-4.
60. Rosner B. Fundamentals of Biostatistics. Belmont CA: Duxbury Press; 1990.
61. Rice JP. Statistical Issues in the Interpretation of Tests. In: Screening for Alcoholism in Primary Care Settings. 1987; National Institute on Alcohol Abuse and Alcoholism. Rockville, MD. p3-5.
3. Canadian Task Force on the Periodic Health Examination. The Periodic Health Examination. CMAJ 1979;121:1193-1254.
4. Health Canada. Knowledge and Attitudes of Health Professionals About Fetal Alcohol Syndrome: Results of a National Survey. 2004; available at: http://www.phac-aspc.gc.ca/hpps/ index.html.
5. Stratton K, Howe C, Battaglia F. Institute of Medicine Summary: Fetal Alcohol Syndrome. Washington DC: National Academy Press; 1996.
6. Health Canada. Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue. 2005. available at: http://.phacaspc. gc.ca/fasd-etcaf/index.html.
7. Jones KL, Smith DW, Ulleland CN, Streissguth, AP. Pattern of Malfunction in Offspring of Chronic Alcoholic Mothers. Lancet 1973;1267- 71.
8. Sokol RJ, Martier SS, AAger JW. The T-ACE Equations: Practical Prenatal Detection of Riskdrinking. Am J Obstet Gynecol 1989;160(4):863- 8.
9. Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, Janisse J, Martier S, Sokol RJ. Prenatal Alcohol Exposure and Childhood Behavior at Age 6 to 7 Years: I. Dose-Response Effect. Pediatrics 2001;108(2);e34.
10. Stade BC, Stevens B, Ungar WJ, Beyene J, Koren G. Health-Related Quality of Life of Canadian Children and Youth Prenatally Exposed to Alcohol. Health and Quality of Life Outcomes 2006;4:81.
11. Square D. Fetal Alcohol Syndrome Epidemic on Manitoba Reserve. Canadian Medical Association Journal. 1997;157(1):59-60.
12. Stade B, Ungar WJ, Stevens B, Beyen J, Koren G. Cost of Fetal Alcohol Spectrum Disorder in Canada. Canadian Family Physician August 2007;53(8):1303-4.
13. Henderson J, Gray R, Brocklehurst P. Systematic Review of Effects of Low-Moderate Prenatal Alcohol Exposure in Pregnancy Outcome. BJOG 2007;114:243-252.
14. Testa M, Quigley BM, Das Eiden R. The Effects of Prenatal Alcohol Exposure on Infant Mental Development: A Meta-Analytical Review. Alcohol and Alcoholism 2003;38(4):295-304.
15. Tough S, Clarke M, Hicks M, Clarren S. Attitudes and Approaches of Canadian Providers to Preconception Counselling and the Prevention of Fetal Alcohol Spectrum Disorders. Journal FAS International 2005; 3:e3.
16. Nevin AC, Parshuram C, Nulman I, Koren G, Einarson A. A Survey of Physicians’ Knowledge Regarding Awareness of Maternal Alcohol Use and the Diagnosis of FAS. Biomed Central Family Practice 2002; 3(1):2.
17. Cyr MG, Wartman SA. The Effectiveness of Routine Screening Questions in the Detection of Alcoholism. JAMA 1988;259:51-4.
18. Burd L, Klug MG, Martsolf JT, Martsolf C, Deal E, Kerbeshian J. A Staged Screening Strategy for Prenatal Alcohol Exposure and Maternal Risk Stratification. JRSH 2006;126(2):86-94.
19. Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B, et al. Brief Intervention for Alcohol Use in Pregnancy - A Randomized Trial. Addiction 1999;94:1499-1508.
20. Hanking JR. Fetal Alcohol Syndrome Prevention Research. Alcohol Research and Health 2002;26(1):58-65.
21. Chang G. Screening and Brief Intervention in Prenatal Care Settings. Alcohol Research and Health 2004/2005; 28( 2):80-84
22. Miller WR, Rolnick S. Motivational Interviewing: Preparing People for Change. 2nd edition. New York, N.Y.: The Guilford Press; 2002.
