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Thursday, July 21, 2011

Screen All Women for Alcohol Use, ACOG Says

Screen All Women for Alcohol Use, ACOG Says
By Todd Neale

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Pregnant or not, all women seeing their ob/gyn should be screened for alcohol use to identify at-risk drinking and alcohol dependence, according to the American College of Obstetricians & Gynecologists (ACOG).

The screenings should take place at least every year and within the first trimester of pregnancy, stated an opinion from ACOG's committee on healthcare for underserved women, which was published in the August issue of Obstetrics & Gynecology.

"It should be noted that women who drink at risk levels are less likely to maintain routine annual visits, and screening should be considered for episodic visits if not completed within the past 12 months," the authors wrote.

The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use as more than three drinks per occasion (binge drinking) or seven drinks per week for healthy women, and any amount of drinking for women who are pregnant or who are at risk of becoming pregnant.

According to the authors of the ACOG opinion paper, at-risk alcohol use is a greater risk to women than men, with wide-ranging health effects.

Those include negative effects on reproductive function and pregnancy outcomes and greater risks of various cancers, sexually transmitted diseases, menstrual disorders, altered fertility, injuries, and a host of psychosocial problems, such as relationship loss, sexual assault, loss of income, altered judgment, depression, and suicide.

In addition, women who drink during pregnancy place their unborn children at risk of birth defects.

According to ACOG, ob-gyns play an integral part in mitigating the health effects of problem drinking in three main areas -- screening, intervention and education, and treatment referral.

Various screening tools can be used, and the opinion highlighted TACE (Tolerance, Annoyed, Cut down, Eye-opener), which asks about a woman's tolerance to alcohol, annoyance with being criticized for her drinking, feelings about the need to decrease her amount of drinking, and drinking first thing in the morning.

The authors noted that "although the CAGE mnemonic screening tool has been taught in most medical schools and residency programs, it has not proved to be sensitive for women and minorities."

They also noted that women with alcohol use problems are often more likely than men to deny the existence of a problem and often do not have any signs on physical examination.

In terms of intervention, a brief educational session and motivational interviewing by the ob-gyn can be effective in women who are not addicted to alcohol.

The provision of clear advice on avoiding alcohol and achieving abstinence should be used for pregnant women and those at risk for getting pregnant, the authors wrote.

"Women who have already consumed alcohol during a current pregnancy should stop in order to minimize further risk, and those who are considering becoming pregnant should abstain from drinking alcohol," they wrote.

They added that "healthcare providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for pregnancy termination."

If intervention and education fail to get a woman who is drinking at risky levels to curtail her drinking, the ob-gyn should refer her to a substance abuse specialist, according to the opinion. The appointment should be made with the woman still in the ob-gyn's office.

"It may take a number of offers before the patient is ready to accept a treatment referral," the authors wrote. "The patient's trust in her medical provider may be key in taking the step toward treatment."


  1. Most women who use alcohol or other drugs do not become addicted, however, a small percentage of women who begin to experience socially with alcohol or other drugs end up having problems. If women begin to use substances as a way of coping and comforting, they can enter a cycle of dependency that could lead to possible addiction

  2. Alcohol harms all the groups, men or women. But women get to many problems in her daily life.
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