Psychometric properties of brief screening tests for alcohol use disorders during pregnancy in Argentina

Abstract

Considering physical, mental and behavioral problems related to fetal alcohol exposure, prenatal clinical guides suggest brief evaluation of alcohol consumption during pregnancy to detect alcohol intake and to adjust interventions, if required. Even if any alcohol use should be considered risky during pregnancy, identify women with alcohol use disorders is important because they could need a more specific intervention than a simple advice to abstain. Most of screening tests have been developed and validated in male populations and focused on long term consequences of heavy alcohol use, so that they might be inappropriate to assess consumption in pregnant women. Objective: To analyze the internal reliability and validity of the alcohol screening instruments AUDIT, AUDIT-C, TWEAK, RAPS-QF and T-ACE to identify alcohol use disorders in pregnant women. Methods: 641 puerperal women were personally interviewed during the 48hs after delivery. ROC curves, sensitivity and specificity of each instrument using different cut off points were analysed. Results: All instruments showed areas under the ROC curves above .80. Larger areas were found for the TWEAK and the AUDIT. The TWEAK, the T-ACE and the AUDIT-C showed higher sensitivity, while the AUDIT and the RAPS-QF showed higher specificity. Reliability (internal consistency) was low for all instruments, improving when optimal cut off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF. Conclusions: In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. In contrast, our results evidenced low reliability of those instruments and a better performance of the AUDIT in this population.Considerando os problemas físicos, mentais e comportamentais relacionados à exposição fetal ao álcool, as orientações clínicas pré-natais sugerem uma breve avaliação do consumo de álcool durante a gravidez para detectar o consumo de álcool e ajustar as intervenções, se necessário. Ainda que qualquer uso de álcool deva ser considerado arriscado durante a gravidez, identificar as mulheres com transtornos de uso de álcool é importante, porque elas podem precisar de uma intervenção mais específica do que um simples conselho para se abster. A maioria dos testes de triagem tem sido desenvolvidos e validados em populações masculinas, e estão focados nas consequências em longo prazo do uso excessivo de álcool, de modo que eles podem ser inadequados para avaliar o consumo em mulheres grávidas.