USPSTF recommends alcohol screening for adults, pregnant women
Public comments are being solicited on a new systematic review from the US Preventive Services Task Force (USPSTF) on unhealthy alcohol use. The panel’s recommendations include screening pregnant women for alcohol use, which is in keeping with guidance from the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO).
The comment period for the draft document is open until July 2. USPSTF recommends that clinicians in primary care settings screen for unhealthy alcohol use in adults aged 18 and older, including pregnant women, and provide brief behavioral counseling interventions to those who are engaged in risky or hazardous drinking.
The guidance is based on evidence from a systematic review of data in MEDLINE, PubMED, PsycINFO, and Cochrane Central Register of Controlled Trials through October 12, 2017 and references in other relevant publications and government websites. The reviewers looked at trials of benefits and harms of screening in health care settings or other comparable populations and nonpharmacologic interventions to reduce unhealthy alcohol use in screen-detected people who report unhealthy alcohol use, and test accuracy studies of selected screening tools to detect unhealthy alcohol use.
A total of 108 studies were reviewed across all key questions. Pregnant women were recruited for two of the fair-quality studies and one good-quality study. Two of those studies were in the United States and the third was in Argentina. Primary drinking outcomes were drinks per week, exceeding recommended alcohol use limites, heavy use episodes, and, for pregnant women, abstinence. Other outcomes were mortality, quality of life and consequences of alcohol use; injuries, accidents, and acute health-care utilization; family, social, and academic functioning; and legal outcomes.
The data supported use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen (NIAAA) and other similar 1- or 2-item screeners for alcohol use disorder in adolescents. For adults, 1- to 3-item screeners had better sensitivity and specificity than the full Alcohol Use Disorders Identification Test (AUDIT). A previous USPSTF review concluded that the Tolerance, Worried, Eye-openers, Amnesia, Kut down (TWEAK) and Tolerance-Annoyed, Cut down, Eye opener (T-ACE) tools were best for screening pregnant women, along with the Alcohol Use Disorders Identification Test (AUDIT).
Looking at interventions and specifically counseling, the reviewers assessed 68 trials, 11 of which targeted pregnant or postpartum women. They found that in adults, intervention reduced drinks/week (weight mean difference [WMD]=1.82 [95% CI, -242 to -1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR]=0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR=0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR=1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. Analyses by gender did not indicate differences in effectiveness of the interventions, which included providing feedback to patients on alcohol use, counseling reduction in intake, developing goals and an action plan, and arranging for followup.