Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review.

Ethel Burns, Ronald H Gray, Lesley A. Smith

Research output: Contribution to journalArticle

Abstract

AIMS: Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. METHODS: Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. RESULTS: Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >or=3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >or=8 performed poorly. CONCLUSION: T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.

Original languageEnglish (US)
Pages (from-to)601-614
Number of pages14
JournalAddiction
Volume105
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Drinking
Alcohols
Pregnancy
Amnesia
Guilt
Surveys and Questionnaires
Alcoholism
Pregnant Women
Prenatal Care
Identification (Psychology)
Prenatal Diagnosis
Alcohol Drinking
Cross-Sectional Studies
Databases
Interviews
Sensitivity and Specificity

ASJC Scopus subject areas

  • Medicine(all)
  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Brief screening questionnaires to identify problem drinking during pregnancy : a systematic review. / Burns, Ethel; Gray, Ronald H; Smith, Lesley A.

In: Addiction, Vol. 105, No. 4, 04.2010, p. 601-614.

Research output: Contribution to journalArticle

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abstract = "AIMS: Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. METHODS: Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. RESULTS: Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88{\%}), TWEAK (71-91{\%}) and AUDIT-C (95{\%}), with high specificity (71-89{\%}, 73-83{\%} and 85{\%}, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >or=3 was high for past year alcohol dependence (100{\%}) or alcohol use disorder (96{\%}) with moderate specificity (71{\%} each). For life-time alcohol dependency the AUDIT at score >or=8 performed poorly. CONCLUSION: T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.",
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