Screening for past alcohol drinking behavior among pregnant women

Background: Fetal alcohol syndrome is the leading preventable cause of mental retardation. Women with problem alcohol use prior to pregnancy are at risk for continuing alcohol use during pregnancy. Although most obstetric care providers report screening their pregnant patients for alcohol use, little is known about what questions providers use or whether they ask about past problem drinking.

Objective: To examine provider-patient screening conversations about alcohol use during the first obstetric visits.

Methods: We audio-taped and transcribed verbatim first obstetrics visits in an outpatient hospital clinic, then qualitatively analyzed them for content and process of communication. Alcohol screening discussions were categorized as past use questions, current use questions, and general questions (not specifying past or current use).

Results: Fifty-one patients and 29 obstetric care providers (21 residents, 5 midwives, 3 nurse practitioners) participated. Alcohol discussions occurred in 50 of the 51 patient visits, 94% initiated by the provider. In 19 visits (37%), the provider used general questions without specifying either past or current alcohol use (e.g., Any alcohol use?). In 19 visits (37%), the provider only asked about alcohol use during the current pregnancy (e.g., Any alcohol use this pregnancy?) and did not ask about past or even recent use. In only 10 visits (20%) did the providers explicitly ask about past alcohol drinking patterns.

Conclusion: During first outpatient visits most obstetric care providers did not specifically assess past drinking behavior. Patients with past alcohol use problems who are at risk for continued use during pregnancy are then missed.