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Comparing Screens for Drinking in Pregnancy

Most of us were taught to use the four CAGE questions to detect problem alcohol use, but other systems have been devised. Which is the best screen for pregnant women to assess risk drinking (i.e., at levels associated with adverse pregnancy outcomes)?

These authors administered three screens -- CAGE, the 25-item Michigan Alcoholism Screening Test (MAST) commonly used in men, and an alcohol tolerance question ("How many drinks can you hold?") -- to 2717 low-income black women during their first prenatal visit to an urban clinic. Two other tests, TWEAK (five items) and T-ACE (four items), were constructed from responses to the tolerance question and questions from CAGE and MAST. Another 1420 women were screened with T-ACE only.

Screening focused on periconceptual risk drinking, which has been correlated with fetal damage in a dose-response manner. Nearly 7% of the women screened with multiple tests were risk drinkers. Overall, TWEAK and T-ACE were more sensitive than CAGE and MAST in detecting risk drinking at most cutpoint values examined, while maintaining fairly good specificity. CAGE had sensitivities of only 27% to 66%, depending on the cutpoint. When T-ACE was given alone, rather than as part of MAST and CAGE, sensitivity fell markedly.

Comment: Sensitivity is important when screening for a serious, preventable outcome and when the cost and risk of false-positives are minimal. The standard CAGE questions don't seem particularly sensitive for detecting risk drinking in pregnant women. TWEAK and T-ACE, provided in this paper, show more promise. However, current research supports their use only as part of longer interviews including all the CAGE and MAST questions.

— EP Whitlock

Published in Journal Watch Women's Health December 1, 1996

Citation(s):

Russell M et al. Detecting risk drinking during pregnancy: a comparison of four screening questionnaires. Am J Public Health 1996 Oct 86 1435-1439.

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