Validation of the Alcohol Use Module from a Multidimensional Prenatal Psychosocial Risk Screening Instrument
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The purpose of the study was to validate the Prenatal Risk Overview (PRO) Alcohol use domain against a structured diagnostic interview. The PRO was developed to screen for 13 psychosocial risk factors associated with poor birth outcomes. After clinic staff administered the PRO to prenatal patients, they asked for consent to administration of selected modules of the structured clinical interview for DSM-IV (SCID) by a research assistant. To assess the criterion validity of the PRO, low and moderate/high risk classifications from the alcohol use domain were cross-tabulated with SCID Alcohol Use Disorder variables. The study sample included 744 women. Based on PRO responses, 48.7% reported alcohol use during the 12 months before they learned they were pregnant; 5.4% reported use post pregnancy awareness. The typical quantity consumed pre-pregnancy was four or more drinks per occasion. Based on the SCID, 7.4% met DSM-IV criteria for either Alcohol Abuse or Dependence. Sensitivity and specificity of the PRO for Alcohol Use Disorders were 83.6 and 80.3%, respectively. Negative predictive value was 98.4% and positive predictive value was 25.3%. The results indicate the PRO effectively identified pregnant women with Alcohol Use Disorders. However, prenatal screening must also detect consumption patterns that do not meet diagnostic thresholds but may endanger fetal development. The PRO also identified women who continued to drink after they knew they were pregnant, as well as those whose previous drinking habits put them at risk for resumption of hazardous use.
KeywordsPrenatal alcohol use Prenatal screening Alcohol use disorders Pregnancy
This research was funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Grant Number R40MC07840. The Community University Health Care Center and North Point Health and Wellness Center in Minneapolis and West Side Community Health Services East Side Family Clinic in St. Paul served as study sites. The authors acknowledge Stacye Ballard for conducting diagnostic interviews and study coordination, and Carol Peterson for SCID training.
- 4.Centers for Disease Control, Prevention. (2004). Alcohol consumption among women who are pregnant or who might become pregnant—United States, 2002. MMWR. Morbidity and Mortality Weekly Report, 53, 1167–1181.Google Scholar
- 6.U.S. Clinical Preventive Services Task Force. The guide to clinical preventive services 2010–2011. Available at: http://www.ahrq.gov/clinic/pocketgd1011/pocketgd1011.pdf. Accessed September 28, 2011.
- 7.Sullivan, E., & Fleming, M. (1997). U.S. Department of Health and Human Services. A guide to substance abuse services for primary care physicians. Treatment improvement protocol (TIP) series 24. DHHS publication no. (SMA)97-3139. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
- 8.American College of Obstetricians and Gynecologists Committee on Ethics. ACOG Committee Opinion. Number 294. (May 2004). At-risk drinking and illicit drug use: Ethical issues in obstetric and gynecological practice. Obstetrics and Gynecology, 103(5 Pt 1), 1021–1031.Google Scholar
- 10.American College of Obstetric and Gynecology (ACOG). (1995). Domestic violence. Washington, DC: ACOG Technical Bulletin 209.Google Scholar
- 11.American Medical Association (AMA) House of Delegates. (2005). Policy H-515.965. Family and intimate partner violence. Chicago, IL: AMA.Google Scholar
- 15.American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- 16.Research Triangle Institute. (2003). 2004 National survey on drug use and health, CAI specs for programming, English Version. Rockville, MD: Substance abuse and mental health services administration.Google Scholar
- 18.First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. (2005). Structured clinical interview for DSM-IV-TR axis I disorders, research version-patient edition (SCID-I/P). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
- 24.SPSS for Windows, Rel. 17.0.0. 2008. Chicago: SPSS Inc.Google Scholar
- 33.National Institute of Alcohol Abuse, Alcoholism. (2004). NIAAA council approves definition of binge drinking. NIAAA Newsletter, 3, 3.Google Scholar
- 34.Department of Health, Human Services. (2008). Alcohol: A woman’s health issue. Washington, DC: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. NIH publication no. 03 4956.Google Scholar
- 35.American College of Obstetricians and Gynecologists. (2006). Drinking and reproductive health. A fetal alcohol spectrum disorders prevention tool kit. Available at http://www.acog.org/departments/healthIssues/FASDToolKit.pdf. Accessed September 28, 2011.
- 36.U. S. Surgeon General. Advisory on Alcohol Use in Pregnancy. (Press Release), February 21, 2005 (available at http://www.surgeongeneral.gov/pressreleases/sg02222005.html. Accessed September 28, 2011.
- 39.Jacobson, J. L., & Jacobson, S. W. (1999). Drinking moderately and pregnancy. Effects on child development. Alcohol Research and Health, 21, 25–30.Google Scholar
- 41.Russell, M. (1994). New assessment tools for risk drinking during pregnancy: T-ACE, TWEAK and others. Alcohol Health and Research World, 18, 55–61.Google Scholar
- 47.Meschke, L. L., Hellerstedt, W., Holl, J. A., & Messelt, S. (2008). Correlates of prenatal alcohol use. Maternal Child Health Journal, 3, 18–28.Google Scholar
- 48.Public Health Agency of Canada. Research Update. Alcohol use and Pregnancy: An important Canadian public health and social issue (2006). Available at http://www.phac-aspc.gc.ca/publicat/fasd-ru-ectaf-pr-06/index-eng.php. Accessed on September 28, 2011.