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Screening for pregnancy risk-drinking

M Russell1, S S Martier, R J Sokol

  • 1Research Institute on Addictions, Buffalo, New York 14203.

Alcoholism, Clinical and Experimental Research
|October 1, 1994
PubMed
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This study compared alcohol screening questionnaires for pregnant women. TWEAK and T-ACE showed high accuracy in detecting risk-drinking, with TWEAK potentially being more effective.

Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Addiction Medicine

Background:

  • Periconceptional risk-drinking poses significant health risks to both mother and fetus.
  • Effective screening tools are crucial for early identification and intervention in prenatal care settings.
  • Previous research has evaluated various alcohol screening questionnaires with varying degrees of success.

Purpose of the Study:

  • To investigate the efficacy of five alcohol screening questionnaires (TWEAK, T-ACE, NET, MAST, CAGE) in detecting periconceptional risk-drinking among African-American women.
  • To compare the sensitivity, specificity, and overall performance of these questionnaires at different positive score cut-points.
  • To assess the impact of gestational timing on screening accuracy.

Main Methods:

Related Experiment Videos

  • A cohort of 4743 African-American women attending an inner-city prenatal clinic who reported ever drinking were administered five alcohol screening questionnaires.
  • Sensitivity, specificity, positive predictive value, efficiency, and receiver operating characteristics were analyzed for each questionnaire.
  • Performance was evaluated across cut-points defining positive scores from 1 to 3, and stratified by gestational age at screening.

    • Main Results:

    • TWEAK, T-ACE, and MAST demonstrated comparable accuracy in receiver operating characteristic analyses, outperforming NET and CAGE.
    • At cut-point 1, TWEAK (87% sensitivity/72% specificity) and T-ACE (83% sensitivity/75% specificity) were most sensitive.
    • At cut-point 2, TWEAK (79% sensitivity/83% specificity) showed significantly higher sensitivity than T-ACE (70% sensitivity/85% specificity). MAST (61% sensitivity/92% specificity) and TWEAK (59% sensitivity/94% specificity) were most sensitive at cut-point 3.
    • Screening accuracy was generally unaffected by the time between conception and administration, but sensitivity was highest in the first 15 weeks of pregnancy.

    Conclusions:

    • Brief alcohol screening questionnaires are effective for identifying risk-drinking during pregnancy.
    • T-ACE is validated as an effective screening tool, and preliminary data suggest TWEAK may offer superior performance.
    • Risk-drinkers' delayed entry into prenatal care can increase positive predictive values for later-pregnancy screenings.