Screening for Pregnancy Risk‐Drinking

Abstract

The efficacy of alcohol screening questionnaires, the TWEAK, T-ACE, NET, MAST, and CAGE, in detecting periconceptional risk-drinking, > or = 1 oz absolute alcohol/day, was investigated in 4743 African-American women attending an inner-city prenatal clinic who had reported ever drinking. Sensitivity, specificity, positive predictive value, efficiency, follow-up rates, and receiver operating characteristics of the questionnaires were examined to compare the overall effectiveness of the questionnaires and their performance at cut-points defining positive scores ranging from 1 to 3. Relatively little difference between TWEAK, T-ACE, and MAST was seen in the receiver operating characteristic accuracy indices; NET and CAGE lagged behind. Sensitivity/specificity scores for the two questionnaires most sensitive at cut-point 1 were TWEAK (87/72) and T-ACE (83/75). At cut-point 2, sensitivity was optimized with respect to specificity; TWEAK (79/83) was significantly more sensitive than T-ACE (70/85; p = 0.002). At cut-point 3, the two most sensitive tests were MAST (61/92) and TWEAK (59/94). In general, measures of merit were not greatly affected by the time between conception and the administration of the screens. Screening was most sensitive for women interviewed during the first 15 weeks of pregnancy; risk-drinkers tended to delay entry into prenatal care, increasing positive predictive values associated with screening later in pregnancy. This study confirms the utility, when screening for risk-drinking during pregnancy, of brief questionnaires that assess alcohol intake indirectly by asking women about their tolerance to alcohol's effects, psychological consequences of drinking, and significant others' concern about their drinking. It validates T-ACE and provides preliminary data indicating that TWEAK may outperform T-ACE.

Effects of Alcohol Intake During Pregnancy on Docosahexaenoic Acid and Arachidonic Acid in Umbilical Cord Vessels of Black Women

“…However, pregnant women tend to underreport their alcohol consumption, 34,35 and this effect is likely to increase during the course of pregnancy. 32,36 Previous studies have shown that women who drink the most around the time they discover they are pregnant, as assessed by AAD and AADD, are more likely to continue to drink throughout pregnancy, and to drink in binge patterns, although both the self-reported and the actual levels of consumption are usually reduced. [32][33][34][35][36] Therefore, asking the women about their drinking habits around the time of conception seems to better reflect the actual amount of alcohol consumption over the course of the pregnancy than repeated questionnaires.…”

“…33,37 The structured interview included the full-scale Michigan Alcoholism Screening Test 38 and T-ACE (Tolerance, Angry or Annoyance, Cut down or quit, eye opener) scales 39 to identify risk drinkers. 32 Socioeconomic status (SES) was measured by using a modified Hollingshead 2-factor index (occupation and education) of social position. 40 Dietary information at the time of delivery was determined by the Harvard Women's Nutrition Questionnaire, 41 which has been validated for low-income pregnant women.…”

“…Previous studies have shown that women who drink the most around the time they discover they are pregnant are more likely to continue drinking throughout pregnancy, and to drink in binge patterns, although both the self-reported and actual levels of consumption are usually reduced. [32][33][34][35][36] Therefore, to best estimate the degree of alcohol consumption over the course of the pregnancy, we chose to ask the women at their first visit to the antenatal clinic about their periconceptional drinking habits.…”

Violência física entre parceiros íntimos na gestação como fator de risco para a má qualidade do pré-natal

“…The lifestyle dimension was represented by the variables: smoking and alcohol consumption by the woman and use of illicit drugs by the couple. We considered cases of inappropriate use women who had two or more positive responses to the instrument Tolerance-Worry-Eye-opener-Amnesia-Cut-down (TWEAK), 19 previously adapted and validated for use in Brazil. 12 For identifi cation of drug consumption, we used the Non-Student Drug Use Questionnaire (NSDUQ -Portuguese version).…”

The 4P's Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes

“…The T-ACE (Tolerance, Annoyed by criticism, Cut down, Eye-opener) 14 and the TWEAK (Tolerance, Worry about drinking, Eye-opener, Amnesia, K/Cut down) [15][16][17] have been validated as reliable screening instruments for obstetrical practice, but, again, heavy drinkers are the primary targets of these two instruments, and they do not identify more moderate or light drinkers or users of illicit drugs.…”