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Increased Cut-Point of the TACER-3 Screen Reduces False Positives Without Losing Sensitivity in Predicting Risk Alcohol Drinking in Pregnancy

Authors

  • Lisa M. Chiodo,

    Corresponding author
    1. College of Nursing, Wayne State University, Detroit, Michigan
    • Reprint requests and Present address: Lisa M. Chiodo, PhD, School of Nursing, University of Massachusetts, Skinner Hall, 651 North Pleasant Street, Amherst, MA 01003-9299; Tel.: 413-545-9754; Fax: 413-577-2550; E-mail: lisachiodo@nursing.umass.edu

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  • Virginia Delaney-Black,

    1. Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan
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  • Robert J. Sokol,

    1. Department of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan
    2. The C.S. Mott Center for Human Growth & Development, Wayne State University, Detroit, Michigan
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  • James Janisse,

    1. Department of Family Medicine & Public Health Sciences, Wayne State University, Detroit, Michigan
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  • Yobany Pardo,

    1. Women's Center, St Joseph Mercy Oakland, Pontiac, Michigan
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  • John H. Hannigan

    1. Department of Obstetrics & Gynecology, Wayne State University, Detroit, Michigan
    2. The C.S. Mott Center for Human Growth & Development, Wayne State University, Detroit, Michigan
    3. Department of Psychology, Wayne State University, Detroit, Michigan
    4. Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, Michigan
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Abstract

Background

Detection of in-pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T-ACE screen was developed for that purpose. We recently reported that increasing the total T-ACE score cut-point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4-year-old children with neurobehavioral effects associated with prenatal alcohol exposure.

Methods

In this study, the TACER-3 was further validated in another prospectively identified high-risk urban cohort. Women were categorized as follows: (i) Not At-Risk Group (negative on T-ACE and TACER-3); (ii) At-Risk Group (positive on T-ACE and TACER-3); and (iii) Change Risk Group (positive on T-ACE but negative on TACER-3).

Results

The TACER-3 total score cut-point of 3 yielded fewer “false positives” than the T-ACE cut-point of 2. Based on relative risk scores, women in the TACER-3-positive At-Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At-Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At-Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at-risk alcohol consumption in the At-Risk Group was over >10 times that of the Change Risk Group.

Conclusions

Thus, the TACER-3 was more effective at selectively identifying women drinking at fetal risk levels than the original T-ACE. The TACER-3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.

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