Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 16

The US Preventive Services Task Force recommends that all adults seen in a primary care setting, including women seen annually by OB‐GYNs, should be screened for alcohol use and counseling should be provided when there is evidence of risky or harmful drinking. Referral to a specialist for treatment should be considered when there is evidence of an AUD. There is evidence that routine screening and brief behavioral counseling interventions in women who engage in at‐risk drinking reduce the incidence of alcohol‐exposed pregnancies.

All women seeking obstetric care should be screened for alcohol use within the first trimester of pregnancy and again during the postpartum period; however, screening for alcohol use in an obstetric setting can be more complicated. Many women fear that disclosure of their alcohol use may have negative consequences, such as criminal or civil penalties or the loss of custody of their children. Therefore, it is crucial that, when screening for substance use, clinicians must assure their patients that the information disclosed is privileged and confidential.

Many validated screening tools for AUDs are available, including the CAGE, Alcohol Use Disorders Identification Test (AUDIT), and the revised AUDIT‐C; however, most of these commonly used tools have not been validated in pregnant populations. The American College of Obstetricians and Gynecologists (ACOG) and the National Institute on Alcohol Abuse and Alcoholism recommend using the T‐ACE or revised TACER‐3 (T‐tolerance, A‐annoyance, C‐cutting down, and E‐eye Opener) screening tools which have been specifically validated for use in pregnant women. Because T‐ACE/T‐ACER‐3 define risky drinking as the consumption of one ounce or more of alcohol per day and identify patterns of use suggestive of AUD, additional questions must be used to assess for the use of any alcohol.

Another option is the Substance Use Risk Profile–Pregnancy (SURP‐P), which was designed specifically to screen for alcohol and other illicit/recreational drug use in pregnancy. The SURP‐P is easily administered and consists of three questions: 1) Have you ever smoked marijuana? 2) In the month before you knew you were pregnant, how many beers, how much wine, or how much liquor did you drink?, and 3) Have you ever felt that you needed to cut down on your drug or alcohol use? Scoring requires tallying the number of affirmative responses (0 = low risk, 1 = moderate risk, 2–3 = high risk).

Screening for alcohol use during pregnancy allows clinicians to stratify risk in women according to their patterns of use. It is recommended that women at low risk should receive brief counseling regarding the risk of alcohol use during pregnancy. Women classified as moderate risk should receive a brief intervention (described below), and women at high risk should be referred for specialized substance abuse treatment.

Providers must also be aware of the possibility of concurrent psychiatric illness, as women with risky alcohol use are more likely to suffer from psychiatric illness, and women with untreated psychiatric illness are more likely to use alcohol (and other substances) during pregnancy. Consultation with mental health professionals is indicated and attending to co‐morbid psychiatric illness can increase the likelihood of abstinence during pregnancy and improve compliance with prenatal care.