23. Cox N. Perinatal Substance Abuse: An Intervention Kit for Providers. Adapted from the Women’s Lifestyle Questionnaire. Rural South Central Wisconsin Perinatal Substance Abuse Project, July 1991.
24. Sobell L, Sobell M. Timeline follow-back: A Technique for Assessing Self-Reported Alcohol Consumption. Maternal Alcohol Consumption. Ed. R. Litten and J. Allen. 1992. Totowa, NJ: Humana Press. 41-72.
25. Searles JS, Helzer JE, Rose GL, Badger GJ. Comparisons of Drinking Patterns Measured by Daily Reports and Timeline Follow Back. Psychology, Addiction and Behaviour. 2002;14:277-286.
26. Hartford TC. Effects of Order of Questions on Reported Alcohol Consumption. Addiction. 1994;89:421-424.
27. Sobell LC, Sobell MB, Leo GI, Cancilla A. Reliability of a Timeline Method: Assessing Normal Drinkers’ Reports of Recent Drinking and a Comparative Evaluation Across Several Populations. Br J Addict. 1988;84(4):393-402.
28. Sacks JA. Utility of the Time Line Follow Back to Assess Substance Abuse Among Homeless Adults. Journal of Nervous and Mental Disease 2003;191(3):145-153.
29. Bradley KA, Boyd-Wickizer J, Powell SH, Berman ML. Alcohol Screening Questionnaires in Women: A Critical Review. JAMA 1998;280(2):166-171.
30. Chang G, Walkins-Haug L, Berman S, Goetz MA. The TWEAK: Application in a Prenatal Setting. Journal of Studies on Alcohol 1999;60(3):306-9.
31. Russell M, Martier SS, Sokol RJ, Mudar P, Jacobson S, Jacobson J. Detecting Risk Drinking During Pregnancy: A Comparison of Four Screening Questionnaires. Am J Public Health 1996;86(10):1435-9.
32. Torres LAPD, Fernandez-Garcia JA, Arias-Vega R, Muriel-Palomino M, Marquez-Rebollo E, Ruiz-Moral R. Validity of AUDIT Test for Detection of Disorders Related with Alcohol Consumption in Women. Medicina Clinica 2005;125(19):727-30.
33. Cherpitel CJ. Performance of Screening Instruments for Identifying Alcohol Dependence in the General Population, Compared with Clinical Populations. Alcohol Clin Exp Res 1998;22(7):1399-1404.
34. Crowe RR, Kramer JR, Hesselbrock V, Manos G, Bucholz KK. The Utility of the 'Brief MAST' and the 'CAGE' in Identifying Alcohol Problems: Results from National High-Risk and Community Samples. Archives of Family Medicine 1997;6(5):477-483.
35. Breakey WR, Calabrese L, Rosenblatt A, Crum RM. Detecting Alcohol Use Disorders in the Severely Mentally Ill. Community Mental Health Journal 1998;34(2):165-174.
36. Chang G, Goetz MA, Wilkins-Haug L, Berman S. Identifying Prenatal Alcohol Use: Screening Instruments Versus Clinical Predictors. American Journal on Addictions 1999;8(2):87- 93.
37. Robin RW, Saremi A, Albaugh B, Hanson RL, Williams D, Goldman D. Validity of the SMAST in Two American Indian Tribal Populations. Substance Use & Misuse 2004;39(4):601-624.
38. Smart RG, Adlaf EM, Knoke D. Use of the CAGE Scale in a Population Survey of Drinking. Journal of Studies on Alcohol 1991;52:593-6.
39. Aertgeerts B, Buntinx F, Bande-Knops J, Vandermeulen C, Roelants M, Ansoms S, Fevery J. The Value of CAGE, CUGE, and AUDIT in Screening for Alcohol Abuse and Dependence Among College Freshmen. Alcoholism: Clinical & Experimental Research 2000;24(1):53-57.
40. Hankin JR, Sokol RJ. Identification and Care of Problems Associated with Alcohol Ingestion in Pregnancy. Seminars in Perinatology 1995;19:286-292.
41. Bisson J, Nadeau L, Demers A. The Validity of the CAGE Scale to Screen for Heavy Drinking and Drinking Problems in a General Population Survey. Addiction 1999;94(5): 715-722.
