Alcohol, tobacco and drug use among pregnant women is a major public health concern, putting both mother and child at risk.
Alcohol is the leading cause of preventable birth defects and developmental disabilities, including Fetal Alcohol Syndrome, the primary cause of mental retardation in the United States. More than 16 percent of pregnant women smoke, putting them at risk for multiple complications. Slightly more than 5 percent of women aged 15 to 44 use illicit drugs, and among the youngest patients – women aged 15 to 17 – an alarming 21.6 percent use illicit drugs.
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ISMS Resolution 25 (A-09) encourages physicians to routinely inquire about alcohol, tobacco and drug use during prenatal visits with patients and to assist affected patients with identifying treatment options. |
Current Trends and Statistics
Alcohol, tobacco and drug use among pregnant women is a major public health concern, putting both mother and child at risk.
Alcohol is the leading cause of preventable birth defects and developmental disabilities, including Fetal Alcohol Syndrome, the primary cause of mental retardation in the United States.
According to a 2008 survey sponsored by the Substance Abuse and Mental Health Services Administration, 10.6 percent of pregnant women aged 15 to 44 reported current alcohol use and 10.3 percent reported binge drinking during the first trimester.
More than 16 percent of pregnant women smoke, putting them at risk for multiple complications including:
- Placenta previa
- Abruption
- Preterm delivery
- Low birth weight
- Orofacial clefts
According to the results from a 2008 National Survey on Drug Use and Health: National Findings, 5.1 percent of women aged 15 to 44 use illicit drugs, and among the youngest patients - women aged 15 to 17 - an alarming 21.6 percent use illicit drugs.
Screening and Intervention
Despite these sobering statistics, the good news is that screening and intervention can be effective. While many pregnant patients may be hesitant to disclose alcohol use, smoking or drug use, physicians who foster a trusting relationship with their patients and who are familiar with the surrounding legal and ethical issues, are better able to ensure patients receive the necessary treatment.
Alcohol use
The following screening tools help physicians assess their patients’ alcohol use. For information on how to apply these tools in the practice setting, look under “Resources” at the bottom of this page.
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T-ACE:
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Tolerance (how many drinks does it take to make you feel high?)
Annoyed (have people annoyed you by criticizing your drinking?)
Cut down (have you ever felt you ought to cut down on your drinking?)
Eye opener (have you ever had a drink first thing in the morning?) |
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TWEAK:
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Tolerance or number of drinks needed to feel high
Worry or concerns by family or friends about drinking behavior
Eye-opener in the morning; blackouts
Amnesia while drinking
K Self-perception of the need to cut down on alcohol use |
Alcohol Use Disorders Identification Test (AUDIT) is a 10-question screening tool for identifying the patients’ risk level related to alcohol, developed by the World Health Organization.
Tobacco use
Use the Five A’s of tobacco to screen and intervene with patients who smoke:
- Ask about tobacco use
- Advise women to quit
- Assess willingness to make a quit attempt
- Assist in the quit attempt
- Arrange follow-up
Drug use
Screening for pregnant women for substance use raises ethical considerations. The American College of Obstetricians and Gynecologist Committee Opinion discusses these considerations and endorses the use of universal screening questions, brief intervention and referral to treatment for both obstetric and gynecological patients (At-Risk Drinking and Illicit Drug Use: Ethical Issues in Obstetric and Gynecologic Practice).
In addition, a slide lecture presentation developed by ACOG and The Physician Leadership on National Drug Policy offers guidance on how to approach the issue of substance use with patients.
Resources
- The American Congress of Obstetricians and Gynecologists (ACOG)’s Drinking and Reproductive Health: A Fetal Alcohol Spectrum Disorders Prevention Tool kit
- The National Institute on Alcohol Abuse and Alcoholism guide for clinicians: Helping Patients Who Drink Too Much
- The Office of the Surgeon General’s Helping Smokers Quit: A Guide for Clinicians and Treating Tobacco Use and Dependence: 2008 Update
- The Illinois Department of Healthcare and Family Services’ Illinois Tobacco Quit-line 1-866-QUIT-YES or 1-866-784-8937, which provides free, confidential counseling for all patients who use tobacco, especially pregnant women, or enroll patients into this tobacco treatment program
- ACOG’s At-Risk Drinking and Illicit Drug Use: Ethical Issues in Obstetric and Gynecologic Practice
- ACOG and Physician Leadership on National Drug Policy at Brown University developed a slide lecture on identification and treatment of drug abuse and dependence in women.
- The National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health, has created NIDAMED to help physicians and other health care professionals assess patients' use of tobacco, alcohol and illicit and nonmedical prescription drugs. NIDAMED includes an online screening tool, a comprehensive resource guide for physicians, a quick reference guide and a patient-tested postcard.
- ACOG’s patient education brochure on tobacco, alcohol, drugs and pregnancy
- U.S. Department of Health and Human Services’ Helping Smokers Quit: A Guide for Clinicians (including the National Quitline, 1-800-QUIT NOW)
- The Illinois Department of Human Services/Department on Alcohol and Substance Abuse funds special programs for pregnant women addicted to alcohol or other drugs. Physicians may refer pregnant patients to this program for treatment. Division of Alcoholism and Substance Abuse