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Alcohol & Pregnancy
What amount of alcohol is safe in pregnancy?
In the pregnant woman, any amount of alcohol use is considered at-risk drinking
The Surgeon General recommends that women who are pregnant or may become pregnant abstain from alcohol
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 use
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 week
In Maryland, less than 1% of pregnant women reported binge drinking in the last 3 months of pregnancy
Fetal alcohol syndrome and disorders
Fetal alcohol syndrome (FAS) is leading preventable cause of birth defects in the U.S.
FAS affects up to 2 per 1,000 births nationwide
Consists of CNS abnormalities, facial abnormalities, and poor growth
Infant small for gestational age
Infant Failure to thrive
Short palpebral fissures
Thin upper lip
Major organ defects
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 needed
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 use
In Maryland, up to 30% of pregnant women reported that they never received alcohol counseling during prenatal care
Only 1 in 6 adults in the U.S. reports discussing alcohol use with a health professional
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?
= 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)
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 use
Screening is performed using a validated, standardized screening tool
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 use
Additional information can be found at
What resources are available for referral to treatment?
National Drug and Alcohol Treatment Referral Routing Service
Substance Abuse Treatment Facility Locator
American Congress of Obstetricians and Gynecologists
Additional resources for alcohol use disorders, screening, and treatment referral can be found under the resources section
Maryland Fetal Alcohol Spectrum Disorder (FASD) Coalition
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
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.
Maryland PRAMS: Focus on Alcohol Use and Binge Drinking.
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.
Wendell, A.D (2013). Overview and epidemiology of substance abuse in pregnancy. Clinical Obstetrics and Gynecology 56. 91-96.
Alwan, S. et al” Teratology Primer-2nd edition (7/9/2010)” (2010).
Department of Pediatrics Faculty Papers. Paper 31
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
Chang, G. Alcohol-screening Instruments for Pregnant Women.
Retrieved January 15, 2014 from The National Institute on Alcohol Abuse and Alcoholism Web site:
SBIRT: Screening, Brief Intervention, and Referral to Treatment. Retrieved January 15, 2014 from The Substance Abuse and Mental Health Services Administration Web site:
Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol Series 2009: 09-4226.
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.
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