42. Soderstrom CA, Smith GS, Kufera JA, Dischinger PC, Hebel JR, McDuff DR, et al. The Accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in Screening Trauma Centre Patients for Alcoholism. Journal of Trauma 1997;43(6):962-9.
43. Knight JR, Sherritt L, Harris SK, Shrier LA, Chang G. Validity of the CRAFFT Substance Abuse Screening Test Among General Adolescent Clinical Patients. Archives of Pediatrics & Adolescent Medicine 2002;156(6):607-614.
44. Knight JR, Sherritt L, Harris SK, Gates EA, Chang G. Validity of Brief Alcohol Screening Tests Among Adolescents: A Comparison of the AUDIT, CAGE, POSIT and CRAFFT. Alcoholism: Clinical and Experimental Research 2003;27(1):67-73.
45. Sokol RJ, Martier SS, Ager JW. The T-ACE Questionnaire: Practical Prenatal Detection of Risk-Drinking. Am J Obstet Gynecol 1989;160(4):864-8.
46. Chang G, Wilkins-Haug L, Berman S, Goetz M, Behr S. Alcohol Use and Pregnancy: Improving Identification. Obstet Gynecol 1998;91(6):892-8.
47. Saunders JB, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT), 1993.
48. Selzer ML, Vinokur A, van Rooijen L. A Self- Administered Short Michigan Alcoholism Screening Test (SMAST). J. Stud Alcohol 1975;36(1):117-126.
49. McNamara T, Orav E, Wilkins-Haug L. Chang G. Risks During Pregnancy - Self-Report Versus Medical Record. American Journal of Obstetrics and Gynecology 2005;193(6):1981-5.
50. Russell M, Martier SS, Sokol RJ, Mudar P, Bottoms S, Jacobson S, et al. Screening for Pregnancy Risk-Drinking. Alcohol Clin Exp Res 1994;18(5):1156-61.
51. Russell M. New Assessment Tools for Risk- Drinking During Pregnancy. Alcohol Health & Research World. 1994;18:55-61.
52. Russell M, Skinner JB. Early Measures of Maternal Alcohol Misuses as Predictors of Adverse Pregnancy Outcomes. Alcohol Clin Exp Res 1988;12(6):824-30.
53. Chan AK, Pristach EA, Welte JW, Russell M. The TWEAK Test in Screening for Alcoholism / Heavy Drinking in Three Populations. Alcohol Clin Exp Res 1993;6:1188-1192.
54. Cherpitel CJ. Screening for Alcohol Problems in the Emergency Department. Annals of Emergency Medicine 1995;26:158-166.
55. Reinert DF and Allen JP. The Alcohol Use Disorders Identification Test (AUDIT): A Review of Recent Research. Alcohol Clin Exp Res 2002;26(2):272-9.
56. Ernhart CB. Underreporting of Alcohol use in Pregnancy. Alcohol Clin Exp Res 1988;12(4):506- 511.
57. Auwarter V. Sporkert F, Hartwig S, Pragst F, Vater H, Diefenbacher A. Fatty Acid Ethyl Esters in Hair as Markers of Alcohol Consumption. Segmental Hair Analysis of Alcoholics, Social Drinkers, and Teetotallers. Clinical Chemistry. 2001;47(12):2114-23.
58. Pragst F. Auwaerter V, Sporkert F, Spegel K. Analysis of Fatty Acid Ethyl Esters in Hair as Possible Markers of Chronically Elevated Alcohol Consumption by Headspace Solid- Phase Microextraction (HS-SPME) and Gas Chromatography-Mass Spectrometry (GC-MS). Forensic Sci Int 2001;121(1-2):76-88.
59. Koren G, Hutson J, Gareri J. Novel Methods for the Detection of Drug and Alcohol Exposure during Pregnancy: Implications for Maternal and Child Health. Clin Pharmacol Ther 2008;83(4):631-4.
60. Rosner B. Fundamentals of Biostatistics. Belmont CA: Duxbury Press; 1990.
61. Rice JP. Statistical Issues in the Interpretation of Tests. In: Screening for Alcoholism in Primary Care Settings. 1987; National Institute on Alcohol Abuse and Alcoholism. Rockville, MD. p3-5.