Screening for Prenatal Alcohol Exposure

Overview

Early identification of developmental disorders, including fetal alcohol spectrum disorders (FASDs), is critical to the well-being of children and their families. Over the past 50 years, research has confirmed the harmful effects of alcohol on the developing fetus and subsequent lifelong cognitive, emotional, behavioral, and physical effects.

Screening for prenatal alcohol exposure is an essential function of the primary care medical home and the responsibility of all pediatricians. Early identification of a child at risk for developmental disability because of a positive history for prenatal alcohol exposure should lead to further evaluation, and when warranted, diagnosis and treatment. Pediatricians are well-positioned to screen children for prenatal alcohol exposure, spearheading the process of accurate diagnosis and the coordination of care necessary to improve health and psychosocial outcomes for children with an FASD and their families.

Bright Futures Health Supervision Visit: Prenatal and Newborn

Screening for prenatal alcohol exposure is a component of heath supervision visits for newborns and new patients (Page 343) according to the Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (4th Edition). A risk assessment tool for maternal alcohol and substance use is included in Screening for Prenatal Alcohol Exposure: An implementation guide for pediatric primary care providers.

• Download the implementation guide that offers an evidence-informed method to determine a history of prenatal alcohol exposure. The implementation guide provides advice and concrete examples to support pediatricians in facilitating early identification of children who are at risk for one of the fetal alcohol spectrum disorders.  The implementation guide provides a format for information gathering and conversation between parents, caregivers, families, and pediatricians.
• Screening for prenatal exposure to alcohol can be conducted at any family interaction time-prenatal visits, in the newborn period, at the time of adoption, and as new patients and families join a practice or when developmental issues emerge.
• Maternal self-report remains the primary method for identifying alcohol consumption during pregnancy, though information may also be gathered from key individuals in the child’s life such as fathers and other family members who can confirm observation of prenatal alcohol use. The accuracy of information gathered about alcohol use in pregnancy is improved when screening is conducted in a nonjudgmental and nonconfrontational manner, respecting confidentiality.
• In addition to maternal report, prenatal alcohol exposure can be inferred if a birthing parent has been arrested, detained, or entered into an alcohol use treatment program for an alcohol‐related behavior or activity while pregnant (e.g. DUI).

Obtaining Prenatal Alcohol Exposure History for Adopted/Foster Children

When children are adopted or enter foster care, pediatricians can gather information from case records or the child’s case worker. When gathering information about the child’s background, biological family history, details about pregnancy and delivery, and the child’s early history, an inquiry about prenatal alcohol exposure should be included. Encourage foster or adoptive parents to ask their case worker for the information.  This also provides an opportunity to provide guidance to foster/adoptive families about the effects of prenatal alcohol exposure for the child and issues they should monitor. 

Alcohol and Pregnancy

• Obtaining a history of prenatal alcohol exposure should be routine for all pediatric patients.
• Approach mothers using a non-judgmental attitude and non-stigmatizing language.
• No amount of alcohol intake is considered safe during pregnancy.
• There is no safe trimester to drink alcohol.
• Prenatal alcohol exposure may occur before an individual is aware they are pregnant.
• All forms of alcohol, including beer, wine, and liquor, pose similar risk.
• Binge drinking (having 4 or more drinks at one time) poses an increased, dose-related risk to the developing fetus.

The Centers for Disease Control and Prevention Alcohol Portal offers additional information about Alcohol & Pregnancy, specifically the effects that drinking alcohol during pregnancy can have on a developing baby. 

 “No mother drinks because she wants to hurt her baby.” - Kathleen Tavenner Mitchell, MHS, LCADC, Vice President and National Spokesperson, National Organization on Fetal Alcohol Syndrome and The Circle of Hope Birth Mothers Network

Additional information and resources to support families impacted by FASDs are available through the National Organization on Fetal Alcohol Syndrome.

Sample Screen for Prenatal Alcohol Exposure

The following screen for prenatal alcohol exposure has a variety of important questions. The screen is meant to normalize information collection with a choice of generalized questions. Be aware to avoid reactions that might indicate judgement if a person acknowledges prenatal alcohol use. Remind the parents that the information will help to guide the child’s care.

“Now that we have [child’s name] medical history, let’s talk about the pregnancy. This will help me get to know [child’s name] and your family better.”

“How far along were you before you found out that you were pregnant with child’s name?”

“Did you have any medical conditions or concerns during the pregnancy?”

“Did you experience any anxiety or depression during the pregnancy?”

“Now I am going to move onto a series of questions that I ask all women about their use of tobacco, alcohol, prescription and non-prescription drugs during pregnancy.”

“Before you knew you were pregnant, how much alcohol (beer, wine, liquor, etc.) did you drink?”

If the mother shows concern that she drank before she knew she was pregnant, reassure her that she is not alone in doing so and that awareness allows for monitoring, moving forward, and intervention if needed.

“After you found out you were pregnant, how much alcohol did you drink? ”

“Were there any prescription or non-prescription drugs that you took while pregnant?” 

If yes:  “Can you tell me the names of the drugs and how often you took them?”

“Has there been a time when you smoked cigarettes?”

If yes: “During the pregnancy how often did you smoke any cigarettes?”

“Is this your first pregnancy?”

If no: “Tell me about the other pregnancies.”

”Was [child’s name] born full term? ”

Ask questions about the delivery and solicit any neonatal information that has not been discussed earlier.

“Is there anything else that you might want to tell me about your pregnancy with [child’s name]?”

Additional Resources

• Language and Stigma Guide (FASD United)