What is the Optimal T-ACE Screening Cut-Point for At-Risk Alcohol Use in Pregnant Women?
The T-ACE* screener was developed to detect at-risk alcohol use among pregnant women; however, in some settings the usual cut-point of ≥2 points may produce false-positives. To assess the potential advantage of increasing the T-ACE cut-point to 3 points, researchers administered the T-ACE to 239 urban-dwelling African-American pregnant women (mean age = 25 years; gestational age at screen = 23 weeks) at their first prenatal visit and compared different T-ACE scores for detecting alcohol use at conception, at the first prenatal visit, and across pregnancy. Alcohol use was measured by validated semi-structured interview.
- Of all participants, 42% had a T-ACE score of ≥2 and 12% had a T-ACE of ≥3.
- Participants with a T-ACE score of ≥3 were significantly more likely to have greater mean daily alcohol consumption and consumption on a drinking day at conception, the first prenatal visit, and across pregnancy than participants with a T-ACE equal to 2 (30% of participants), and those with a T-ACE of <2.
* T-ACE screener: Tolerance – “How many drinks does it take to make you feel high?” (2 points for “2 or more drinks”); Annoy – “Has anybody ever annoyed you by complaining about your drinking?” (1 point for “Yes”); Cut Down – “Have you ever felt you ought to cut down on your drinking?” (1 point for “Yes”); Eye-opener – “Have you ever needed a drink first thing in the morning to get going?” (1 point for “Yes”). A T-ACE score of ≥3 is labeled “TACER-3” by the authors of the report.
Comments:
This study found that women in this cohort with a T-ACE score of ≥3 points reported higher levels of alcohol use at several key points in pregnancy than those with lower scores. Unfortunately, the study’s implications for screening in the prenatal setting are not clear because an “at-risk” alcohol use screening target was not defined; the main comparison T-ACE cut-point was a score equal to 2 points rather than ≥2; and the usual screening tool measures of sensitivity, specificity, positive predictive value, and negative predictive value were not reported. Regardless, it remains important to identify and address any drinking during pregnancy to reduce the risk for fetal alcohol effects.
Kevin L. Kraemer, MD, MSc
Reference:
Chiodo LM, Delany-Black V, Sokol RJ, et al. Increased cut-point of the TACER-3 screen reduces false positives without losing sensitivity in predicting risk alcohol drinking in pregnancy. Alcohol Clin Exp Res. 2014;38(5):1401–1408.