New Assessment Tools for Risk Drinking During Pregnancy TACE, TWEAK, and Others

A much has been done to educate the public about the dangers of drinking during pregnancy, not everyone has received the message that such behav­ ior puts the fetus at risk for acquiring alcohol­related birth defects. Routine assessments of their alcohol intake give women opportunities to ask questions about drinking during pregnancy and give health care providers opportunities to advise patients whose alcohol use may put their pregnancy outcomes at risk. Even when women have heard public health messages about alcohol­related birth defects, having their health care provider ask about their drinking turns a general message into a specific and per­ sonal one, which is more likely to evoke a positive response (Minor and Van Dort 1982). Accurate information about the risk involved and advice about drinking during pregnancy are sufficient to elimi­ nate hazardous drinking in many or per­ haps even most pregnant patients (Rosett et al. 1983). However, followup and referral to alcoholism treatment profes­ sionals are necessary for heavy­drinking pregnant women who are unable to reduce their alcohol intake. Effective linkage with such professionals is a critical com­ ponent of any screening program. It also is useful to assess retrospective­ ly a mother’s drinking during pregnancy when making a diagnosis in a child who has developmental deficits. Documenting maternal alcohol abuse during pregnancy can help establish a diagnosis of fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE). Although some health practitioners have questioned the utility of diagnosing alcohol­related birth defects because there is no known cure, such a diagnosis may help to identify why a child has problems learning or displays abnormal behavior. Recent studies indi­ cate that some children exposed to alco­ hol prenatally have serious behavioral and learning deficits even though their IQ’s are normal or borderline (Streissguth et al. 1991). Because the etiology of their problems is not recognized, these children are often thought to be willfully inatten­ tive and disobedient. Societal response is censorious, rather than constructive. There­ fore, appropriately diagnosing alcohol­ related birth defects in these children can be a great relief to parents and teach­ ers and can serve as a basis for implement­ ing remedial programs to minimize the negative consequences of the developmen­ tal deficits. Several tools exist for assessing a pregnant woman’s drinking habits, in­ cluding tests for biochemical indications of alcohol­related damage to body sys­ tems and screening procedures based on questionnaires about drinking behaviors. Of the two, questionnaires currently are the tools most frequently used in prenatal