title: Screening for alcohol and drug use in pregnancy.
abstract: OBJECTIVE
  this study examined the clinical utility and precision of routine screening for alcohol and other drug use among women attending a public antenatal service.
  
  
  METHODS
  a survey of clients and audit of clinical charts.
  
  
  METHODS
  clients attending an antenatal clinic of a large tertiary hospital in Queensland, Australia, from October to December 2009.
  
  
  RESULTS
  data were collected from two sources. First, 32 women who reported use of alcohol or other drugs during pregnancy at initial screening were then asked to complete a full substance use survey. Second, data were collected from charts of 349 new clients who attended the antenatal clinic during the study period. Both sensitivity (86%, 67%) and positive predictive value (100%, 92%) for alcohol and other drug use respectively, were high. Only 15% of surveyed women were uncomfortable about being screened for substance use in pregnancy, yet the chart audit revealed poor staff compliance. During the study period, 25% of clients were either not screened adequately or not at all. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: despite recommended universal screening in pregnancy and the apparent acceptance by our participants, alcohol and other drug (A&OD) screening in the antenatal setting remains problematic. Investigation into the reasons behind, and ways to overcome, the low screening rate could improve health outcomes for mothers and children in this at-risk group. Targeted education and training for midwives may form part of the solution as these clinicians have a key role in implementing prevention and early intervention strategies.
authors.affiliation: School of Nursing and Midwifery, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia. c.seib@qut.edu.au
authors.forename: Charrlotte A
authors.initials: CA
authors.lastname: Seib
authors.forename: Mark
authors.initials: M
authors.lastname: Daglish
authors.forename: Renée
authors.initials: R
authors.lastname: Heath
authors.forename: Catriona
authors.initials: C
authors.lastname: Booker
authors.forename: Carol
authors.initials: C
authors.lastname: Reid
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D008425:Maternal Behavior; D008880:Midwifery / Q000458:organization & administration*; D009035:Mothers / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011793:Queensland / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult