PRENATAL COUNSELING

In 2004, as it became clear that the adverse effects of binge alcohol consumption were more significant in women than men, at-risk binge drinking was redefined as more than three drinks in a single session.

…and also on the rise among pregnant women

In a separate study by Tsai and colleagues using the same data, one in 50 gravidas reported alcohol consumption in a binge fashion during the current pregnancy, with a background rate of 9% to 12% of pregnant women who reported any use of alcohol. More than 50% of the pregnant women who reported binge drinking said they had engaged in binge drinking at least twice during the preceding month.

Binge drinking and unplanned pregnancy—a risky combination

Binge drinking among women of reproductive age is especially risky because roughly half of all pregnancies in the United States are unplanned, so a woman may unwittingly engage in binge drinking during pregnancy. The rate of unintended pregnancy is highest among adolescents (82%) and 20- to 24-year-olds (61%), the groups with the highest rate of binge drinking (20%) and the most episodes in the preceding month (3.5). These figures suggest that efforts to prevent FAS should encompass the concept of binge drinking as an at-risk behavior and focus on all women of reproductive age, not just those known to be pregnant.

The typical binge drinker? She’s young, white, single, and employed

Utilizing the 2002 National Epidemiologic Survey on Alcohol and Related Conditions, Caetano and colleagues explored alcohol consumption among women of reproductive age before they recognized they were pregnant. Women of childbearing age who are social drinkers but develop a pattern of binge drinking represent a larger percentage of the female population than do women who consume alcohol daily, but both groups face an increased risk of bearing a child with alcohol-related neurodevelopmental difficulties.

Unplanned pregnancies were associated with a higher rate of preconception binge drinking than were planned gestations, and unmarried Caucasian women who smoked were most likely to engage in preconception binge drinking.

When the year preceding the study was assessed for both alcohol use and pregnancy, Caetano and associates found that 20% of women met the criteria for binge drinking or alcohol dependence. The high prevalence probably reflects the longer time span for acknowledgment of alcohol consumption (an entire year) and the lower drink limit for the redefined term “binge drinking” (in this study, it was defined as four drinks or more rather than five or more drinks on one occasion). The highest-risk women were young, single, and Caucasian, and had a higher income (>$40,000). White women had higher rates of binge drinking than black or Hispanic women at comparable ages, marital status, and income levels.

What’s the best way to screen for “at-risk” alcohol consumption?

Drinking and Reproductive Health: A Fetal Alcohol Spectrum Disorders Prevention Tool Kit. Washington, DC: American College of Obstetricians and Gynecologists; 2006. Available at: cdc.gov/ncbddd/fas/acog_toolkit.htm

In 2006, in collaboration with the CDC, ACOG developed a comprehensive educational tool kit for physicians. The kit, which can be downloaded from the CDC Web site, outlines office-based screening for at-risk drinking patterns in pregnant and nonpregnant women. It includes a screening tool—T-ACE—that has proved to be effective and can be incorporated into practice fairly efficiently. T-ACE and a similar tool—TWEAK—are presented in the TABLE.

ACOG recommends, and research supports, routine screening of all women of childbearing age. Studies assessing the prevalence of at-risk drinking and the efficacy of various interventions suggest that screening for alcohol use should be a routine part of prenatal care—as well as annual gynecologic care among women of childbearing age. One applicable approach is incorporation of a screening tool into the health-and-habits questionnaire administered to the patient.

Available as companion pieces to the tool kit are patient education sheets covering the risks of alcohol exposure and emphasizing basic concepts such as:

• alcohol equivalency (12 oz of beer=5 oz of wine=1 oz of liquor)
  
• risks of alcohol exposure before pregnancy is recognized
  
• goals for reducing or eliminating alcohol consumption.
  

Use these tools to screen for excessive alcohol consumption