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Screening for use of alcohol, tobacco and cannabis in pregnancy using self-report tools

Published online by Cambridge University Press:  28 May 2012

E. Hotham ,
J. White ,
R. Ali  and
J. Robinson
E. Hotham*
Affiliation:
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
J. White
Affiliation:
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
R. Ali
Affiliation:
Drug and Alcohol Services, Community-Based Treatment Interventions, WHO Collaborating Centre for the Treatment of Drug and Alcohol Problems, University of Adelaide, Adelaide, Australia
J. Robinson
Affiliation:
Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
*
*Address for correspondence: Dr E. Hotham, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia. (Email libby.hotham@unisa.edu.au)
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Abstract

The World Health Organization has identified substance use in the top 20 risk factors for ill health. Risks in pregnancy are compounded, with risk to the woman's health, to pregnancy progression and on both the foetus and the newborn. Intrauterine exposure can result in negative influences on offspring development, sometimes into adulthood. With effectively two patients, there is a clear need for antenatal screening. Biomarker reliability is limited and research efforts have been directed to self-report tools, often attempting to address potential lack of veracity if women feel guilty about substance use and worried about possible stigmatization. Tools, which assume the behaviour, are likely to elicit more honest responses; querying pre-pregnancy use would likely have the same effect. Although veracity is heightened if substance use questions are embedded within health and social functioning questionnaires, such tools may be too lengthy clinically. It has been proposed that screening only for alcohol and tobacco, with focus on the month pre-pregnancy, could enable identification of all other substances. Alternatively, the Revised Fagerstrom Questionnaire could be used initially, tobacco being highly indicative of substance use generally. The ASSIST V.3.0 is readily administered and covers all substances, although the pregnancy ‘risk level’ cut-off for tobacco is not established. Alcohol tools – the 4Ps, TLFB and ‘drug’ CAGE (with E: query of use to avoid withdrawal) – have been studied with other substances and could be used. General psychosocial distress and mental ill-health often co-exist with substance use and identification of substance use needs to become legitimate practice for obstetric clinicians.

Keywords

pregnancyscreeningself-reportsubstance use
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 3 , Issue 4 , August 2012 , pp. 216 - 223
Copyright
Copyright © Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2012

