title: Validity of the T-ACE in pregnancy in predicting child outcome and risk drinking.
abstract: Preventing fetal alcohol spectrum disorders (FASDs) requires detection of in-pregnancy maternal risk drinking. The widely used T-ACE screen has been applied in various ways, although the impact of those different uses on effectiveness is uncertain. We examined relations among different T-ACE scoring criteria, maternal drinking, and child outcome. Self-reported across-pregnancy maternal drinking was assessed in 75 African-American women. The different T-ACE criteria used varied the level of drinking that defined tolerance (two or three drinks) and the total T-ACE score cut-points (two or three). Receiver operator curves and regression analysis assessed the significance of relations. Increasing the total T-ACE score cut-point to 3 almost doubled specificity in detecting risk drinking whereas maintaining adequate sensitivity, equivalent to that in the original report, and identified substantially more neurobehavioral deficits in children. Redefining tolerance at three drinks did not improve T-ACE effectiveness in predicting outcomes. This study is among the first to show the ability of an in-pregnancy T-ACE assessment to predict child neurodevelopmental outcome. In addition, increasing the total T-ACE score criterion (from 2 to 3) improved identification of non-drinking mothers and unaffected children with little loss in detection of drinkers and affected children. Efficient in-pregnancy screens for risk drinking afford greater opportunities for intervention that could prevent/limit FASDs.
authors.affiliation: College of Nursing, Wayne State University, Detroit, MI 48202, USA. lchiodo@med.wayne.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chiodo
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sokol
authors.forename: Virginia
authors.initials: V
authors.lastname: Delaney-Black
authors.forename: James
authors.initials: J
authors.lastname: Janisse
authors.forename: John H
authors.initials: JH
authors.lastname: Hannigan
mesh_terms: D000328:Adult; D001741:Black or African American; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology*; D000437:Alcoholism; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D002675:Child, Preschool; D004361:Drug Tolerance; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis