title: Screening for prenatal substance use: development of the Substance Use Risk Profile-Pregnancy scale.
abstract: OBJECTIVE
  To report on the development of a questionnaire to screen for hazardous substance use in pregnant women and to compare the performance of the questionnaire with other drug and alcohol measures.
  
  
  METHODS
  Pregnant women were administered a modified TWEAK (Tolerance, Worried, Eye-openers, Amnesia, K[C] Cut Down) questionnaire, the 4Ps Plus questionnaire, items from the Addiction Severity Index, and two questions about domestic violence (N=2,684). The sample was divided into "training" (n=1,610) and "validation" (n=1,074) subsamples. We applied recursive partitioning class analysis to the responses from individuals in the training subsample that resulted in a three-item Substance Use Risk Profile-Pregnancy scale. We examined sensitivity, specificity, and the fit of logistic regression models in the validation subsample to compare the performance of the Substance Use Risk Profile-Pregnancy scale with the modified TWEAK and various scoring algorithms of the 4Ps.
  
  
  RESULTS
  The Substance Use Risk Profile-Pregnancy scale is comprised of three informative questions that can be scored for high- or low-risk populations. The Substance Use Risk Profile-Pregnancy scale algorithm for low-risk populations was mostly highly predictive of substance use in the validation subsample (Akaike's Information Criterion=579.75, Nagelkerke R=0.27) with high sensitivity (91%) and adequate specificity (67%). The high-risk algorithm had lower sensitivity (57%) but higher specificity (88%).
  
  
  CONCLUSIONS
  The Substance Use Risk Profile-Pregnancy scale is simple and flexible with good sensitivity and specificity. The Substance Use Risk Profile-Pregnancy scale can potentially detect a range of substances that may be abused. Clinicians need to further assess women with a positive screen to identify those who require treatment for alcohol or illicit substance use in pregnancy.
  
  
  METHODS
  III.
authors.affiliation: From the Departments of Psychiatry and Obstetrics, Gynecology and Reproductive Sciences and the School of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Yonkers
authors.forename: Nathan
authors.initials: N
authors.lastname: Gotman
authors.forename: Trace
authors.initials: T
authors.lastname: Kershaw
authors.forename: Ariadna
authors.initials: A
authors.lastname: Forray
authors.forename: Heather B
authors.initials: HB
authors.lastname: Howell
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Rounsaville
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D011247:Pregnancy; D018709:Statistics, Nonparametric; D019966:Substance-Related Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D055815:Young Adult