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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(07): 322-329
DOI: 10.1055/s-0037-1603744
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Psychometric Properties of Brief Screening Tests for Alcohol Use Disorders during Pregnancy in Argentina

Propriedades psicométricas de instrumentos de triagem de consumo de álcool durante gestação na Argentina
Mariana Beatriz López
1   Centro Interdisciplinario de Investigaciones en Psicología Matemática y Experimental (Interdisciplinary Center of Mathematics and Experimental Psychology Research), Consejo Nacional de Investigaciones Científicas y Técnicas (National Council of Scientific and Technological Research, CONICET), Buenos Aires, Argentina
,
Aldana Lichtenberger
2   Instituto de Psicología Básica, Aplicada y Tecnología (Institute of Basic Applied Psychology and Technology); Universidad Nacional de Mar del Plata; CONICET, Buenos Aires, Argentina
,
Karina Conde
2   Instituto de Psicología Básica, Aplicada y Tecnología (Institute of Basic Applied Psychology and Technology); Universidad Nacional de Mar del Plata; CONICET, Buenos Aires, Argentina
,
Mariana Cremonte
2   Instituto de Psicología Básica, Aplicada y Tecnología (Institute of Basic Applied Psychology and Technology); Universidad Nacional de Mar del Plata; CONICET, Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

03 October 2016

15 March 2017

Publication Date:
13 June 2017 (online)

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Abstract

Background Considering the physical, mental and behavioral problems related to fetal alcohol exposure, prenatal clinical guides suggest a brief evaluation of alcohol consumption during pregnancy to detect alcohol intake and to adjust interventions, if required. Even if any alcohol use should be considered risky during pregnancy, identifying women with alcohol use disorders is important because they could need a more specific intervention than simple advice to abstain. Most screening tests have been developed and validated in male populations and focused on the long-term consequences of heavy alcohol use, so they might be inappropriate to assess consumption in pregnant women.

Objective To analyze the internal reliability and validity of the alcohol screening instruments Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down (TWEAK), Rapid Alcohol Problems Screen – Quantity Frequency (RAPS-QF) and Tolerance, Annoyed, Cut-Down and Eye-Opener (T-ACE) to identify alcohol use disorders in pregnant women.

Methods A total of 641 puerperal women were personally interviewed during the 48 hours after delivery. The receiver operating characteristics (ROC) curves and the sensitivity and specificity of each instrument using different cut-off points were analyzed.

Results All instruments showed areas under the ROC curves above 0.80. Larger areas were found for the TWEAK and the AUDIT. The TWEAK, the T-ACE and the AUDIT-C showed higher sensitivity, while the AUDIT and the RAPS-QF showed higher specificity. Reliability (internal consistency) was low for all instruments, improving when optimal cut-off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF.

Conclusions In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. In contrast, our results evidenced the low reliability of those instruments and a better performance of the AUDIT in this population.

Resumo

Introdução Considerando os problemas físicos, mentais e comportamentais relacionados à exposição fetal ao álcool, as orientações clínicas pré-natais sugerem uma breve avaliação do consumo de álcool durante a gravidez para detectar o consumo de álcool e ajustar as intervenções, se necessário. Ainda que qualquer uso de álcool deva ser considerado arriscado durante a gravidez, identificar as mulheres com transtornos de uso de álcool é importante, porque elas podem precisar de uma intervenção mais específica do que um simples conselho para se abster. A maioria dos testes de triagem tem sido desenvolvidos e validados em populações masculinas, e estão focados nas consequências em longo prazo do uso excessivo de álcool, de modo que eles podem ser inadequados para avaliar o consumo em mulheres grávidas.

Objetivo Analisar a confiabilidade e a validade internas dos instrumentos de triagem de álcool Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down (TWEAK), Rapid Alcohol Problems Screen – Quantity Frequency (RAPS-QF) e Tolerance, Annoyed, Cut-Down and Eye-Opener (T-ACE) para identificar transtornos por uso de álcool em mulheres grávidas.

Método Um total de 641 puérperas foram entrevistadas pessoalmente durante as 48 horas após o parto. As curvas receiver operating characteristic (ROC), a sensibilidade e a especificidade de cada instrumento foram analisadas utilizando diferentes pontos de corte.

Resultados Todos os instrumentos mostraram áreas sob as curvas ROC acima de 0.80. Foram encontradas áreas maiores para o TWEAK e para o AUDIT. O TWEAK, o T-ACE e o AUDIT-C apresentaram maior sensibilidade, enquanto o AUDIT e o RAPS-QF apresentaram maior especificidade. A confiabilidade (consistência interna) foi baixa para todos os instrumentos, melhorando quando foram utilizados pontos de corte ótimos, especialmente para o AUDIT, o AUDIT-C e o RAPS-QF.

Conclusões em outros contextos culturais, estudos concluíram que o T-ACE e o TWEAK são os melhores instrumentos para avaliar mulheres grávidas. Em contrapartida, nossos resultados evidenciaram baixa confiabilidade desses instrumentos e melhor desempenho do AUDIT nessa população.

Keywords

alcoholic beverages - screening - pregnancy - women - Argentina

Palavras-chave

bebidas alcoólicas - triagem - gravidez - mulheres - Argentina
 

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