The Importance of Screening for Alcohol Use During Pregnancy

Screening for alcohol use during pregnancy is a crucial strategy to protect the health of both the baby and the mother. Despite clear international recommendations, studies show significant variation between countries in the implementation of protocols and in the training of health professionals.

Alcohol consumption during pregnancy can cause a range of problems for the child, grouped under the term Fetal Alcohol Spectrum Disorders (FASD). There is no safe amount, and any exposure can increase the risk of physical, cognitive, and behavioral alterations with lifelong impact.

In Australia, considered a global reference in screening policies, a study involving more than 45,000 pregnant women receiving public healthcare between 2010 and 2021 found that 99.3% were asked about alcohol use during their first prenatal appointment¹. Screening was conducted by trained professionals using validated tools and systematic follow-up. Among the analyzed cases, about 7% of pregnant women reported alcohol exposure, with 1.3% classified as high risk. Even so, only half of the women considered high risk were reassessed during follow-up, revealing that there are still points to improve, including documentation of information and coordination with multidisciplinary teams.

A different scenario is observed in the United States. According to a national study, only 35% of healthcare professionals reported asking screening questions about alcohol use during pregnancy². Additionally, 37% of professionals interviewed mistakenly believed that consuming alcohol at some point during pregnancy could be safe. This finding reveals a significant gap in training and in the consistency of practices, reinforcing that clear protocols, ongoing education, and validated tools are essential for screening to fulfill its preventive role.

An international review compared the main screening tools currently used to identify alcohol use during pregnancy³. Questionnaires such as T-ACE, TWEAK, AUDIT-C, 4Ps Plus, and the Hoja Verde show good validity and can be applied quickly and easily. The success of screening, however, depends on the context: supportive environments, inclusion of partners in consultations, and systematic repetition of questions throughout pregnancy greatly improve the detection rate of at-risk cases. Barriers such as lack of professional knowledge, cultural issues, access to services, and alcohol use by partners still affect outcomes in different countries.

In summary, international experiences show that countries adopting universal screening policies integrated into prenatal care are more successful in identifying at-risk pregnant women, preventing complications, and promoting better health for both mother and baby. Family involvement, team training, effective documentation, and educational campaigns are essential pillars for advancing the prevention of the effects of alcohol during pregnancy.

In Brazil, there is currently no official policy or protocol for screening and intervention to identify and treat cases of alcohol use during pregnancy. Therefore, it is crucial to validate and implement such tools in the public healthcare system, provide training for health professionals to ensure early recognition of the problem, disseminate information to the population, and ensure specialized treatment availability for children affected by the syndrome⁴.

References:

1. QianS, Seddon Examining alcohol screening rates during pregnancy and documentation of prenatal alcohol exposure in a public health district in Australia. Journal of Advanced Nursing. 2025.
2. ChiodoLM, Cosmian C, Pereira K, et al. Prenatal alcohol screening during pregnancy by midwives and Alcoholism Clinical and Experimental Research. 2019;43(8):1747-1758.​
3. Azurmendi-Funes ML, Sánchez-SaucoMF, Campillo López F, et al. Revisão dos questionários utilizados para a detecção do consumo de álcool durante a gravidez e a Hoja Adicciones. 2023;35(4):493-502.​
4. FUNDAÇÃO OSWALDO CRUZ. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Portal de Boas Práticas em Saúde da Mulher, da Criança e do Adolescente. Postagens: Principais Questões sobre Efeitos do Álcool na Gestante, Feto, Recém-nascido e Criança. Rio de Janeiro, 9 jan. 2025. Disponível em: <https://portaldeboaspraticas.iff.fiocruz.br/atencao-recem-nascido/principais-questoes-sobre-efeitos-do-alcool-na-gestante-feto-recem-nascido-e-crianca/>.