Well Woman and Prenatal Visits Should Include Alcohol Abuse Screening

The new recommendations highlight the ob-gyn’s role in identifying women who drink at unhealthy levels, encouraging healthy behaviors through brief intervention and education, and referring alcohol-dependent patients for treatment.

At-risk alcohol use—defined as more than seven drinks per week, more than three drinks per occasion (binge drinking), or any amount of consumption among those who are pregnant or at risk of pregnancy—is on the rise among women. Thirteen percent of women in the US consume more than seven drinks per week. Among 18-34-year-olds who binge drink, almost one-third report drinking eight or more drinks per occasion.

“Alcohol is so ubiquitous in our society, many women may be surprised to learn that their drinking exceeds a safe level. They may consider their alcohol use normal because it’s similar to the drinking patterns of their family, friends, and social circles,” said Maureen G. Phipps, MD, chair of The College’s Committee on Health Care for Underserved Women. “But because of our physiology, we don’t process alcohol the same way men do, and too much can wreak havoc on our bodies. The risks are amplified in women who are or may become pregnant, because the effects of alcohol exposure on a fetus can be harmful.”

High levels of alcohol consumption can result in multiple adverse health effects in women including decreased fertility; menstrual disorders; injuries; an increased risk of breast, liver, rectal, mouth, throat, and esophageal cancers; seizures; and malnutrition. Psychosocial problems such as loss of income, child neglect or abuse, altered judgment, driving under the influence, and depression can also occur. Binge drinking, in particular, is associated with a sudden peak in blood alcohol level resulting in unsafe behavior and a higher risk of damage to organs and reproductive function.

Alcohol-related mortality is the third leading cause of preventable death among women in the US. Additionally, alcohol is toxic to fetuses and its use during pregnancy s associated with growth impairment, facial abnormalities, central nervous system impairment, behavioral disorders, and impaired intellectual development. Fortunately, alcohol-related health problems in women and birth defects in infants are preventable, ideally through abstention.

The new Committee Opinion provides guidance to ob-gyns for talking to patients about alcohol use and includes screening tests that identify at-risk drinking patterns, information on when and how to refer alcohol-dependent women for professional treatment, a chart of standard drink measurements, and additional resources. “Ob-gyns have an opportunity to educate women on making safe and healthy choices about alcohol intake,” Dr. Phipps said.

Committee Opinion #496 “At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications” is published in the August 2011 issue of Obstetrics & Gynecology.

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The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. Follow us on Twitter at www.twitter.com/acognews and at www.acog.org.