title: Increased cut-point of the TACER-3 screen reduces false positives without losing sensitivity in predicting risk alcohol drinking in pregnancy.
abstract: BACKGROUND
  Detection of in-pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T-ACE screen was developed for that purpose. We recently reported that increasing the total T-ACE score cut-point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4-year-old children with neurobehavioral effects associated with prenatal alcohol exposure.
  
  
  METHODS
  In this study, the TACER-3 was further validated in another prospectively identified high-risk urban cohort. Women were categorized as follows: (i) Not At-Risk Group (negative on T-ACE and TACER-3); (ii) At-Risk Group (positive on T-ACE and TACER-3); and (iii) Change Risk Group (positive on T-ACE but negative on TACER-3).
  
  
  RESULTS
  The TACER-3 total score cut-point of 3 yielded fewer "false positives" than the T-ACE cut-point of 2. Based on relative risk scores, women in the TACER-3-positive At-Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At-Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At-Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at-risk alcohol consumption in the At-Risk Group was over >10 times that of the Change Risk Group.
  
  
  CONCLUSIONS
  Thus, the TACER-3 was more effective at selectively identifying women drinking at fetal risk levels than the original T-ACE. The TACER-3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.
authors.affiliation: College of Nursing, Wayne State University, Detroit, Michigan.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chiodo
authors.forename: Virginia
authors.initials: V
authors.lastname: Delaney-Black
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sokol
authors.forename: James
authors.initials: J
authors.lastname: Janisse
authors.forename: Yobany
authors.initials: Y
authors.lastname: Pardo
authors.forename: John H
authors.initials: JH
authors.lastname: Hannigan
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000517:prevention & control*; D005189:False Positive Reactions; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000517:prevention & control; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000379:methods / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000523:psychology; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D012680:Sensitivity and Specificity
keywords: Alcohol Use Screens; Fetal Alcohol Spectrum Disorders; Fetal Alcohol Syndrome; Pregnancy; TACER-3