Prevention

There are a multitude of tests designed to help medical professionals evaluate and identify risky drinking behaviors. However, because there is no safe amount of alcohol use during a pregnancy, women who are moderate/light drinkers often fly under the radar of these tests. To increase the effectiveness at screening pregnant women, several brief screening tools have been developed specifically to identify women whose substance use habits fall below the DSM-IV criteria, but still present a risk from any level of use of alcohol or drugs. The 4 P’s Plus Test, the T-ACE test, and the TWEAK test have been found to be highly effective at identifying women at risk during their pregnancy.

The 4 P’s Plus test is a four question test that can often be used to start the discussion about alcohol/substance use as it flows fairly naturally from the family history.

  • PARENTS (Did either of your parents ever have a problem with alcohol or drugs?)
  • PARTNER (Does your partner have a problem with alcohol or drugs?)
  • PAST (Have you ever drunk beer, wine, or liquor?)
  • PREGNANCY (In the month before you knew you were pregnant, how many cigarettes did you smoke? In the month before you were pregnant, how many beers/ how much wine/ how much liquor did you drink?)

Any “yes” answer is a positive screen. Part of the effectiveness of this test is that it frames the questions in a non-judgmental manner so that you get more honest and accurate responses. In addition, it exploits the high correlation between “yes” answers and certain behaviors to get a more accurate picture of the woman’s substance habits. For example, with a positive answer about their partner, 65% were found to need drug treatment. Of the women identified on the clinical assessment as using alcohol or illicit drugs during the pregnancy, 45% were using less than 1 day a week, a level of use that would not have been elicited by other forms of screening, including urine toxicologies.

The T-ACE test is another valuable tool, often used in conjunction with the 4 P’s Plus test that can help gain a more complete picture of a woman’s drinking habits. Because it too is designed to be non-judgmental, women are less likely to understate their usage.

  • T: TOLERANCE (How many drinks does it take you to feel high? More than 2 drinks is a positive response- score 2 points)
  • A: ANNOYED (Have people annoyed you by criticizing your drinking? Yes- score 1 point)
  • C: CUT DOWN (Have you ever felt you ought to cut down on your drinking? Yes- score 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- score 1 point)

A score of 2 or more points indicates at-risk drinking in pregnancy.

With both tests, if a women cites substance use since knowledge of her pregnancy, or has a positive screen (admitted the use of alcohol or substances) she is given a standard clinical interview to establish the frequency, dose, and pattern of use for harmful substances both legal and illegal from a month prior to the pregnancy to the current point in gestation.

While all women should be provided with information regarding the dangers of substance use while pregnant, women with positive profiles should also be offered a referral to a social worker. The whole process takes no more than a minute to screen women with a negative profile, or about 5-10 minutes to catch women with positive profiles. It can be tacked on to the end of doctor’s appointments, and should be repeated with each visit if possible.