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Directive clinique no 405 : Dépistage et conseils en matière de consommation d'alcool pendant la grossesse

      RÉSUMÉ

      Objectif

      Établir des normes pancanadiennes fondées sur les meilleures données probantes actuelles sur le dépistage et les conseils en matière de consommation d'alcool et de troubles de consommation d'alcool chez les femmes enceintes ou en âge de procréer.

      Professionnels concernés

      Les fournisseurs de soins qui prodiguent des soins aux femmes enceintes et aux femmes en âge procréer.

      Population cible

      Les femmes enceintes, les femmes en âge de procréer et leurs familles.

      Données probantes

      Des recherches ont été effectuées dans les bases de données Medline, Embase et CENTRAL avec le thème « alcohol use and pregnancy ». Les résultats ont été filtrés de façon à obtenir des publications parues entre 2010 et septembre 2018. Les termes de recherche ont été mis au point à partir des termes du thésaurus de référence biomédicale MeSH et de mots clés, dont les suivants : pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring et brief intervention. Les données probantes retenues proviennent d'essais cliniques, d’études observationnelles, de revues de la littérature, d'analyses systématiques et méta-analyses, de lignes directrices et de conférences de consensus.

      Méthodes de validation

      Les auteurs ont rédigé et accepté le contenu et les recommandations de la présente directive. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des données probantes a été évaluée au moyen des critères de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation) (consulter les tableaux A1 et A2 de l'annexe en ligne).

      Bénéfices, risques, coûts

      La mise en œuvre des recommandations de la présente directive à l'aide d'outils de dépistage validés et de stratégies d'intervention brève peut améliorer la capacité des fournisseurs de soins obstétricaux à reconnaître la consommation d'alcool et la consommation problématique d'alcool chez les femmes enceintes ou en âge de procréer. Il est attendu des fournisseurs de soins de santé qu'ils deviennent confiants et compétents en matière de prise en charge et de soutien de ces femmes afin qu'elles puissent avoir la meilleure santé possible et une issue de grossesse optimale.

      DÉCLARATIONS SOMMAIRES (classement GRADE entre parenthèses)

      • 1
        L'alcool est un agent tératogène connu (élevée).
      • 2
        Les données actuelles ne permettent pas d’établir un seuil sécuritaire pour la consommation d'alcool pendant la grossesse (élevée).
      • 3
        S'abstenir de consommer de l'alcool pendant la grossesse est l'option la plus sûre (élevée).
      • 4
        S'abstenir de consommer de l'alcool pendant l'allaitement est l'option la plus sûre (élevée).

      RECOMMANDATIONS (classement GRADE entre parenthèses)

      • 1
        Il y a lieu d'interroger chaque femme enceinte sur sa consommation d'alcool en lui posant une seule question (sans porter de jugement) afin de déterminer sa consommation. Si la femme consomme de l'alcool, il est recommandé d'utiliser un des outils de dépistage suivants : AUDIT-C, T-ACE ou un autre outil de dépistage fondé sur des données probantes disponible dans le dossier prénatal provincial ou territorial. Si la femme consomme de l'alcool, il est recommandé de déterminer ses habitudes de consommation afin de dépister l'hyperalcoolisation rapide binge drinking (forte, élevée).
      • 2
        Si le dépistage révèle un trouble de consommation d'alcool, une intervention brève doit être effectuée au même moment (forte, élevée).
      • 3
        Lorsqu'un trouble maternel de consommation d'alcool est diagnostiqué, il doit être consigné au dossier médical du nourrisson après l'accouchement (forte, basse). Les proches aidants doivent être encouragés à discuter de l'exposition à l'alcool in utero avec le fournisseur de soin de santé de l'enfant (forte, basse).
      • 4
        Chaque rencontre clinique est une occasion de discuter de la consommation d'alcool. Il y a lieu d'effectuer un dépistage périodique de la consommation problématique d'alcool auprès de toutes les femmes en âge de procréer. Le dépistage, l'intervention brève et l'orientation vers le traitement peuvent être des mesures brèves ou exhaustives selon le contexte. Les fournisseurs de soins de santé doivent intégrer le dépistage de la consommation problématique d'alcool dans le dépistage systématique en santé des femmes et le partage d'information et inclure le dépistage, l'intervention brève et l'orientation vers le traitement au besoin (forte, élevée).
      • 5
        L'intervention brève et, au besoin, l'orientation et un suivi coordonnés doivent accompagner le dépistage de la consommation d'alcool. Il est important d'adopter une stratégie de soutien sans jugement afin d'encourager la femme à divulguer sa consommation d'alcool et favoriser l'accès aux services (forte, élevée).
      • 6
        Lorsqu'une femme continue à consommer de l'alcool pendant la grossesse, il y a lieu de favoriser les stratégies de réduction des méfaits, de traitement et de soutien social (forte, élevée).
      • 7
        Le fournisseur de soins de santé doit savoir comment effectuer une intervention brève et connaître les divers canaux d'orientation (forte, moyenne).
      • 8
        La femme doit être en mesure de participer à l'intervention brève et au traitement sans risquer indûment de perdre la garde de l'enfant; lorsque le dépistage systématique et l'intervention brève sont mis en place, les politiques doivent être harmonisées de façon à ce que le soutien et le traitement puissent être encouragés par le fournisseur et accessibles à la femme sans crainte (une attention adéquate doit toujours être portée à la sécurité de l'enfant) (forte, modérée).
      • 9
        Des interventions communautaires spécialisées doivent être disponibles et accessibles aux femmes ayant une consommation problématique d'alcool et des problèmes de santé et préoccupations sociales connexes (fortes, modérées).

      Mots clés

      ABBRÉVIATIONS:

      TSAF (Trouble du spectre de l'alcoolisation fœtale), DIBOT (dépistage, intervention brève et orientation vers le traitement)
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