Alcohol, tobacco, cannabinoid, and substance use in pregnancy: Clinical sciences

During pregnancy, screening for the use of alcohol, tobacco, cannabinoids, and other substances, such as opioids, is important and should be completed for all patients at least once during each pregnancy. Use of any of these substances may cause pregnancy complications including fetal malformations, abnormal fetal development, and poor pregnancy outcomes. Providing education and behavioral counseling to your patients is essential, as they need continued care and support during pregnancy and postpartum.

Alright, universal screening for alcohol, tobacco, cannabinoids, and other substances, such as opioids, should be completed for all pregnant patients, regardless of age, race, ethnicity, or socioeconomic status. The ideal time for screening is during the preconception period so that interventions can be made prior to pregnancy, however, screening should be completed, or repeated, during pregnancy as well.

There are many different screening tests available, but it’s best to have a thorough direct conversation with your patient or use a validated questionnaire with which you are familiar. One simple and comprehensive questionnaire is the two-part National Institute on Drug Abuse’s “Tobacco, Alcohol, Prescription medications, and other Substance screen”, or TAPS screen, which takes about 5 minutes. Part one of this questionnaire quantifies the use of tobacco, alcohol, prescription medications, and illicit substances, such as cannabinoids, cocaine, methamphetamines, and hallucinogens over the last 12 months. Part two assesses use over the past 3 months as well as a patient's desire to continue use, concerns about use, and attempts to stop use. Each category has its own scoring scale, but in general, the higher a patient scores, the greater the severity of their use.

Another easy-to-remember screening tool for alcohol use disorder is the four-question TACE screen. It stands for tolerance, annoyance, cut down, and eye-opener, with questions assessing each category. At the end of the day, choose a screening questionnaire you’re comfortable with and stick to it!

These questionnaires are meant to assess your patient's level of use and risks associated with pregnancy, plus open the door for a conversation aimed at providing education and support.

Here’s a clinical pearl! While urine drug tests are available, they should only be performed with your patient's informed consent after discussing the potential legal and social consequences of a positive test. As such, urine drug tests can be offered but they are in no way mandatory.