Alcohol screening tools are testing procedures used to help doctors identify people likely to have problems with alcohol consumption. A number of these tools are in common use in the U.S. and other countries, including the Alcohol Use Disorders Identification Test (AUDIT) and a short four-question test known by the abbreviation T-ACE. In a study published in 2014 in The International Journal of Alcohol and Drug Research, a Canadian research team assessed the usefulness of the T-ACE screening tool for pregnant women, not just as an evaluation of risky drinking practices, but also as a means of identifying women with mental health problems and inadequate support networks during pregnancy.
The term T-ACE is derived from each of the four questions that make up the screening tool. These questions address a person’s relative tolerance to the effects of alcohol consumption, the presence of annoyance stemming from criticism of drinking behaviors, the self-perceived need to cut down on alcohol intake and the use of alcohol as an “eye opener” after waking up in the morning. The T-ACE questions strongly resemble the questions used in another alcohol screening tool, known by the abbreviation CAGE. However, T-ACE is specifically designed for the evaluation of alcohol-related risks during pregnancy. If a pregnant woman reports tolerance to the effects of two standard servings of alcohol, she has a positive finding for risky drinking behavior. Affirmative answers to any two of the other three questions also indicate risky involvement in alcohol consumption.
As many as one in five American women experiences a serious mental health issue during pregnancy or in the weeks or months following pregnancy. In some cases, the issue in question precedes the onset of pregnancy; however, in other cases, problems appear for the first time during pregnancy or in the postpartum recovery period. Specific mental health concerns found in pregnant women include major depression (including postpartum depression), panic disorder and other forms of anxiety disorder and a bipolar disorder-related condition called postpartum psychosis. In some cases, medications normally used to treat several of these illnesses are not available to pregnant women.
A strong support network can dramatically improve a woman’s ability to endure the mental and physical rigors of pregnancy. In some cases, the mental and physical benefits of support overlap. For example, in a study reported in 2013, researchers from UCLA concluded that a strong family network can help pregnant women withstand the harmful effects of a stress hormone known to increase the risks for postpartum depression when present in large amounts.
In the study published in The International Journal of Alcohol and Drug Research, the Canadian research team gave the T-ACE screening to 1,929 pregnant women living in or near the city of Calgary. Each woman answered the questionnaire in her first trimester of pregnancy, her third trimester and two months after giving birth. On each of these occasions, the participants also answered questions that covered topics such as their self-reported alcohol and drug intake, their experience with any significant mental health issues and their level of social support, as well as their income levels and other demographic details.
In their first trimester of pregnancy, almost 44 percent of the women enrolled in the study had T-ACE scores that indicated the presence of risky drinking behaviors. However, the vast majority of these high-scoring women (93.1 percent) consumed no alcohol in the final two-thirds of their pregnancies. Women most likely to continue to have a high T-ACE score included individuals with European ancestry, individuals under the age of 30, individuals who made less than $80,000 a year, individuals who drank during the course of previous pregnancies and individuals who smoked while pregnant. Importantly, women with relatively low levels of social support and women affected by depression also had elevated odds of continuing to register high T-ACE scores during or after pregnancy.
The study’s authors concluded that there is a significant link between a pregnant woman’s high T-ACE scores, her self-admitted intake of alcohol, her struggles with mental health issues and her lack of an adequate support network. For this reason, they believe that regular employment of the screening tool can help doctors and public health officials focus on women in need of additional resources to avoid the potential pitfalls associated with pregnancy.