ALCOHOL-USE AND PREGNANCY - IMPROVING IDENTIFICATION

Objective: To test the effectiveness of a four-item prenatal-alcohol-u se, self-administered screening questionnaire that asks about toleranc e to alcohol, being annoyed by other's comments about drinking, attemp ts to cut down, and having a drink first thing in the morning (''eye-o pener'') (T-ACE) in an ethnically and socioeconomically diverse sample . Methods: Two hundred fifty T-ACE-positive and 100 T-ACE-negative wom en completed a comprehensive assessment of their alcohol use after ini tiating prenatal care at the Brigham and Women's Hospital in Boston, M assachusetts. This comprehensive assessment, which included the Alcoho l Use Disorders Identification Test and the Short Michigan Alcoholism Screening Test as comparisons to the T-ACE, generated three criterion standards: Diagnostic and Statistical Manual of Mental Disorders, Thir d, Ed., Revised (DSM-III-R), lifetime alcohol diagnoses, risk drinking (regularly having more than one fluid ounce of alcohol per drinking d ay before pregnancy), and current drinking. Results: T-ACE-positive pr egnant women were more likely than T-ACE-negative women to satisfy DSM -III-R criteria for lifetime alcohol diagnoses (40% versus 14%, P < .0 01) and risk drinking (39% versus 8%, P < .001) and to have current al cohol consumption (43% versus 13%, P < .001). In contrast, obstetric s taff members documented only 33 (9%) women as using alcohol at any tim e, even though nearly all subjects (96%) were asked about drinking upo n initiation of prenatal care. Conclusion: The T-ACE was the most sens itive screen for lifetime alcohol diagnoses, risk drinking, and curren t alcohol consumption. It outperformed obstetric staff assessment of a ny alcohol use by pregnant women enrolled in the study. (C) 1998 by Th e American College of Obstetricians and Gynecologists.