Most health care providers screen for alcohol use and cigarette smoking in the first trimester of pregnancy, but brief intervention and referral to treatment are often not incorporated into clinical practice, according to a study in the Journal of Addiction Medicine (2020;14[4]:e76-e82. doi:10.1097/ADM.0000000000000588).
Prenatal alcohol and cigarette smoking are associated with many risks during pregnancy, but national surveys show that 12% of women smoke and 11% consume alcohol while pregnant. An approach for the management and identification of substance use in obstetrics and gynecology includes Screening, Brief Intervention, and Referral to Treatment (SBIRT), but adoption of this approach by health care providers is not universal.
“The purpose of the study was to determine current practices, barriers to implementation, and education needs of healthcare providers utilizing SBIRT to address prenatal alcohol and cigarette smoking,” wrote Alice Ordean, MD, St. Joseph's Health Centre, Family Medicine Clinic (Toronto, ON, Canada) and colleagues.
An anonymous questionnaire was mailed to 118 providers including family physicians, midwives, and obstetricians. The questionnaire surveyed for demographic information, current screening, and management practices with respect to alcohol and cigarette smoking during pregnancy, barriers to each element of care, and interest in further medical education. Statistical tests were used to determine significant differences.
A 79% response rate determined that almost all providers screened for alcohol and smoking during pregnancy, but brief intervention was offered by fewer providers. Up to 60% of providers referred pregnant women to treatment programs.
“There is a need for education of all providers regarding effective brief counseling strategies and referral to appropriate treatment resources. Development of clinical care pathways may also increase adoption of all components of SBIRT for prenatal alcohol use and cigarette smoking,” concluded Dr Ordean and colleagues.—Lisa Kuhns
