Pregnant drinkers put their kids at risk on Page C2 of Monday, April 15, 2013 issue of Providence Journal
Rita Watson
In a world of happy hours, we sip and smile until a pregnant woman walks onto the scene. Then we begin to watch to see if she is drinking. We look at neighbors and socialites who party with seltzer instead of Chardonnay and wonder when the baby bump will appear. With approximately 5,000 infants born each year with fetal alcohol syndrome in the United States, heightened awareness is key. Dr. Peter D. Friedmannat Rhode Island Hospital, a proponent of screening, says: “During the first trimester any alcohol consumption is concerning.” As such, it is important for a physician to ask when the woman had her last drink.
Dr. Friedmann pointed out in “Alcohol Use in Adults,” published in a January issue of the New England Journal of Medicine, “Clinicians should routinely screen patients for risk drinking and further discuss management strategies.”
The AmericanAcademy of Pediatrics tells us that “Children with fetal alcohol syndrome don’t grow to normal size. They have abnormally small heads, distinctive facial features and can develop mild to moderate mental retardation. Some children with fetal alcohol syndrome are also born with other birth defects including heart, eye and ear problems. As children with this syndrome grow, most will develop learning and behavior problems.”
What happens if a physician suspects that his patient might be drinking? Dr. Friedmann noted that “Physicians have the opportunity to perform a brief counseling intervention or motivational interview to help a woman reduce her drinking.”
There are two tests that clinicians might use to assess drinking in pregnant women. T-ACE is a measurement tool of four questions that are significant identifiers of risk drinking (i.e., alcohol intake sufficient to potentially damage the embryo or fetus), devised by Robert J. Sokol. T-ACE stands for Tolerance, Annoyance, Cut Down, and Eye-Opener.
A similar test called TWEAK stands for Tolerance, Worried, Eye-Opener, Amnesia, K-Cut down.
In both tests, the short questionnaires essentially try to determine alcohol consumption, including how many drinks it takes to get high. Annoyance felt when friends express worry about your drinking. And drinking first thing in the morning as an eye-opener. Forgetting what happened during drinking (amnesia) is a serious concern. And both questionnaires ask: Do you think you should cut down?
Based on the results, a clinician will make recommendations for intervention, which often includes counseling.
A British study in 2010, led by University College London, found that some drinking was acceptable during pregnancy. However, the BBC reported that the president of the Royal College of Obstetricians and Gynecologists said that abstinence was the safest choice.
Dr. Friedmann agrees, stating: “No universally safe level of alcohol consumption during pregnancy has been identified.”
The Centers for Disease Control and Prevention say that 1 in 8 pregnant women in the United States reports alcohol use and about 1 in 50 pregnant women report binge drinking; that is, five or more drinks at one time. The Surgeon General has reported that nearly half of all U.S. births are unplanned, as such, “Any woman who could become pregnant should talk to her doctor and take steps to lower the chance of exposing her baby to alcohol.”
Rita Watson, MPH, ( www.ritawatson.com ) is a regular contributor to The Providence Journal and a relationship columnist for our “All About You” section.