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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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