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References

1.World Health Organization (WHO). The Global Burden of Disease: 2004 Update, 2008. WHO: Geneva.Google Scholar
2.Begg, S, Vos, T, Barker, B, et al. . The Burden of Disease and Injury in Australia 2003; PHE 82, 2007. Australian Institute of Health and Welfare: Canberra.Google Scholar
3.Windsor, R. Smoking, Cessation and Pregnancy. Women and the Tobacco Epidemic Challenges for the 21st Century, 1999. World Health Organization: Geneva.Google Scholar
4.WHO. Gender, Health and Tobacco, 2003. WHO: Geneva. Retrieved 27 November 2011, from http://www.who.int/gender/documents/Gender_Tobacco_2.pdfGoogle Scholar
5.British Medical Association and Board of Science and Education and the Tobacco Control Centre. Smoking and reproductive life. The impact of smoking on sexual, reproductive and child health, 2004. Last update 20 November 2007. Retrieved 27 November 2011, from http://www.bma.org.uk/images/smoking_tcm41-21289.pdfGoogle Scholar
6.Sokol, RJ, Delaney-Black, V, Nordstrom, B. Fetal alcohol spectrum disorder. J Am Med Assoc. 2003; 290, 2996–2999.Google Scholar
7.Fergusson, DM, Horwood, LJ, Northstone, K, et al. . Maternal use of cannabis and pregnancy outcome. BJOG: Int J Obstet Gynaecol. 2002; 109, 21–27.Google Scholar
8.Dawe, S, Harnett, P, Frye, S. Improving Outcomes for Children Living in Families with Parental Substance Misuse: What Do We Know and What Should We Do, 2008. Child Abuse Prevention Issues No. 29. Australian Institute of Family Studies: Canberra.Google Scholar
9. Barker D. Human growth and cardiovascular disease. Nestlé Nutrition Workshop Series Pediatric Program: The Window of Opportunity: Pre-Pregnancy to 24 Months of Age, 2008. Nestec Ltd, Vevey/S. Karger AG: Basel, Switzerland.Google Scholar
10.Chudley, AE, Conry, J, Cook, JL, et al. . Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Can Med Assoc J. 2005; 172(Suppl. 5); S1–S21.CrossRefGoogle ScholarPubMed
11.Bowling, A. Measuring Health: A Review of Quality of Life Measurement Scales, 1997. Open University Press: Buckingham, Philadelphia.Google Scholar
12.Australian Institute of Health and Welfare (AIHW). Statistics on Drug Use in Australia 2006, 2007. Drug Statistics Series No. 18. Catalogue no. PHE 80. AIHW: Canberra.Google Scholar
13.Hotham, E, Ali, R, White, J, et al. . Pregnancy-related changes in tobacco, alcohol and cannabis use reported by antenatal patients at two public hospitals in South Australia. Aust N Z J Obstet Gynaecol. 2008; 48, 248–254.Google Scholar
14.Jacobson, SW, Jacobson, JL, Sokol, RJ, et al. . Maternal recall of alcohol, cocaine, and marijuana use during pregnancy. Neurotoxicol Teratol. 1991; 13, 535–540.Google Scholar
15.Poole, N, Dell, C. Girls, Women and Substance Use, 2005. Canadian Centre on Substance Abuse: Ottawa.Google Scholar
16.Russell, M, Martier, SS, Sokol, RJ, et al. . Detecting risk drinking during pregnancy: a comparison of four screening questionnaires. Am J Public Health. 1996; 86, 1435–1439.Google Scholar
17.Savage, C, Wray, J, Ritchey, P, et al. . Current screening instruments related to alcohol consumption in pregnancy and a proposed alternative method. J Obstet Gynecol Neonatal Nurs. 2003; 32, 437–446.CrossRefGoogle Scholar
18.New South Wales (NSW) Department of Health. Background Papers to the National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and the Early Development Years of the Newborn, 2006. 172, NSW Department of Health: Sydney.Google Scholar
19.Alexander, D. A review of marijuana assessment dilemmas: time for marijuana specific screening methods? J Soc Work Pract Addict. 2003; 3, 5–28.CrossRefGoogle Scholar
20.Burd, L, Martsolf, J, Klug, MG, et al. . Prenatal alcohol exposure assessment: multiple embedded measures in a prenatal questionnaire. Neurotoxicol Teratol. 2003; 25, 675–679.Google Scholar
21.Lindenberg, C, Strickland, O, Solorzano, R, et al. . Correlates of alcohol and drug use among low-income Hispanic immigrant childbearing women living in the USA. Int J Nurs Stud. 1999; 36, 3–11.CrossRefGoogle ScholarPubMed
22. Tobin M. Lost Opportunity or Lifeline? Women with substance use issues and their perceptions of the barriers to pregnancy care. A report on research conducted for the Women's Alcohol & Drug Services, 2005. Women's Alcohol and Drug Service, The Royal Women's Hospital: Melbourne.Google Scholar
