Alcohol Screening and Brief Intervention in Pregnancy — 24 Jurisdictions, 2017 and 2019

In brief. Alcohol screening and brief intervention (ASBI) is a proven way to reduce drinking among adults, pregnant people included. In 2017 and 2019, 80% of pregnant people said they were asked about alcohol at their most recent checkup, but only 16% of those who had drunk in the past 30 days were advised by a provider to cut down or quit. Pregnant people with less education were screened less often. Screening built into electronic health records, better payment for ASBI, and new tools such as electronic ASBI could help.

Why it matters

Drinking during pregnancy is a major preventable cause of birth defects and developmental disabilities. No amount, type or timing of alcohol is known to be safe during pregnancy or while trying to conceive. Yet 11.5% of pregnant U.S. women aged 18–44 reported current drinking in 2015–2017, and 13.5% of pregnant adults aged 18–49 in 2018–2020.

Brief intervention or behavioural counselling in primary care raises the chance that a pregnant person stops drinking — one analysis found interventions increased the share reporting abstinence (odds ratio 2.26). The U.S. Preventive Services Task Force recommends ASBI for all adults in primary care, pregnant people included, to reduce excessive drinking — which, in pregnancy, means any drinking. Even so, some groups may be screened less than others, and no national estimate had described ASBI among pregnant people.

How the study was done

The Behavioral Risk Factor Surveillance System (BRFSS) is an annual random-digit-dialled telephone survey of U.S. adults. CDC analysed the 23 states and the District of Columbia that used an optional ASBI module in 2017 or 2019 (248,901 respondents; median response rates 45.9% and 49.4%; California, Kansas and Nebraska took part both years).

It compared 950 pregnant people with nonpregnant women aged 18–49. People who had a routine checkup in the past 2 years were asked whether they were asked about drinking there, in person or on a form; those who were, whether they were told what level of drinking is harmful and whether they were advised to cut down or quit. Estimates were standardised to the ages of people who gave birth to a single live baby in 2017.

Results

Drinking. Among pregnant people, 13.3% reported drinking in the past 30 days and 6.9% binge drinking; among nonpregnant women, 56.4% and 20.2%.

Screening. 80.1% of pregnant people and 86.0% of nonpregnant women said they were screened at their last visit. Among pregnant people who were drinking, 96.7% had been screened.

Among pregnant people, screening did not differ significantly by race and ethnicity, disability, frequent mental distress, insurance, having a usual provider, or living in a Medicaid expansion state. Among nonpregnant women, it was lower for those of other races and ethnicities (American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, or multiracial) than for Hispanic, Black and White women, and lower for the uninsured (79.3%) than the insured (87.0%).

Brief intervention.

What it means

Despite the call for universal screening, about 1 in 5 pregnant people were not asked about alcohol at their last primary care visit, and only 16% of those who were drinking were advised to cut down or quit. People without a high school diploma, and those not reporting behaviours that raise HIV risk, were screened less. Among nonpregnant women, the lower screening of the uninsured suggests that lacking insurance gets in the way of routine screening and follow-up, and screening differed by race and ethnicity.

The American College of Obstetricians and Gynecologists recommends a brief intervention for every pregnant person who reports any drinking. Only 28.8% of screened pregnant people who were drinking were told what level of drinking is harmful — a missed chance to discuss the risks. Brief interventions can be short or long, delivered in many settings, and given in person or electronically.

Providers face several barriers to ASBI. Ways around them include:

• building screening into electronic health records;
• paying more for ASBI services;
• electronic ASBI;
• training and tools for ASBI in traditional and non-traditional settings.

Limitations

• Answers are self-reported and subject to recall and social-desirability bias.
• Some pregnancies may not yet have been recognised at the visit or the survey.
• BRFSS does not ask the trimester, although drinking varies across pregnancy; brief intervention is warranted whenever drinking occurs.
• The survey cannot tell whether screening and advice came before or after the patient reported drinking, or whether the patient was drinking at the time of the visit.
• Some groups, such as veterans and sexual and gender minority people, were too small to study.
• Only jurisdictions that used the module were included, so results may not apply elsewhere.

Sources

• Luong J, Board A, Gosdin L, Dunkley J, Thierry JM, Pitasi M, Kim SY. Alcohol Use, Screening, and Brief Intervention Among Pregnant Persons — 24 U.S. Jurisdictions, 2017 and 2019. MMWR Morbidity and Mortality Weekly Report, CDC.