Benefits, Harms, Costs
SUMMARY STATEMENTS (GRADE ratings in parentheses)
- 1Alcohol is a known teratogen (high).
- 2The current evidence cannot establish a safe threshold for alcohol consumption in pregnancy (high).
- 3Abstaining from alcohol during pregnancy is the safest option (high).
- 4Abstaining from alcohol while breastfeeding is the safest option (high).
RECOMMENDATIONS (GRADE ratings in parentheses)
- 1All pregnant women should be questioned about alcohol use by asking a single question (in a nonjudgmental way) to determine use. If women consume alcohol, one of the following screening tools should be used: AUDIT-C or T-ACE, or another evidence-based screening tool available in the provincial/territorial prenatal record. If women consume alcohol, pattern of use should be established to screen for binge drinking (strong, high).
- 2If screening identifies an alcohol use disorder, brief intervention should be provided at the same time screening is completed (strong, high).
- 3When a maternal alcohol use disorder is diagnosed, it should be documented in the infant's medical record after delivery (strong, low). Carers should be encouraged to discuss in utero alcohol exposure with their child's health care provider (strong, low).
- 4Every clinical encounter is an opportunity to discuss alcohol use. All women of child-bearing age should be periodically screened for problematic alcohol use. Screening, brief intervention, and referral to treatment can be brief or in depth depending on the context. Health care providers should incorporate screening for problematic alcohol use into routine women's health screening and information sharing and include screening, brief intervention, and referral to treatment where needed (strong, high).
- 5Brief interventions and, if needed, coordinated referral and follow-up should accompany screening for alcohol use. A nonjudgmental, supportive approach is important to encourage disclosure of alcohol use and accessing of services (strong, high).
- 6If a woman continues to use alcohol during pregnancy, harm reduction, treatment, and social support strategies should be encouraged (strong, high).
- 7Health care providers should be knowledgeable on providing brief interventions and be aware of referral pathways (strong, moderate).
- 8Women need to be able to participate in brief interventions and treatment without undue risk of loss of child custody; where universal screening and brief interventions are implemented, policies must be aligned so that support and treatment can be encouraged by providers and accessed by women without fear (appropriate attention must still be given to the safety of the child) (strong, moderate).
- 9Specialized, community-based interventions need to be available and accessible to women with problematic drinking and related health and social concerns (strong, moderate).
Abbreviations:FASD (Fetal alcohol spectrum disorder), MI (Motivational interviewing), SBIRT (Screening, brief intervention, and referral to treatment)
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This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed Consent: Everyone has the right and responsibility to make informed decisions about their care together with their health care providers. In order to facilitate this, the SOGC recommends that they provide their patients with information and support that is evidence-based, culturally appropriate, and personalized.
Language and Inclusivity: This document uses gendered language in order to facilitate plain language writing but is meant to be inclusive of all individuals, including those who do not identify as a woman/female. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person's needs.
Copyright: The contents of this document cannot be reproduced in any form, in whole or in part, without prior written permission of the publisher of the Journal of Obstetrics and Gynaecology Canada.