ACOG Recommends Alcohol Abuse Screen for Women

Clinical Context

The US Preventive Services Task Force recommends screening adults for alcohol misuse in primary care settings, but many clinicians struggle with the very definition of alcohol misuse. The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use among women as more than 3 drinks per occasion or more than 7 drinks per week. In addition, any amount of drinking during pregnancy is considered at-risk alcohol use. Binge drinking is defined as more than 3 drinks per occasion, whereas moderate drinking is defined as 1 alcoholic beverage per day.Women are at particularly high risk for negative consequences from alcohol misuse. The current Committee Opinion from the American College of Obstetrics and Gynecology (ACOG) examines means to detect alcohol misuse among women and how to provide the best care for women with at-risk alcohol use.

Study Synopsis and Perspective

Women should be screened for alcohol use at least annually and during the first trimester of pregnancy, according to new recommendations from ACOG. The ACOG Committee Opinion, entitled “At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications” is published in the August 2011 issue of Obstetrics & Gynecology.“Alcohol is so ubiquitous in our society, many women may be surprised to learn that their drinking exceeds a safe level. They may consider their alcohol use normal because it’s similar to the drinking patterns of their family, friends, and social circles,” said Maureen G. Phipps, MD, chair of The College’s Committee on Health Care for Underserved Women. “But because of our physiology, we don’t process alcohol the same way men do, and too much can wreak havoc on our bodies. The risks are amplified in women who are or may become pregnant, because the effects of alcohol exposure on a fetus can be harmful.”The Committee Opinion defines at-risk alcohol use as more than 7 drinks per week, binge drinking (> 3 drinks per occasion), or any amount of alcohol intake among women who are pregnant or at risk for pregnancy. These ACOG guidelines offer suggestions for how healthcare providers can discuss alcohol use with their patients, screening tests to detect at-risk drinking patterns, information on when and how to refer alcohol-dependent women for professional treatment, a chart of standard drink measurements, and other useful resources.“Ob-gyns have an opportunity to educate women on making safe and healthy choices about alcohol intake,” Dr. Phipps said.Obstetrician-gynecologists play a key role in screening women for at-risk alcohol use and in offering brief intervention, patient education, and treatment referral when needed. Women who are not physically addicted to alcohol may benefit from brief intervention and motivational interviewing incorporated into an office visit. Pregnant women and those at risk for pregnancy should receive clear, compelling advice to avoid alcohol use, and assistance in becoming abstinent or effective contraception. Healthcare providers should advise women that low-level alcohol drinking in early pregnancy is not an indication for pregnancy termination.Among women in the United States, alcohol-related mortality is the third leading cause of preventable death. The adverse effects of high levels of alcohol use include reduced fertility, menstrual disorders, injuries, increased risk for some cancers, seizures, and malnutrition. Psychosocial problems may include loss of income, child neglect or abuse, impaired judgment, driving under the influence, and depression. Alcohol is teratogenic, and prenatal exposure may result in growth impairment, facial abnormalities, central nervous system and/or intellectual impairment, and behavioral disorders.“Women who develop alcohol or substance use dependence are often more likely than men to deny that they have a problem and to minimize the problems associated with their use,” the Committee Opinion states. “However, when they do seek help for the problem, it often is from their primary care providers. Importantly, most women who use alcohol at risk levels have no signs on physical examination. A detailed medical history obtained by a trusted clinician remains the most sensitive means of detecting alcohol abuse.”

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