Flynn Heather A, Marcus Sheila M, Barry Kristen L, Blow Frederic C
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, 48108-3318, USA.
Alcohol Clin Exp Res. 2003 Jan;27(1):81-7. doi: 10.1097/01.ALC.0000046595.47491.37.
The purpose of this study was to demonstrate feasibility of screening and to identify rates and correlates of alcohol use in a large, demographically representative sample of pregnant women across a number of obstetrics clinics, extending previous studies of single or high-risk settings. Identification of harmful alcohol use during pregnancy and of associated factors is critical for the design and implementation of secondary prevention strategies.
A total of 1131 pregnant women age 18 and older were screened in the waiting areas of eight obstetrics clinics in Southeastern Michigan using a brief (10 min) screening questionnaire. This survey consisted of direct and indirect (TWEAK) measures of alcohol use, as well items assessing demographic characteristics, use of tobacco, and whether participants' physicians discussed alcohol use behavior with them. Women ranged in age from 18 to 46, with a mean age of 28.7 (SD = 5.3). The racial/ethnic distribution of our sample suitably reflects the various racial segments of the Michigan population.
We found that 15.1% of the total sample (n = 169) reported any alcohol use during pregnancy, with the majority of those women reporting relatively low levels of alcohol use. One hundred and forty-seven women (13%) scored above the cutoff on the TWEAK (i.e., above a score of 2). Based on multivariate analyses, higher risk alcohol use (defined as binge drinking or greater than one standard drink per week) during pregnancy was predicted by smoking and earlier stage of pregnancy. Caucasian race, smoking, psychological distress, and greater number of drinks during pregnancy predicted scores above a cutoff of 2 on the TWEAK.
This study demonstrated that screening in busy obstetrics clinics is feasible and acceptable to women and that it may be optimal to use both indirect and direct measures of alcohol use. In addition, brief assessments should be conducted throughout pregnancy and may be targeted or intensified for smokers and for women earlier in their pregnancy.
本研究的目的是证明筛查的可行性，并确定在多个产科诊所的大量具有人口统计学代表性的孕妇样本中酒精使用的比率及相关因素，扩展先前对单一或高危环境的研究。识别孕期有害酒精使用及其相关因素对于二级预防策略的设计和实施至关重要。
在密歇根州东南部的八家产科诊所的候诊区，使用一份简短（10分钟）的筛查问卷对1131名18岁及以上的孕妇进行了筛查。该调查包括酒精使用的直接和间接（TWEAK）测量方法，以及评估人口统计学特征、烟草使用情况，以及参与者的医生是否与她们讨论过酒精使用行为的项目。女性年龄在18至46岁之间，平均年龄为28.7岁（标准差=5.3）。我们样本的种族/族裔分布恰当地反映了密歇根州人口的各个种族部分。
我们发现，总样本中的15.1%（n = 169）报告在孕期有任何酒精使用，其中大多数女性报告的酒精使用水平相对较低。147名女性（13%）在TWEAK上的得分高于临界值（即得分高于2分）。基于多变量分析，孕期较高风险的酒精使用（定义为暴饮或每周饮用超过一杯标准饮品）可通过吸烟和孕期早期来预测。白人种族、吸烟、心理困扰以及孕期饮酒量较多可预测TWEAK得分高于临界值2分。
本研究表明，在繁忙的产科诊所进行筛查对女性来说是可行且可接受的，同时使用酒精使用的间接和直接测量方法可能是最佳选择。此外，应在整个孕期进行简短评估，对于吸烟者和孕期早期的女性可进行有针对性的或强化的评估。
