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Almost Half of Nurses Providing Prenatal Care Are Misinformed About Alcohol Use During Pregnancy: Study

Organizations like the American College of Obstetricians and Gynecologists (ACOG) openly discourage moms-to-be from drinking any amount of alcohol during pregnancy because the research indicates doing so can restrict fetal growth and lead to facial anomalies and neurobehavioral problems. But a new study reveals that many clinicians who provide prenatal care don’t hold the same point of view.

What Did the Study Find?

A survey of American midwives, nurse practitioners and prenatal care nurses conducted through Wayne State University found 44 percent of respondents believed “one drink per occasion” is acceptable while pregnant. Another 38 percent reported thinking it’s safe to drink alcohol during at least one trimester of pregnancy.

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“Many prenatal care providers remain inadequately informed of the risks of drinking during pregnancy,” said study co-author John Hannigan, PhD, professor at Wayne State University’s Merrill Palmer Skillman Institute, in a statement. “They fail to screen actively for alcohol use and miss opportunities for intervention.”

To come to this conclusion, researchers sent out a questionnaire to 6,000 members of the American College of Nurse-Midwives. It asked about the effects of prenatal alcohol exposure, the prevalence of alcohol use during pregnancy, and practices for screening patients’ alcohol use.

Some 578 surveys came back completed. Additional prominent findings include:

  • Only 35.2 percent of respondents reported screening to assess patient alcohol use.
  • Only 23.3 percent reported using a specific screening tool, and few of those were validated screens recommended for use in pregnant women.
  • Respondents who believe alcohol is safe at some point in pregnancy were significantly less likely to screen their patients.
  • In response to a pregnant patient admitting to drinking alcohol, only 56 percent of respondents recommended abstaining.

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As the study authors explain it: “Even among providers who are aware of the risks and consequences, providers tend to underestimate the prevalence of [fetal alcohol spectrum disorders (FASD)] in their communities and practices.”

“Improving prenatal care provider knowledge about the effects of prenatal alcohol exposure and the availability of valid alcohol screening tools will improve detection of drinking during pregnancy, provide more opportunities for meaningful intervention, and ultimately reduce the incidence of FASD,” they add.

What should providers know about drinking during pregnancy?

To start, research shows that roughly 10 percent of pregnant women say they’ve consumed alcohol during the past month, and about 50 percent admit to drinking at least once during their first trimester, often prior to learning they were pregnant. In the U.S., the frequency of FASD ranges from 31.1 to 98.5 per 1,000 children. Fetal alcohol syndrome, the most severe FASD, is more common in the U.S. than most other birth defects, including anencephaly, spina bifida and Down Syndrome. It occurs in 1.5 out of every 1,000 people worldwide.

ACOG’s official stance is that “there is no safe amount or type of alcohol use during pregnancy.” For patients who drank a small amount before learning they were pregnant, ACOG says: “Although it is true that no amount of alcohol use is safe during pregnancy, serious harm from this kind of use is unlikely. The important thing is to not drink any alcohol for the rest of the pregnancy.”

When it comes to screening patients, asking them a single yes/no question about whether they drink isn’t enough. ACOG has approved the T-ACE screening tool because “its high sensitivity helps meet a goal of (theoretically) identifying every woman who may be drinking at fetal‐risk levels,” the authors write. Risk drinking during pregnancy is defined as consuming 1 ounce of alcohol or more per day while pregnant.

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T-ACE stands for “tolerance,” “annoyed,” “cut down,” and “eye opener.” The questions are as follows:

  • T: How many drinks does it take to make you feel high? 
  • A: Have people annoyed you by criticizing your drinking?
  • C: Have you ever felt you ought to cut down on your drinking?
  • E: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

According to the National Institute on Alcohol Abuse and Alcoholism, you can calculate the results as follows:

  • A reply of more than two drinks to question T is considered a positive response and scores 2 points.
  • An affirmative answer to question A, C, or E scores 1 point, respectively.
  • A total score of 2 or more points on the T-ACE indicates a positive outcome for pregnancy risk drinking.
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