School of Health and Social Care, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, UK.
Addiction. 2010 Apr;105(4):601-14. doi: 10.1111/j.1360-0443.2009.02842.x.
Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women.
Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care.
Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >or=3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >or=8 performed poorly.
T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.
尽管已经建议对孕期问题饮酒进行产前筛查，但缺乏有关筛查工具的指导。我们调查了简短酒精筛查问卷识别孕妇问题饮酒的敏感性、特异性和预测值。
从创建开始至 2008 年 6 月，检索电子数据库，以及合格论文的参考文献列表和相关综述论文。我们寻找了比较一种或多种简短酒精筛查问卷（s）与使用结构化访谈获得的参考标准以检测接受产前护理的孕妇“风险”饮酒、酒精滥用或依赖的队列或横断面研究。
共纳入 5 项研究（6724 名参与者）。总共评估了七种工具：TWEAK（耐受性、担心、清醒剂、健忘、减少）、T-ACE（饮酒量、生气、减少、清醒剂）、CAGE（减少、生气、内疚、清醒剂）、NET（正常饮酒者、清醒剂、耐受性）、AUDIT（酒精使用障碍识别测试）、AUDIT-C（AUDIT-消费）和 SMAST（短密歇根酒精筛查测试）。研究质量总体较好，但缺乏盲法是一个常见的弱点。对于风险饮酒，T-ACE（69-88%）、TWEAK（71-91%）和 AUDIT-C（95%）的敏感性最高，特异性高（分别为 71-89%、73-83%和 85%）。CAGE 和 SMAST 表现不佳。AUDIT-C 评分>或=3 对过去一年的酒精依赖（100%）或酒精使用障碍（96%）具有高敏感性，特异性适中（各为 71%）。对于终生酒精依赖，AUDIT 评分>或=8 表现不佳。
T-ACE、TWEAK 和 AUDIT-C 显示出筛查风险饮酒的潜力，AUDIT-C 也可能有助于识别酒精依赖或滥用。然而，它们作为独立工具的性能尚不确定，需要进一步评估用于产前酒精使用的问卷。
