Research evaluates prenatal care providers' understanding of alcohol exposure and screening practices

There is no amount, pattern or timing of alcohol use during pregnancy proven safe for a developing fetus. Repeat: there is no amount, pattern or timing of alcohol use during pregnancy proven safe for a developing fetus. Drinking in pregnancy can have a range of harmful consequences for the child ─including poor growth, learning and behavioral difficulties, problems with movement and co-ordination, and distinctive facial features ─that are collectively known as fetal alcohol spectrum disorders (FASD).

Screening for alcohol use during pregnancy is a necessary first step in preventing FASD, but studies have suggested that primary care providers do not screen consistently and can be hesitant to follow up with women who report drinking. New research published in the journal Alcoholism: Clinical & Experimental Research has evaluated midwives' and nurse-midwives' understanding of the risks of drinking in pregnancy, and their screening practice.

Almost six hundred professional members of the American College of Nurse Midwives responded to a survey developed by researchers at the University of Massachusetts. The survey questions assessed knowledge of the effects of prenatal alcohol exposure, attitudes to and perceived barriers to screening for alcohol use, and use of standardized clinical screening tools (questionnaires) in respondents' clinical practice.

Analysis showed that 38% of respondents believe it is safe to drink alcohol during at least one trimester of pregnancy, and 44% reported that having one drink per occasion is acceptable. Respondents tended to underestimate the prevalence of FASD nationally and more so among their own communities and patients; just 3% correctly answered all of six questions relating to FASD knowledge.

Only around one in three (35%) respondents reported that they screen for alcohol use at least some of the time, with 23% reporting use of a specific screening tool (rather than simple yes/no questioning); however, few of the tools used 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.

Just over half (56%) of respondents reported that they recommend abstinence to women who admit to drinking during pregnancy. Those who reported that pregnancy alcohol use is unsafe feel more prepared to educate and intervene. Perceived barriers to screening ─including patients' denial of drinking, patients' resistance to treatment, and time limitations ─also appeared to influence midwives' screening practice.

The findings expand on previous research indicating that many prenatal care providers remain inadequately informed of the risks of drinking during pregnancy, and fail to screen actively for alcohol use. The researchers believe that providers, including midwives, require more comprehensive training on the effects of prenatal alcohol exposure and the importance of screening, as well as on the specific screening tools available. This would improve detection of drinking during pregnancy and provide more opportunities for meaningful intervention and education ─and would ultimately reduce the numbers of children born with FASD.