We feel this is a fundamental error because any screening programme, particularly one focused on drinking in pregnancy where any alcohol use is to be discouraged, should be targeted at identifying both hazardous and harmful drinkers in addition to those drinking at social levels. The screening tools will exclude the majority of patients whose alcohol use could be having an impact on their baby, particularly given the Royal College of Obstetricians Guidance on the safe use of alcohol in pregnancy.
Dr Martin Weatherhead and associates, Sunderland
Dr Weatherhead makes an important point here that any alcohol use should be avoided in pregnancy. This ought to be the clear and consistent message clinicians give to patients who are pregnant or trying to conceive. We entirely agree and hope this comes across in our paper.
Regarding the use of screening tools in pregnancy, these are no substitute for routine clinical assessment and questioning.
Screening tools are not about condoning alcohol use, but two advantages of using them are more honest and accurate reporting of alcohol use than elicited by direct questioning; and that they help the non-specialist determine which patients need further assessment, specialist treatment and referral.
Furthermore one has to be realistic in acknowledging that, despite public health messages, some pregnant women drink. For these patients, use of screening tools offer opportunities to ask about their drinking (and its consequences) and offer the clinician opportunities to give relevant advice and intervene.
Dr Sanju George, consultant in addiction psychiatry, The Bridge community drug team, Chelmsley Wood, Birmingham and Dr Mosun Fapohunda, specialist trainee in psychiatry, Queen Elizabeth Psychiatric Hospital, Edgbaston, Birmingham.