23.Sokol, RJ, Martier, SS, Ager, JW. The T-ACE questions: practical prenatal detection of risk-drinking. Am J Obstet Gynecol. 1989; 160, 863–868.Google Scholar
24.Chang, G. Alcohol-screening instruments for pregnant women. Alcohol Res Health. 2001; 25, 204–209.Google Scholar
25.Russell, M. New assessment tools for risk drinking during pregnancy. Alcohol Health Res World. 1994; 18, 55–62.Google Scholar
26.Chasnoff, IJ, McGourty, RF, Bailey, GW, et al. . The 4P's Plus screen for substance use in pregnancy: clinical application and outcomes. J Perinatol. 2005; 25, 368–374.Google Scholar
27.Kaskutas, LA, Graves, K. Pre-pregnancy drinking: how drink size affects risk assessment. Addiction. 2001; 96, 1199–1209.Google Scholar
28.Clark, KA, Dawson, S, Martin, SL. The effect of implementing a more comprehensive screening for substance use among pregnant women in North Carolina. Matern Child Health J. 1999; 3, 161–166.CrossRefGoogle ScholarPubMed
29.Chiodo, LM, Sokol, RJ, Delaney-Black , et al. . Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking. Alcohol. 2010; 44, 595–603.CrossRefGoogle ScholarPubMed
30.Bad Heart Bull, L, Kvigne, V, Leonardson, GR, et al. . Validation of a self-administered questionnaire to screen for prenatal alcohol use in Northern Plains Indian women. Am J Prev Med. 1999; 16, 240–243.Google Scholar
31.Chasnoff, IJ, Neuman, K, Thornton, C, et al. . Screening for substance use in pregnancy: a practical approach for the primary care physician. Am J Obstet Gynecol. 2001; 184, 752–758.Google Scholar
32.Kennedy, C, Finkelstein, N, Hutchins, E, et al. . Improving screening for alcohol use during pregnancy: the Massachusetts ASAP Program. Matern Child Health J. 2004; 8, 137–147.CrossRefGoogle ScholarPubMed
33.Kharrazi, M, Epstein, D, Hopkins, B, et al. . Evaluation of four maternal smoking questions. Public Health Rep. 1999; 114, 60–69.CrossRefGoogle ScholarPubMed
34.Fagerstrom, K. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. J Behav Med. 1978; 3, 235–241.Google Scholar
35.Heatherton, TF, Kozlowski, LT, Frecker, RC, et al. . The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict. 1991; 86, 1119–1127.Google Scholar
36.Tate, JC, Schmitz, JM. A proposed revision of the Fagerstrom Tolerance Questionnaire. Addict Behav. 1993; 18, 135–143.Google Scholar
37.Dolan-Mullen, PD, Carbonari, JP, Tabak, ER, et al. . Improving disclosure of smoking by pregnant women. Am J Obstet Gynecol. 1991; 165, 409–413.Google Scholar
38. Project Team: Mercy Hospital for Women Southern Health and Women's and Children's Health. Three Centres Consensus Guidelines on Antenatal Care, 2001. Mercy Hospital for Women, Southern Health Service and Womens’ and Children's Health Service: Melbourne.Google Scholar
39.Hotham, E, Gilbert, A, Atkinson, E. A randomised-controlled pilot study using nicotine patches with pregnant women. Addict Behav. 2006; 31, 641–648.Google Scholar
40.Handel, G, Hannover, W, Roske, K, et al. . Intention to change smoking in pregnant and postpartum women according to number of pregnancies. Eur J Public Health. 2009; 19, 218–221.Google Scholar
41.Midanik, LT, Zahnd, EG, Klein, D. Alcohol and drug CAGE screeners for pregnant, low-income women: The California Perinatal Needs Assessment. Alcohol Clin Exp Res. 1998; 22, 121–125.Google Scholar
42.Sobell, LC, Sobell, MB. Timeline FollowBack: a technique for assessing self-reported alcohol consumption. In Measuring Alcohol Consumption Psychosocial and Biochemical Methods (eds. Litten R, Allen J), 1992; pp. 41–69. Humana Press: Totowa, NJ, USA.Google Scholar
43.Duhig, AM, Cavallo, DA, McKee, SA, et al. . Daily patterns of alcohol, cigarette, and marijuana use in adolescent smokers and nonsmokers. Addict Behav. 2005; 30, 271–283.Google Scholar
44.Horrigan, T, Piazza, N, Weinstein, L. The substance abuse subtle screening inventory is more cost effective and has better selectivity than urine toxicology for the detection of substance abuse in pregnancy. J Perinatol. 1996; 16, 326–330.Google ScholarPubMed
45.Feldstein, S, Miller, W. Does subtle screening for substance abuse work? A review of the Substance Abuse Subtle Screening Inventory (SASSI). Addiction. 2007; 102, 41–50.Google Scholar
46.Miller, CS, Woodson, J, Howell, RT, et al. . Assessing the reliability of scores produced by the substance abuse subtle screening inventory. Subst Use Misuse. 2009; 44, 1090–1100.Google Scholar
