Applying Ethical Principles When Discussing Alcohol Use During Pregnancy

Screening and Brief Interventions for Alcohol Use During Pregnancy: Practices Among US Primary Care Clinicians, DocStyles 2019

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.

Alcohol messages disseminated to pregnant women by midwives

BACKGROUND

Pregnant women frequently report inconsistent messages regarding alcohol consumption from their healthcare providers. Midwives play a major role in prenatal care. However, little research has examined alcohol-related information provided by midwives.

OBJECTIVE

To examine alcohol-related messages disseminated to pregnant women by midwives.

METHODS

In 2018, 61 certified professional midwives (CPMs) and certified nurse-midwives (CNMs) were recruited from professional organizations in a southwestern state. Midwives responded to an online cross-sectional survey containing the prompt: "A pregnant patient confides in you that she drinks alcohol. She then asks you to tell her a "safe" level of alcohol consumption that won't cause harm to her unborn fetus. How would you respond?" Open-ended responses were analyzed through content analysis and categorized using an inductive approach.

RESULTS

Responses were grouped into five non-exclusive themes: "harmful effects and unknown safe limits" (77.0%); "abstaining is best" (50.8%); "light drinking is acceptable" (16.4%); "describe your drinking" (21.3%); "I will refer you" (16.4%). The most frequently shared messages were "safe levels of prenatal alcohol use are unknown" (68.9%) and "discontinue alcohol during pregnancy" (45.9%). However, some messages contradicted US dietary guidelines, including "a little bit of alcohol unlikely to cause harm" (11.5%); "cut-down if having more than 1-2 drinks per occasion" (4.9%); and "if you must drink, wine is best" (1.6%). CPMs were less likely to share abstinence messages (p = .003) and more likely to suggest referrals (p = .024), compared to CNMs.

CONCLUSION

Concerted efforts are needed to ensure information disseminated aligns with health guidelines and encourages abstinence during pregnancy.