A staged screening strategy for prenatal alcohol exposure and maternal risk stratification

Abstract

This screening process has very modest time commitments in the early stages. Time commitments increase for women drinking during pregnancy and the process focuses on the population at highest risk of having a child with FASD. The process has the benefit of risk specificity, since the process refines risk estimates for an adverse outcome specific for FASD. The process concludes with a programme to facilitate intervention and to monitor changes in prenatal alcohol exposure during pregnancy. Prevention of FASD is an important public health priority. In addition to the ongoing study of clinical strategies to improve detection rates of alcohol exposure at all stages of pregnancy, additional research on the tools and the process used in screening efforts is urgently needed. The efforts should also include research on both the screening tools and the outcome of the screening process in routine prenatal care settings.

Biomarkers for detection of prenatal alcohol exposure: A critical review of fatty acid ethyl esters in meconium

“…Alternatively, the use of risk stratification strategies to identify women at increased levels of risk may further increase statistical options . In addition to data on smoking, other useful indicators of risk include previous substance abuse treatment of all types (alcohol is often used in combination with other drugs), current substance abuse for all types of drugs, late or no prenatal care, low levels of educational achievement, previous sibling with a diagnosis of FASD, previous infant or child death, increased maternal age, and a family history of female relatives with a history of alcohol abuse (Abel, 1998;Burd et al, 2006). Including alcohol screening questionnaires and using blood biomarkers could be of some value as well.…”

“…Several strategies for early detection of alcohol use during pregnancy are available (ACOG Committee, 2004;Burd et al, 2006;Chang, 2001). However, none has adequate epidemiologic performance criteria to be recommended as a single strategy that is optimal across populations and in multiple settings.…”

The epidemiology of alcohol utilization during pregnancy: an analysis of the Canadian Maternity Experiences Survey (MES)

“…An Alberta study found that while 50% of women reported alcohol consumption pre-pregnancy recognition, 18% continued to drink even after post-pregnancy recognition [21]. A review of the Canadian literature, while somewhat lacking, supports this and overall, Canadian rates of maternal alcohol consumption during pregnancy are comparable with those of the U.S., estimated between 5-15% [19,22-25]. Worldwide rates are variable, with other nations including Australia and many European countries reporting higher prevalence [6,8,26].…”

“…Regardless, many women continue to consume alcohol to various degrees throughout their pregnancies. This is a problem in much, if not all, of the world [19]. It appears from the published data on women's gestational consumption of alcohol that Canadian and U.S. rates have generally been declining since the 1990's.…”

Diagnosis, surveillance and screening for fetal alcohol syndrome spectrum disorders: Methods and dilemmas

“…Screening of childbearing age or pregnant women is the only approach to primary prevention of FASD (58)(59). Screening methods focusing on infants or children with FAS have also been developed.…”