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    Alcohol & Pregnancy
     
    Definitions
    What amount of alcohol is safe in pregnancy?
    • In the pregnant woman, any amount of alcohol use is considered at-risk drinking1
    • The Surgeon General recommends that women who are pregnant or may become pregnant abstain from alcohol2
     
    Prevalence in Pregnancy
    • Nationally, just under 10% of pregnant women report current alcohol use, while approximately 3% report binge drinking and less than 1% report heavy alcohol use3
    • In Maryland, approximately 8% of pregnant women reported drinking at least one drink in the last 3 months of pregnancy and 20% reported drinking more than one drink per week2
    • In Maryland, less than 1% of pregnant women reported binge drinking in the last 3 months of pregnancy2
     
    Health Impact
    • Fetal alcohol syndrome and disorders
      Fetal alcohol syndrome (FAS) is leading preventable cause of birth defects in the U.S.4
      FAS affects up to 2 per 1,000 births nationwide4
      Consists of CNS abnormalities, facial abnormalities, and poor growth1, 4
    • Preterm birth4
    • Infant small for gestational age4
    • Infant Failure to thrive4
    • Brain damage4
      Behavioral impairment1
      Cognitive impairment1
      Mental retardation5
    • Skeletal abnormalities4
    • Facial abnormalities1
      Short palpebral fissures5
      Flat midface5
      Short nose5
      Indistinct philtrum5
      Thin upper lip5
    • Vision/hearing problems1
    • Major organ defects4
     
    Screening Tools
    What is the role of the provider?
    • The American Congress of Obstetricians and Gynecologists recommends that providers identify women with at-risk drinking habits, engage in brief intervention and education, and refer patients to professional treatment as needed1
      Screening all women for alcohol use yearly
      Screening pregnant women during the first trimester
    • Despite recommendations for universal screening, women remain less likely than men to be screened for at-risk alcohol use1
    • In Maryland, up to 30% of pregnant women reported that they never received alcohol counseling during prenatal care2
    • Only 1 in 6 adults in the U.S. reports discussing alcohol use with a health professional6
     
    TACE
    • TACE was the first screening tool developed and validated for use in pregnant women.  It takes less than one minute to complete.

      T – Tolerance
      How many drinks does it take to make you feel high?
      (More than 2 drinks = 2 points)
      A – Annoyed
      Have people annoyed you by criticizing your drinking?
      (Yes  = 1 point)
      C – Cut down
      Have you ever felt you ought to cut down on your drinking?
      (Yes = 1 point)
      E – Eye opener
      Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
      (Yes = 1 point)
     
    SCORING - A score of 2 points or more indicates a positive screen for at-risk drinking
     
    What if the screen is positive?
    • In pregnancy, a positive screen identifies at-risk drinking and warrants a more detailed conversation and possible referral to treatment resources
     
    Screening, Brief Intervention, Referral to Treatment (SBIRT)
    • Screening, Brief Intervention, and Referral to Treatment (SBIRT) was developed by The Center for Substance Abuse Treatment as an evidence-based method for identifying at-risk alcohol and substance use8, 9
    • Screening is performed using a validated, standardized screening tool8
    • Brief intervention is initiated for patients who screen positive based on the tool
      Can consist of a 3-5 minute conversation or more in-depth counseling
    • Referral to treatment consists of providing the patient with additional treatment resources
    • Multiple randomized controlled trials have demonstrated the efficacy of integration of SBIRT into primary care settings in reducing alcohol use810
    • Additional information can be found at http://www.integration.samhsa.gov/clinical-practice/sbirt
     
    What resources are available for referral to treatment?
    • National Drug and Alcohol Treatment Referral Routing Service
      1-800-662-HELP (4357)
    • Substance Abuse Treatment Facility Locator
      www.findtreatment.samhsa.gov
    • American Congress of Obstetricians and Gynecologists
       http://www.womenandalcohol.org
    • Additional resources for alcohol use disorders, screening, and treatment referral can be found under the resources section
     
    This group meets regularly to increase awareness of the tragic effects of FASD, help women abstain from alcohol during pregnancy, and advocate for a comprehensive action plan for families affected by FASD. In Maryland, 8% of women reported drinking during the last three months of pregnancy.

     
    Resources
    1. American College of Obstetricians and Gynecologists. (2011). ACOG committee opinion 496: At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications. Washington, DC: American College of Obstetricians and Gynecologists.
    2. Maryland PRAMS: Focus on Alcohol Use and Binge Drinking.  Available at: www.marylandprams.org
    3. Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
    4. Wendell, A.D (2013). Overview and epidemiology of substance abuse in pregnancy. Clinical Obstetrics and Gynecology 56. 91-96.
    5. Alwan, S. et al” Teratology Primer-2nd edition (7/9/2010)” (2010).  Department of Pediatrics Faculty Papers. Paper 31
    6. CDC Morbidity and Mortality Weekly Report, January 7, 2014, Vital signs: Communication between health professionals and their patients about alcohol use – 44 states and the District of Columbia, 2011
    7. Chang, G. Alcohol-screening Instruments for Pregnant Women. Retrieved January 15, 2014 from The National Institute on Alcohol Abuse and Alcoholism Web site: http://pubs.niaaa.nih.gov/publications/arh25-3/204-209.htm.
    8. SBIRT: Screening, Brief Intervention, and Referral to Treatment. Retrieved January 15, 2014 from The Substance Abuse and Mental Health Services Administration Web site: http://www.integration.samhsa.gov/clinical-practice/sbirt
    9. Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol Series 2009: 09-4226.
    10. Moyer, A. et al (2002).  Brief Interventions for Alcohol Problems; A Meta-analytic Review of Controlled Investigations in Treatment Seeking and Non-treatment Seeking Populations. Addiction 97. 279-292.
     
     
    January, 2014