47.Spitzer, RL, Williams, JBW, Gibbon, M, et al. . Structured Clinical Interview for DSM-III-R, 1990. American Psychiatric Press: Washington, DC.Google Scholar
48.Alexander, D, Leung, P. The Marijuana Screening Inventory (MSI-X): reliability, factor structure, and scoring criteria with a clinical sample. Am J Drug Alcohol Abuse. 2004; 30, 321–351.Google Scholar
49.Kelly, RH, Zatzick, DF, Anders, TF. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry. 2001; 158, 213–219.Google Scholar
50.Sobell, LC, Brown, J, Leo, GI, et al. . The reliability of the Alcohol Timeline FollowBack when administered by telephone and by computer. Drug Alcohol Depend. 1996; 42, 49–54.CrossRefGoogle ScholarPubMed
51.Weinstock, J, Whelan, J, Meyers, AW, et al. . Behavioral assessment of gambling: an application of the Timeline FollowBack method. Psychol Assess. 2004; 16, 72–80.Google Scholar
52.Project Choices Research Group. Alcohol-exposed pregnancy: characteristics associated with risk. Am J Prev Med. 2002; 23, 166–173.Google Scholar
53.Ndetei, DM, Khasakhala, LI, Ongecha-Owuor, FA, et al. . Prevalence of substance abuse among patients in general medical facilities in Kenya. Subst Abuse. 2009; 30, 182–190.CrossRefGoogle ScholarPubMed
54.Holmwood, C, Marriott, M, Humeniuk, R. Substance use patterns in newly admitted male and female South Australian prisoners using the WHO-ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Int J Prison Health. 2008; 4, 198–207.CrossRefGoogle ScholarPubMed
55. Hotham E. Investigation of the Alcohol, Smoking and Substance Involvement Screening Test (The ASSIST) in pregnancy. The Australasian Digital Thesis Program, 2010. Retrieved 27 November 2011, from http://digital.library.adelaide.edu.au/dspace/handle/2440/60650Google Scholar
56.Humeniuk, R, Ali, R, Babor, TF, et al. . Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Addiction. 2008; 103, 1039–1047.Google Scholar
57. Boston University School of Public Health, “Do I have a drug problem?” Questionnaire based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) developed by the World Health Organization. Join Together Project. Retrieved 27 November 2011, from http://www.drugscreening.org/Google Scholar
58.Humeniuik, R, Holmood, C. Developing the E-ASSIST: the Alcohol, Smoking and Substance Involvement Screening Test questionnaire in electronic format for Australian clinicians. Drug Alcohol Rev. 2011; 30(Suppl. 1), 41–42.Google Scholar
59.Ostrea, EM Jr, Knapp, DK, Tannenbaum, L, et al. . Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis. J Pediatr. 2001; 138, 344–348.Google Scholar
60.Benowitz, N. The use of biologic fluid samples in assessing tobacco smoke consumption. In NIDA Research Monograph, Vol. 48 (eds. Grabowski J, Bell C), 1983; 6–26. National Institute of Drug Abuse, Department of Health and Human Services: Rockville, MD, USA.Google Scholar
61.Pickett, K, Rathouz, P, Kasza, K, et al. . Self-reported smoking, cotinine levels, and patterns of smoking in pregnancy. Paediatr Perinat Epidemiol. 2005; 19, 368–376.Google Scholar
62.Dempsey, D, Jacob, P III, Benowitz, NL. Accelerated metabolism of nicotine and cotinine in pregnant smokers. J Pharmacol Exp Ther. 2002; 301, 594–598.Google Scholar
63.Stoler, JM, Huntington, KS, Peterson, CM, et al. . The prenatal detection of significant alcohol exposure with maternal blood markers. J Pediatr. 1998; 133, 346–352.CrossRefGoogle ScholarPubMed
64.Stauber, R, Jauk, B, Fickert, P, et al. . Increased carbohydrate-deficient transferrin during pregnancy: relation to sex hormones. Alcohol Alcohol. 1996; 31, 389–392.CrossRefGoogle ScholarPubMed
65.Conigrave, KM, Davies, P, Haber, P, et al. . Traditional markers of excessive alcohol use. Addiction. 2003; 98(Suppl. 2), 31–43.Google Scholar
66.Neumann, T, Spies, C. Use of biomarkers for alcohol use disorders in clinical practice. Addiction. 2003; 98(Suppl. 2), 81–91.Google Scholar
67.Burns, L, Mattick, R, Wallace, C. Smoking patterns and outcomes in a population of pregnant women with other substance use disorders. Nicotine Tob Res. 2008; 10, 969–974.Google Scholar
68.Corse, SJ, Smith, M. Reducing substance abuse during pregnancy: discriminating among levels of response in a prenatal setting. J Subst Abuse Treat. 1998; 15, 457–467.CrossRefGoogle Scholar