Chiodo Lisa M, Delaney-Black Virginia, Sokol Robert J, Janisse James, Pardo Yobany, Hannigan John H
College of Nursing, Wayne State University, Detroit, Michigan.
Alcohol Clin Exp Res. 2014 May;38(5):1401-8. doi: 10.1111/acer.12368. Epub 2014 Mar 21.
Detection of in-pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T-ACE screen was developed for that purpose. We recently reported that increasing the total T-ACE score cut-point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4-year-old children with neurobehavioral effects associated with prenatal alcohol exposure.
In this study, the TACER-3 was further validated in another prospectively identified high-risk urban cohort. Women were categorized as follows: (i) Not At-Risk Group (negative on T-ACE and TACER-3); (ii) At-Risk Group (positive on T-ACE and TACER-3); and (iii) Change Risk Group (positive on T-ACE but negative on TACER-3).
The TACER-3 total score cut-point of 3 yielded fewer "false positives" than the T-ACE cut-point of 2. Based on relative risk scores, women in the TACER-3-positive At-Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At-Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At-Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at-risk alcohol consumption in the At-Risk Group was over >10 times that of the Change Risk Group.
Thus, the TACER-3 was more effective at selectively identifying women drinking at fetal risk levels than the original T-ACE. The TACER-3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.
孕期检测孕妇饮酒风险是预防胎儿酒精谱系障碍的关键第一步，广泛使用的T-ACE筛查就是为此目的而开发的。我们最近报告称，将T-ACE总分切点从2提高到3可使孕期风险饮酒检测的特异性提高一倍，并识别出与产前酒精暴露相关的4岁儿童神经行为影响。
在本研究中，TACER-3在另一个前瞻性确定的高危城市队列中进一步得到验证。女性被分为以下几类：（i）无风险组（T-ACE和TACER-3均为阴性）；（ii）风险组（T-ACE和TACER-3均为阳性）；（iii）风险变化组（T-ACE为阳性但TACER-3为阴性）。
TACER-3总分切点为3时产生的“假阳性”比T-ACE切点为2时少。根据相对风险评分，TACER-3阳性风险组的女性在孕期饮酒的可能性高于风险变化组的女性。相比之下，无风险组的女性饮酒情况与风险变化组的女性基本没有差异。与风险变化组相比，风险组相对风险增加最大的是整个孕期每天的饮酒量（RR = 11.4）和首次产前检查时每次饮酒日的饮酒量（RR = 12.7）。对于这两项指标，风险组中风险饮酒的相对风险是风险变化组超过10倍以上。
因此，TACER-3在选择性识别处于胎儿风险水平饮酒的女性方面比原始的T-ACE更有效。TACER-3能够更有效地利用医疗保健提供者的时间，对被确定为处于胎儿风险水平饮酒的孕妇进行有针对性的临床干预。
