Hoyme et outlined criteria for identifying maternal alcohol exposure during a pregnancy. This can help in the assessment of a pediatric patient for a Fetal Alcohol Spectrum Disorder (FASD). The authors are from multiple institutions in the United States and South Africa.
Patient selection: pregnant or formerly pregnant woman
Source of information:
(1) woman
(2) family member
(3) medical record
(4) social service agency
Assumptions:
(1) The threshold for FASD is 1 drink per day.
(2) Adverse fetal effects are seen from >= 3 drinks per occasion.
Criteria of significant alcohol exposure - one or more of the following:
(1) >= 6 drinks per week for >= 2 weeks during the pregnancy.
(2) >= 3 drinks per occasion on >= 2 occasions during a pregnancy (? binge)
(3) documented alcohol-related social or legal problem just before or during the pregnancy
(4) laboratory evidence of alcohol intoxication during the pregnancy (blood, urine or breath testing)
(5) laboratory evidence of an alcohol-related biomarker (ethyl glucuronide, etc)
(6) positive screening tool (AUDIT, T-ACE, other)
Limitations:
• Many teratogenic events occur during the first trimester. No distinction is made on alcohol use in early, mid or late pregnancy.
• Criterion 1 says that a woman who had a total of 12 drinks over any 2 weeks of a pregnancy is at risk, which seems sensitive but not specific.
