Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking

Abstract

Preventing Fetal Alcohol Spectrum Disorders (FASDs) requires detection of in-pregnancy maternal risk drinking. The widely used T-ACE screen has been applied in various ways although the impact of those different uses on effectiveness is uncertain. We examined relations among different T-ACE scoring criteria, maternal drinking and child outcome. Self-reported across-pregnancy maternal drinking was assessed in 75 African-American women. The different T-ACE criteria used varied the level of drinking that defined tolerance (2 or 3 drinks) and the total T-ACE score cut-points (2 or 3). Receiver-operator curves (ROCs) and regression analysis assessed the significance of relations. Increasing the total T-ACE score cut-point to 3 almost doubled specificity in detecting risk drinking while maintaining adequate sensitivity, equivalent to that in the original report, and identified substantially more neurobehavioral deficits in children. Re-defining tolerance at 3 drinks did not improve T-ACE effectiveness in predicting outcomes. This study is among the first to show the ability of an in-pregnancy T-ACE assessment to predict child neurodevelopmental outcome. In addition, increasing the total T-ACE score criterion (from 2 to 3) improved identification of non-drinking mothers and unaffected children with little loss in detection of drinkers and affected children. Efficient in-pregnancy screens for risk-drinking afford greater opportunities for intervention which could prevent/limit FASDs.

Maternal pre-pregnancy risk drinking and toddler behavior problems: the Norwegian Mother and Child Cohort Study

“…Our findings, based on low prenatal alcohol exposure, may be in line with this. Several studies have shown that T-ACE is effective in predicting prenatal alcohol consumption, but to the best of our knowledge, only one study has examined whether T-ACE also further predicts toddler outcomes, in that case neurobehavioral deficits (lower IQ) among children of a small sample of African–American women of lower socioeconomic status [39]. We are not aware of other studies that have controlled for the effect of prenatal alcohol exposure on psychosocial outcomes in very young children of risk drinking mothers.…”

“…Affirmative responses on the A, C and E items were given one point each. A total score ≥3 was used as cut-off point for risk drinking, which has been shown to give good sensitivity and specificity [38, 39]. …”

Prenatal alcohol exposure selectively enhances young adult perceived pleasantness of alcohol odors

“…We, and others, have effectively used these measures of alcohol use to examine prenatal alcohol-related outcomes (e.g., Beblo et al, 2005; Burden et al, 2005; Jacobson et al, 1994; 1998; 2002; Nordstrom-Bailey et al, 2004). In addition, at the first antenatal visit we assessed problems associated with drinking with the 25-item Michigan Alcoholism Screening Test (MAST; Selzer, 1971), the CAGE screen (Ewing, 1984), and the 4-item T-ACE (or TACER-3) screen (Sokol et al, 1989; Chiodo et al, 2010). The T-ACE/TACER-3 screen includes a question about “tolerance” – the “T” in “T-ACE/TACER-3” – asking how many drinks it takes to feel high.…”

“…; AADDXP ≥ 2.5 oz. ; MAST ≥ 5; CAGE ≥ 2; T-ACE ≥ 3 (i.e., the TACER-3 cut-point; Chiodo et al, 2010). With the exception of the T-ACE, all cut-points are based on standard definitions of “at-risk drinking” (cf.…”

“…The American College of Obstetrics & Gynecology (2006) currently recommends a cut-point of 2 for the total T-ACE score which maximizes sensitivity in identifying women drinking at any level (Sokol et al, 2003). We had demonstrated previously that a total score cut-point of 3 or more rather than 2 or more on the T-ACE (i.e., the “TACER-3” screen), improved prediction of which pregnant women were consuming higher levels of alcohol, reduced “false positives” in detecting at-risk drinking, and improved prediction of alcohol-related neurobehavioral outcomes in children (Chiodo et al, 2009; 2010; 2014). …”