NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy. Geneva: World Health Organization; 2014.

Cover of Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy

Guidelines for the Identification and Management of Substance Use and Substance Use Disorders in Pregnancy.

Show details


MeasureAcronymSubstances screenedNumber of itemsMethod of administrationTraining in administrationOther considerationsInternal consistency reliabilitySensitivitySpecificity
Alcohol, Smoking, and Substance Involvement Screening Test (Version 3.0)1ASSISTTobacco, Alcohol, and Substancesˆ8InterviewerYesAlcohol: 67%
Cannabis: 100%
Alcohol: 36%
Cannabis: 20%
4P's Plus24Ps PlusAlcohol and General Substance Use4Paper-and-pencilNoInpatient and Outpatient.6287%76%
Hospital Screening Questionnaire3HSQTobacco, Alcohol, and Substances18–40Paper-and-pencilNoInpatient: Postpartum
Pregnancy Information Program4PIPTobacco, Alcohol, and Substances∼200ComputerNoPrenatal Clinic and Ob/Gyn Offices
Substance Use Risk Profile – Pregnancy5SURP-PAlcohol and Substances3Paper-and-pencilNoPrenatal ClinicLow-risk: 80–100%
High-risk: 48–100%
Low-risk: 61–64%
High-risk: 84–86%
Alcohol Use Disorder Identification Test6AUDITAlcohol10Paper-and-pencil and InterviewerNo*7–23%*97–100%
Alcohol Use Disorder Identification Test–Consumption7AUDIT-CAlcohol3Paper-and-pencil and InterviewerNo*18–100%*71–100%
NET10NETAlcohol3Paper-and-pencilNoInpatient and Outpatient*24–71%*86–99%
Short Michigan Alcohol Screening Test11SMASTAlcohol13Paper-and-pencilNo*11–15%*96–98%
Ten Question Drinking History12TQDHAlcohol10InterviewerYesPrenatal Clinic
T-ACE13T-ACEAlcohol4Paper-and-pencilNoPrenatal Clinic*60–91%*37–79%
TWEAK14TWEAKAlcohol5Paper-and-pencilNoPrenatal Clinic*59–92%*64–92%

Notes: Sensitivities and Specificities are only provided for samples of prenatal or pregnant women.

The researchers report that “The role of the ASSIST V3.0 is uncertain for this population” [pregnant women] (Abstract).


Questions 1-7 each ask about 10 classes of substances.

Not initially developed and validated for prenatal or pregnant populations.


Sensitivities and Specificities vary depending on the cutpoint used to determine risk.

Alcohol, Marijuana, Cocaine, Sedatives, Opioids


Hotham E, Ali R, White J, Sullivan T, Robinson J. Investigation of the Alcohol, Smoking, and Substance Involvement Screening Test (the ASSIST) Version 3.0 in Pregnancy. Addict Disord Their Treat. 2013;12(3):123–135.


Chasnoff IJ, McGourty RF, Bailey GW, Hutchins E, Lightfoot SO, Pawson LL, et al. The 4P's Plus screen for substance use in pregnancy: clinical application and outcomes. J Perinatol. 2005;25(6):368–374. [PubMed: 15703775]


Streissguth AP, Giunta CT. Subject recruitment and retention for longitudinal research: Practical considerations for a nonintervention model. In: Kilbey MM, Asghar K, editors. Methodological Issues in Epidemiological, Prevention, and Treatment Research on Drug-Exposed Women and Their Children. Rockville: NIDA; 1992. Monograph No. 117(137-154) US DHHS Public Health Services.


Lapham SC, Kring MK, Skipper B. Prenatal behavioral risk screening by computer in a health maintenance organization-based prenatal care clinic. Am J Obstet Gynecol. 1991;165(3):506–514. [PubMed: 1892174]


Yonkers KA, Gotman N, Kershaw T, Forray A, Howell HB, Rounsaville BJ. Screening for prenatal substance use: development of the Substance Use Risk Profile-Pregnancy scale. Obstet Gynecol. 2010;116(4):827–833. [PMC free article: PMC3103106] [PubMed: 20859145]


Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use DisordersIdentification Test: Guidelinesfor Use in Primary Health Care. Geneva: World Health Organization; 2001.


Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–1795. [PubMed: 9738608]


Buchsbaum DG, Buchanan RG, Centor RM, Schnoll SH, Lawton MJ. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med. 1991;115(10):774–777. [PubMed: 1929025]


Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131(10):1121–1123. [PubMed: 4416585]


Bottoms SF, Martier SS, Sokol RJ. Refinements in screening for risk drinking in reproductive-aged women: The “NET” results. Alcoholism Clin Exp Res. 1989;13:339.


Selzer ML, Vinokur A, van Rooijen L. A self-administered Short Michigan Alcoholism Screening Test (SMAST) J Stud Alcohol. 1975;36(1):117–126. [PubMed: 238068]


Weiner L, Rosett HL, Edelin KC. Behavioral evaluation of fetal alcohol education for physicians. Alcohol Clin Exp Res. 1982;6(2):230–233. [PubMed: 7048976]


Sokol RJ, Martier SS, Ager JW. The T-ACE questions: practical prenatal detection of risk-drinking. Am J Obstet Gynecol. 1989;160(4):863–868. discussion 868-870. [PubMed: 2712118]


Russell M, Skinner JB. Early measures of maternal alcohol misuse as predictors of adverse pregnancy outcomes. Alcohol Clin Exp Res. 1988;12(6):824–830. [PubMed: 3064645]

Copyright © World Health Organization 2014.

All rights reserved. Publications of the World Health Organization are available on the WHO website ( or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (

Bookshelf ID: NBK200690
PubReader format: click here to try


Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...