Abstract and Introduction
Abstract
Introduction: Alcohol use during pregnancy can cause birth defects and developmental disabilities. From 2018 through 2020, 13.5% of pregnant women reported current drinking. The US Preventive Services Task Force recommends evidence-based tools (eg, AUDIT-C and SASQ) for implementing screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people, for whom any alcohol use is considered excessive.
Methods: We used DocStyles 2019 data to conduct a cross-sectional analysis to examine current screening and brief intervention practices that primary care clinicians conduct among pregnant patients; clinicians' confidence levels in conducting screening, brief interventions, and referral to treatment; and the documentation of brief interventions in the medical record.
Results: A total of 1,500 US adult medicine clinicians completed the entire survey. Among the respondents who conduct screening (N = 1,373) and brief interventions (N = 1,357) in their practice, nearly all reported implementing screening (94.6%) and brief interventions (94.9%) with their pregnant patients for alcohol use, but fewer than half felt confident about conducting their screening practices (46.5%). Two-thirds (64%) reported using a tool that met the criteria recommended by the US Preventive Services Task Force (USPSTF). Over half documented brief interventions in electronic health record notes (51.7%) or designated space (50.7%).
Conclusion: Pregnancy presents a unique opportunity for clinicians to incorporate screening into routine obstetric care and encourage behavior change among patients. Most providers reported always screening their pregnant patients for alcohol use, but fewer used evidence-based USPSTF-recommended screening tools. Increased clinician confidence in screening and brief intervention, the use of standardized screening tools tailored to pregnant people, and maximal use of electronic health record technology may enhance the benefits of their application to alcohol use, which ultimately can reduce adverse outcomes associated with alcohol use during pregnancy.
Introduction
Excessive alcohol use is associated with more than 60 disease conditions among all adults.[1] Any alcohol use during pregnancy is considered excessive[2] and can cause birth defects and developmental disabilities known as fetal alcohol spectrum disorders.[3] From 2018 through 2020, 13.5% of pregnant women reported current drinking, and 5.2% reported binge drinking in the past 30 days.[4] There is no known safe amount of alcohol use during pregnancy.[5,6] (Hereinafter, for clarity in terminology, "pregnant women" is used for consistency with a cited article, but otherwise we use "pregnant people" or "pregnant patients" to be inclusive of those who are pregnant but do not identify as women.)
The American College of Obstetricians and Gynecologists recommends that all women who receive obstetric–gynecologic care be screened for alcohol use annually and during the first trimester of pregnancy.[7] The US Preventive Services Task Force (USPSTF) recommends screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people for whom any alcohol use is considered excessive.[8] In their updated 2018 recommendations, the USPSTF determined that screening tools of 1 to 3 items have the best accuracy for assessing adults, such as the abbreviated Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the National Institute on Alcohol Abuse and Alcoholism-recommended Single Alcohol Screening Question (SASQ).[8] Although some studies have examined current screening and intervention practices among primary care clinicians, few have focused on pregnant people. Moreover, little is known about how brief intervention practices are documented in the medical record. This study examined current screening and brief intervention practices conducted by primary care clinicians for pregnant patients; clinicians' confidence levels in conducting screenings, brief interventions, and referrals to treatment; and the documentation of brief interventions in the medical record.
Prev Chronic Dis. 2023;20(4):E25 © 2023 Centers for Disease Control and Prevention (CDC)
