Göransson Mona, Magnusson Asa, Heilig Markus
Division of Psychiatry, NEUROTEC, Karolinska Institute, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2006;85(6):657-62. doi: 10.1080/00016340600589677.
It has been repeatedly demonstrated that hazardous alcohol use during pregnancy is rarely detected in regular antenatal care, and that detection can be markedly improved using systematic screening. A major challenge is to translate research-based strategies into regular antenatal care. Here, we examined whether a screening strategy using the Alcohol Use Disorder Test (AUDIT) and time-line follow-back (TLFB) could be implemented under naturalistic conditions and within available resources; and whether it would improve detection to the extent previously shown in a research context.
Regular midwives at a large antenatal care clinic were randomized to receive brief training and then implement AUDIT and TLFB ("intervention"); or to a waiting-list control group continuing to deliver regular care ("control"). In the intervention-condition, AUDIT was used to collect data about alcohol use during the year preceding pregnancy, and TLFB to assess actual consumption during the first trimester. Data were collected from new admissions over 6 months.
Drop out was higher among patients of the intervention group than control midwives, 14% (23/162) versus 0% (0/153), and p<0.0001. A one-day training session combined with continuous expert support was sufficient to implement systematic screening with AUDIT and TLFB largely within resources of regular antenatal care. The use of these instruments identified patients with hazardous consumption during the year preceding pregnancy i.e. AUDIT score 6 or higher (17%, 23/139), and patients with ongoing consumption exceeding 70 g/week and/or binge consumption according to TLFB (17%, 24/139), to a significantly higher degree than regular antenatal screening (0/162). The AUDIT- and TLFB-positive populations overlapped partially, with 36/139 subjects screening positive with either of the instrument and 11/139 were positive for both.
We confirm previous findings that alcohol use during pregnancy is more extensive in Sweden than has generally been realized. Systematic screening using AUDIT and TLFB detects hazardous use in a manner which regular antenatal care does not. This remains true under naturalistic conditions, following minimal training of regular antenatal care staff, and can be achieved with minimal resources. The proposed strategy appears attractive for broad implementation.
多次研究表明，孕期有害饮酒在常规产前护理中很少被发现，而采用系统筛查可显著提高检出率。一个主要挑战是将基于研究的策略转化为常规产前护理。在此，我们研究了使用酒精使用障碍筛查测试（AUDIT）和时间线追溯法（TLFB）的筛查策略是否能在自然条件下且在现有资源范围内实施；以及它是否能像之前在研究环境中显示的那样提高检出率。
一家大型产前护理诊所的普通助产士被随机分为两组，一组接受简短培训，然后实施AUDIT和TLFB（“干预组”）；另一组为等待名单对照组，继续提供常规护理（“对照组”）。在干预组中，AUDIT用于收集怀孕前一年的饮酒数据，TLFB用于评估孕早期的实际饮酒量。数据收集自6个月内的新入院患者。
干预组患者的退出率高于对照组助产士，分别为14%（23/162）和0%（0/153），p<0.0001。为期一天 的培训课程加上持续的专家支持足以在常规产前护理资源范围内，主要通过AUDIT和TLFB实施系统筛查。使用这些工具识别出怀孕前一年有有害饮酒行为的患者，即AUDIT评分6分及以上者（17%，23/139），以及根据TLFB每周饮酒量超过70克和/或有暴饮行为的患者（17%，24/139），其检出率显著高于常规产前筛查（0/162）。AUDIT和TLFB检测为阳性的人群部分重叠，139名受试者中有36名通过其中任何一种工具筛查为阳性，11名两种工具检测均为阳性。
我们证实了之前的研究结果，即瑞典孕期饮酒情况比普遍认识的更为广泛。使用AUDIT和TLFB进行系统筛查能够检测出常规产前护理无法发现的有害饮酒行为。在自然条件下，经过对常规产前护理人员的最少培训后，情况依然如此，并且可以用最少的资源实现。所提议 的策略似乎对广泛实施具有吸引力。
