A staged screening strategy for prenatal alcohol exposure and maternal risk stratification.
OBJECTIVE
To present an incremental process for a staged screening strategy to identify women at increased risk of having a child with fetal alcohol spectrum disorder (FASD) and to enhance the management of women using alcohol during pregnancy. We include an illustrative example of the development of a screening component using an existing data set.


METHODS
We describe a seven-step protocol to screen for alcohol use during pregnancy. The screening process begins with a one-question initial screen, followed by exposure assessment, maternal risk stratification to estimate risk for FASD, and concludes with recommendations for intervention and monitoring of exposure for women drinking during pregnancy.


CONCLUSIONS
This screening process has very modest time commitments in the early stages. Time commitments increase for women drinking during pregnancy and the process focuses on the population at highest risk of having a child with FASD. The process has the benefit of risk specificity, since the process refines risk estimates for an adverse outcome specific for FASD. The process concludes with a programme to facilitate intervention and to monitor changes in prenatal alcohol exposure during pregnancy. Prevention of FASD is an important public health priority. In addition to the ongoing study of clinical strategies to improve detection rates of alcohol exposure at all stages of pregnancy, additional research on the tools and the process used in screening efforts is urgently needed. The efforts should also include research on both the screening tools and the outcome of the screening process in routine prenatal care settings.
Burd
Larry
L
Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, 501 N Columbia Road, Grand Forks, ND 58203, USA. laburd@medicine.nodak.edu
Klug
Marilyn G
MG
Martsolf
John T
JT
Martsolf
Cathy
C
Deal
Eric
E
Kerbeshian
Jacob
J
D000428:Alcohol Drinking; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis*; D005333:Fetus / Q000187:drug effects; D006801:Humans; D011247:Pregnancy